Venous insufficiency from superficial reflux through varicose veins is a serious problem that usually is inexorably progressive if left untreated. When the refluxing circuit involves failure of the primary valves at the saphenofemoral junction, treatment options for the patient are limited, and early recurrences are the rule rather than the exception.
In a traditional surgical approach, ligation and division of the saphenous trunk and all proximal tributaries is followed by stripping or by avulsion phlebectomy. Proximal ligation requires a small incision at the groin crease. Patients with reflux at the level of the groin require ligation. Stripping of the vein may require additional incisions at the knee or below the knee and may associated with a high incidence of haematomas.
Ablation of the vein by endovenous laser (EVLP) is a newer procedure that is less invasive than surgery and has a lower complication rate but may have a higher rate of recurrence. The procedure is well tolerated by patients and produces good cosmetic results. Good clinical results are observed at 1-2 years, but the long-term effectiveness of EVLP is not yet known. Patients who have varicose veins with a diameter of more than 1.5 cm are not adequate candidates for this treatment. Patients at an early stage of disease respond well.
TECHNOLOGY
Endovenous ablation works by means of thermal destruction of the venous tissues. Laser energy from an 940-nm diode laser is delivered to the desired location inside the vein by using a bare laser fiber. When the laser is fired, it deposits thermal energy in the blood and venous tissues, causing irreversible localized venous tissue damage. The laser is repeatedly fired as the laser fiber is gradually withdrawn along the course of the vein until the entire vessel is treated. Although a hole may be created in the vessel wall where the laser beam makes contact with it, permanent ablation of the vein is caused by thermal injury to the entire circumference of the vessel.
Many laser sources are available for medical applications, and many lasers may be effective for endovenous ablation.
TECHNIQUE
Endovenous prcedure is of value in the treatment of truncal varicose veins (eg, greater saphenous vein) in patients with saphenofemoral incompetence. This procedure is also effective in the treatment of large branch veins and other large tributaries. Laser introducer catheters can be passed along small and crooked veins, but they cannot be passed along an extremely tortuous vein with ease.
For treatment of the greater saphenous vein and the saphenofemoral junction, ultrasonography is used to confirm and map all areas of reflux and to trace the path of the refluxing greater saphenous trunk from the saphenofemoral junction down the leg to the
Venous exercises for Varicose Veins offered by The Harley Street Vein Clinic
Skin infections
Skin infections (either fungal or bacterial) can occur as the result of skin problems caused by poor circulation and fluid buildup (oedema). These infections also increase the risk of subcutaneous tissue infection (cellulitis). Occasionally, some infection may spread along a normal or varicose veins and form a painful blood clot with inflammation of the vein called thrombophlebitis.
Patients may develop swelling, ulcers (large sores), and an increase in the pigmentation or darkening of the color of their skin, especially in the ankle region.
Guidelines for reducing the danger of skin infection:
Raise your legs whenever possible with your feet above the level of your heart.
Exercise every day. Walking, cycling, climbing stairs and swimming are excellent ways to keep your calf muscles in motion.
When sitting for prolonged periods, move your legs frequently. moving your ankles and flexing calf muscles will help keep blood moving in your legs. Avoid sitting for extended periods.
Wear compression stockings. Graduated compression provides external pressure (like e.g. the valves in the veins) to aid in blood return to the heart. Compression stockings provide an effective non-operative option for symptom control. Compression is required for most vein surgery recovery.
For your information:
This page has been provided for your information and to answer common questions. This web-site has been prepared to answer questions about a variety of circulatory problems, ranging from cosmetic blemishes through to more serious underlying circulatory problems. The site is intended to be a simple guide, answering commonly asked questions. It does not replace a formal consultation with a vascular or vein specialist, who will be in a better position to
What can I do to prevent them?
Many of the things that seem to cause varicose veins are difficult to avoid such as a family history of Western sedentary way of life. Where possible standing still for long periods should be avoided. Walking is much better for the veins and helps the blood return to the heart from the legs. In occupations that require extended periods of standing then a few steps should be taken at regular short intervals to help circulation. Wearing support stockings may also reduce the likelihood of varicose veins. No creams or drugs are available to prevent varicose veins. The earlier varicose veins and dermal flares are treated the better the long term and cosmetic outcome will be. Elevate your legs. Shower your legs with cold water as often as possible Use compression support hose as described above. Maintain your ideal body weight to reduce excess pressure on your legs. Avoid prolonged sitting and standing. If this is not an option, move your feet up and down as described above to activate your calf muscle. On long car trips, you should stop every few hours for short walks.
Call your doctor if:
Varicose veins make walking or standing painful
A sore or tender lump develops on or near a varicose vein
You have swelling in the feet or ankles
Your leg suddenly becomes swollen and painful
Skin over a varicose vein bleeds on its own or when injured
Thank you for considering the Vein Clinic at Harley Street. If you feel that one of our treatments
for spider veins or varicose veins might benefit your
health or appearance, please make an appointment with
us for further evaluation.
You can also take advantage of our online appointment or E-Mail
notification. Further more our call centre at 0845 652 0064 is available to you 7 days a week.
Elevate your legs. Shower your legs with cold water as often as possible 
Use compression support hose as described above. 
Maintain your ideal body weight to reduce excess pressure on your legs. 
Avoid prolonged sitting and standing. If this is not an option, move your feet up and down as 
described above to activate your calf muscle. On long car trips, you should stop every few 
hours for short walks. 
