In the first of two articles, Eddie Chaloner of Radiance Health describes various ways to treat varicose veins.

Read the second article: Which operation is right for me?

Varicose vein surgery has changed a lot in the last 10 years. From the open surgery option of high tie and strip, technology and medicine have evolved into laser operations, which can be performed in just thirty minutes and under local anaesthetic.

The high tie and strip

Until the beginning of the century, almost all patients with varicose veins were treated through an operation called a high tie and strip. This involved a general anaesthetic, a cut in the groin and the passage of a plastic rod down the main leg vein. This was then forcefully ‘stripped’ out of the leg, ripping off the connecting branches, causing much bruising in the process.

Perhaps not surprisingly, there were a number of problems with that operation – sometimes patients had to stay in hospital for a long time, some people developed infections in the groin incision, and there was an incidence of damage to the sensory nerve that ran next to the stripped out vein. Moreover, there was a recurrence rate of about 30% at 5 years after surgery.

New techniques – minimally invasive surgery

In vein surgery, there has been a successful development in several techniques, which are now in mainstream practice, to close the leaking vein in the leg without cutting the patient in the groin. These are called ‘keyhole’ procedures.

VnUS closure

The first such technique is called VnUS closure. VnUS closure involves inserting a probe into the main vein through a small cut at the knee level and passing it up the vein to the groin. The vein is then sealed by heating it up – this is done by passing electricity through the probe into the vein. This operation worked quite well, but had a few disadvantages – it took quite a long time, so the patient needed to be asleep under general anaesthetic.

Laser operations

The next development made in vein surgery was the use of lasers. In a laser operation, the laser fibre is passed up the vein in exactly the same way as the VnUS probe and the vein is heated up, but this time using laser energy. The main advantage is that the surgery was a lot faster than the VnUS operation –  the whole vein could be treated and closed in about 3 minutes, once the probe was in the right place. Because of this, the operation could be performed with the patient completely awake under local anaesthetic – a major advance. Lasers began to be used in the UK for vein treatment around 2002 and 2003.

Since then, there have been many developments in the technique. A whole variety of lasers made with different wavelengths (the type of laser energy generated) and different fibre types that send the energy into the vein in slightly different ways have been created.

The VnUS technique also advanced to a new probe that could heat the vein in about the same time as a laser and can also be used under local anaesthetic. This was then renamed as the VnuS Fast operation.

In addition, there have been other procedures developed such as foam sclerotherapy, which uses a chemical foam to close the vein, Clarivein which uses a combination of mechanical irritation and chemical treatment, and most recently the use of tissue glues to seal up the vein.

Individual surgeons have different preferences as to which technique they prefer. Partly this is related to their experience – some surgeons are keener than others to learn new operations while others prefer to stick to single operations they regard as ‘tried and tested’. This means that sometimes the patient does not always get a full explanation of the pros and cons of the range of choices available, which is a pity.

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