Vein Treatments

Depending an accurate clinical assessmet problem of varicose veins can be addressed using a variety of techniques. Treatments range from the standard surgical therapy of high ligation and stripping of the greater saphenous and tributaries to sclerotherapy, laser vein ablation, and vein closure devices. As the technique has evolved over time, microphlebectomy has been used to remove varicosities below the knee, and the greater saphenous is stripped from the groin to the knee.

Treatment options are many and include:

• Wearing support stockings. The most conservative approach is simply to wear properly-fitting support hose, especially when the veins cause painful or uncomfortable symptoms. These stockings can generally be purchased at any surgical supply store and at some pharmacies. They come in below-the-knee, above-the-knee and pantyhose styles.
• Making lifestyle changes. Good skin hygiene, weight loss (if needed), and walking can help treat varicose veins and spider veins. Avoid sitting with your legs crossed. Sit or lie down and elevate your legs at least twice a day for 30 minutes at a time.
• Sclerotherapy . This procedure, which has been available since the 1930s, uses a highly concentrated saline (salt) solution or a specially made detergent that is injected directly into the vein, causing the vein to disappear gradually over 3 to 6 weeks. The procedure is simple, relatively inexpensive and can be performed in an outpatient setting.
• Endovenous laser treatment. A small laser fiber is inserted into the vein so that pulses of laser light can be delivered inside the vein, which causes the vein to collapse. The procedure is done as an outpatient under local anesthesia. This is most effective on smaller veins.
• Radiofrequency occlusion. During this procedure, a small catheter is inserted into the vein to deliver radiofrequency energy to the vein wall, causing it to heat, collapse and seal shut. The procedure is generally done in an outpatient or in-office setting and may be done under local anesthesia.
• Surgery. Surgical techniques to treat varicose veins include ligation (tying off of a vein), stripping (removal of a long segment of vein) and ambulatory phlebectomy, which allows for the removal of large surface veins through very small incisions that do not need stitches. Surgery is usually performed using local anaesthesia but lmay be performed using spinal or general anesthesia in some centre. Most patients return home the same day as the procedure. Surgery is generally used to treat large varicose veins in advanced disease.
• Lasers and intense pulsed light. These devices use heat energy to selectively damage or destroy abnormal veins. An advantage of these treatments is that no needles or sclerosing solutions are required; however, there may be some minor discomfort. Side effects do occur, including discoloration or staining and blister formation. Examples include Vasculight and PhotoDerm.

Non-Surgical Treatment

Guidelines for reducing some effects of varicose veins:
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 as often as possible. 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 venous surgery and during recovery time.

Cosmetic Treatment
Before cosmetic treatment can begin, a complete medical evaluation is performed to ensure that underlying conditions are treated, thereby enhancing cosmetic results.

Sclerotherapy

Sclerotherapy remains the "gold standard" in the treatment of telangiectasias or spider veins. Spider veins are tiny veins, visible through the skin. This technique involves injecting a sclerosing agent into a small varicose vein or spider veins. The sclerosing agent irritates the wall of the abnormal vessel, causing it to collapse and seal off.

Microsclerotherapy

Foam sclerotherapy

Read more on sclerotherapy
FAQ about Sclerotherapy 

Laser (Photoderm)

Transcutaneous laser and intense-pulsed-light (IPL) therapy has proven effective for the tiniest surface vessels (eg, those found on the face), but this modality is not generally useful as primary therapy for treatment of spider veins of the lower extremity. This is true for several reasons.

More on Laser treatment

Surgical Treatments

Surgical Vein Removal

1. Ambulatory Phlebectomy -

2. Vein Ligation and Stripping (Babcock procedure).

3. Transilluminated Powered Phlebectomy (Trivex)



Minimally Invasive Treatments

1. Endoluminal Laser Ablation (ELVeS) -
2. Radiofrequency ablation (VNUS)
3. Subfascial Endoscopic Perforator Surgery (SEPS).