Leg vein therapies

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand,1997.


Why remove leg veins?

Leg veins can be unsightly and may sometimes ache, feel heavy or cause cramps. Varicose veins may increase the risk of gravitational eczema, lipodermatosclerosis (a hardening of the tissues of the lower leg), swelling (lymphoedema) and leg ulceration.

How can leg veins be removed?

Methods of removing leg veins include:

Surgery for larger varicose veins

  • If these involve the inner thigh (the greater saphenous vein), the vein in the groin should be tied off and the veins stripped out usually under general anaesthetic. Veins in the lower leg can be pulled out under local anaesthetic (ambulatory phlebectomy). The perforator veins that connect the superficial veins with deeper ones are tied off.

Endovenous laser and radiofrequency occlusion therapy

  • These are new techniques to remove large veins without surgery. A small tube is inserted into the vein and energy is delivered inside it to heat up the blood vessel wall so that it collapses and seals shut. This can be done under local anaesthetic.

Sclerotherapy

  • In sclerotherapy, a small amount of a solution such as hypertonic saline, sodium tetradecyl sulphate or polidocanol is injected into the superficial leg veins and perforator vessels. The vein shuts down and disappears over the next few weeks. One to five treatments may be required. Microsclerotherapy uses very fine needles to inject small surface thread veins.

Ultrasound guided sclerotherapy

  • A foam solution of sclerosant is injected into a larger deep vein, imaged by ultrasound scanning.

Mechanical ultrasound guided sclerotherapy

  • A rotating occlusion catheter inserted into a large varicose vein under ultrasound guidance, ClariVein®, works by mechanically agitating the lining of the veins while spraying a sclerosant. The catheter is disposable and designed for single use.

Vein glue

  • A medical cyanoacrylate adhesive (VenaSeal™ Sapheon Closure system) is also delivered into the vein under ultrasound guidance via disposable, single-use catheter.

Vascular lasers and light devices

  • There are several vascular lasers and pulsed light devices used for removing surface thread veins. To date, they are not as effective as microsclerosclerotherapy. However, they may be useful in patients who cannot undergo these procedures.

Other techniques under evaluation include steam thermal ablation and high frequency ultrasound ablation.

Outcome of sclerotherapy

Whatever treatment is used, new enlarged veins may appear. Further treatment is usually possible. In many cases, two or more techniques may be combined for best effect.

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