There are 5 main types of minimally invasive leg vein treatment that are often required to be used in combination.
The basic principle of treatment is to select the most appropriate treatment modality for a particular vein segment. All of the treatment modalities described below may be utilised in the one treatment session.
- Microslerotherapy also called Direct Vision Sclerotherapy (DVS) - reserved for the treatment of small veins including spider veins.
- Ultrasound Guided Sclerotherapy (UGS) - reserved for the treatment of medium sized veins and bulging small varicose veins and some hidden veins.
- Endovenous Laser Ablation - for large hidden varicose veins previously treated with surgical stripping.
- Modified Ambulatory Phlebectomy - reserved for the large bulging veins that distort the skin.
- Venaseal Procedure using Medical Glue (Sapheon) - for large hidden varicose veins previously treated with surgical stripping.
Microsclerotherapy / Direct Vision Sclerotherapy
The term "sclerotherapy" comes from the Greek word "sclero" which means 'to make hard'. The treated vein reacts to the product that is introduced to basically convert the abnormal vein into a type of bruise.
Once formed, the vein feels a little hard and this is the signal to your body's immune system to start dissolving the vein. Eventually the vein is absorbed and disappears.
For surface veins this is considered the current Gold Standard of treatments: Surface veins are often numerous, widespread and usually require several treatments.
Sclerotherapy is considered the first choice method for the treatment of small reticular and spider veins. This involves the injection of a sclerosant detergent solution via a micro needle into the diseased vein, which causes the vein wall to collapse. The veins dissolve and disappear as the body gradually absorbs them. For most patients with spider veins the underlying blue reticular veins need to be treated first.
Ultrasound Guided Sclerotherapy (UGS)
Ultrasound Guided Sclerotherapy (UGS) and the treatment of varicose veins UGS is a safe and effective method for the eradication of small varicose veins. Unlike the surgical option there is no need for hospitalization or anaesthetic. There is virtually no downtime. Most patients with small varicose veins are suitable for UGS.
Dr Loizou will determine your individual suitability during the course of the assessment. Some patients will require follow-up treatments to achieve the best results. Prior to treatment a duplex ultrasound scan is performed to establish and map out the exact nature of the vein problem and whether there are any underlying hidden veins that are causing the appearance of the visible varicose veins. If there are hidden veins then these will have to be treated first either with UGS or if too large by using Laser technology.
The UGS procedure is performed using an ultrasound unit to locate the abnormal veins and allow the doctor to accurately and safely inject sclerosant detergent solution or more recently with sclerosant detergent foam directly into the veins that are hidden below the skin at strategic locations. Once injected the veins collapse and the body's process of absorption begins. Numerous injections may be required and can be associated with vague sensations of a heavy feeling that usually only lasts for a few minutes.
The sclerosant becomes diluted and neutralised within a short distance from the injection site. It is rapidly broken down and excreted by the liver and kidneys. The appearance of the treated veins rapidly improves over a few weeks with continued improvement still occurring for about three months.
Endovenous Laser Therapy (EVLT™)
Endovenous Laser Therapy (EVLT™) for large varicose veins. EVLT™ is the latest method for the treatment of major veins previously treated by stripping surgery under general anaesthetic. The procedure involves the placement of a laser fiber with ultrasound guidance into the abnormal vein via a tiny incision under local anaesthesia. The vein is then surrounded with local anaesthetic. The laser fiber is removed slowly whilst the laser is activated which destroys the vein wall along the treated length. The procedure involves virtually no discomfort. The published success of EVLT™ treatment is between 98% with significantly fewer complications as compared to stripping surgery. With the addition of EVLT™ to Ultrasound Guided Sclerotherapy it is expected that varicose vein surgical stripping will be performed less frequently.
Modified Ambulatory Phlebectomy
Modified Ambulatory Phlebectomy is the physical removal of visible varicose veins under local anaesthetic using a modified procedure where the veins to be removed are firstly injected with sclerosant foam. This makes the once visible vein contract and renders them empty of blood which can then be removed via a series of tiny skin punctures (usually 1mm which results in virtually no scarring). The procedure sounds awful but with the introduction of new ways of applying local anaesthetic the procedure is virtually painless with quick recovery and minimal discomfort. Most patients are able to return to normal activities immediately with restriction only to heavy physical activity for about a week.
Venaseal Procedure using Medical Glue (Sapheon)
Late 2014 saw an interesting and clever addition to the treatment of large abnormal veins using medical glue (cyanoacrylate) with the introduction of the Venaseal closure procedure. The available data from trials performed from large centres of excellence suggest that Venaseal closure is as effective as Endovenous Laser Ablation (EVLA). Venaseal unlike EVLA does not use heat energy which means the whole procedure can be performed with one anaesthetic micro injection. The procedure involves the painless introductions of a small catheter through anaesthetised skin into the vein humen and the accurate placement of medical glue inside the vein. Hand pressure is applied that bonds the vein wall together so there is no longer any blood flow in the abnormal vein. Medical glue has been used for over 50 years in various medical procedures and is very safe and effective.
1) Only one anaesthetic microinjection required, unlike EVLA that requires large volumes of anaesthetic applied around the veins to numb it before the laser can be activated.
2) The glue produces instant vein closure as the vein walls are bonded shut tight immediately and permanently
3) Venaseal procedure does not require the application of medical grade stockings or bandages.
1) Venaseal is not for everyone and comes at a premium. It is not covered by Medicare at the moment and does not attract reimbursement from private health funds.