Recently several new techniques for the treatment of varicose veins have been reported in the medical literature. The main aim of these is to avoid surgical removal of varicose veins.
Treatment is usually performed in a treatment room or ultrasound examination room, and not an operating theatre. The patients rests comfortable on a couch. In order to treat large varicose veins it is necessary to block the main vein feeding the varices. This could be done surgically, but with foam treatment all that is necessary is to put a needle into the main affected surface vein. This is the only part of the procedure which might cause discomfort and is usually performed with a small amount of local anaesthetic. The position of the needle is carefully monitored using ultrasound imaging to make sure it is in exactly the right place.
Next, the foam is injected whilst watching its progress using the ultrasound machine. Suprisingly, injecting the foam causes no discomfort, although the leg may ache slightly afterwards. Once the foam has filled all the main surface vein, the top end of the vein is pressed on to keep the foam in the surface veins.
The varicose veins in the leg are checked to see if foam has entered these from the main surface vein where the injection was given. A few further injections are usually given through a tiny needle in order to make sure that all the varicose veins have been completely injected. The whole treatment usually takes no more than 15 – 20 minutes.
Finally a firm bandage is applied to the leg. The aim of this is to keep the veins compressed so that they do not fill with blood when the patient stands up. The bandage is usually worn with a stocking for a week followed by the elastic compression stocking for a further week.
When the bandages are removed at the follow up appointment, it is usual to find that all the varicose veins have gone. They can sometimes be felt as small lumps beneath the skin. The leg may be a little bruised at this stage, although this is usually fairly minor. Lumps which can be felt at this stage slowly resolve over several weeks. If any varicose veins have not been completely treated in the first session, they are injected and bandaged to complete the removal of all veins. If varicose veins are present in both legs it is standard practise to treat them on seperate occasions about one week apart.
Are there any adverse effects?
Unwanted side effects are rare. An allergic reaction to the sclerosant fluid occurs in about one person in 100,000. The injection can initiate a migraine attack and suffers are advised to take their prescribed medicine at least one hour beforehand. Occasionally the foam can cause a disturbance of vision or a dry cough. This always passes off after a few minutes.
Up to 40% of treatments may result in some staining of the skin overlying the veins. This is more common if the vein is close to the skin and a superior cosmetic result may be achieved by injecting only the main vein trunks leaving smaller veins to return to normal size once the back pressure has been alleviated. Any staining fades almost completely but may take up to a year to do so