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In the second of his articles about treatments for varicose veins, Eddie Chaloner of Radiance Health answers the question: Which operation is right for me?

Read the first article: What varicose vein treatments are available?


In order to decide which technique is the best to treat your varicose veins, you need to be aware of all the advantages and disadvantages that the different techniques involve. Here is a summary of the pros and cons for each available treatment that will help you to make up your mind.

1. Traditional high tie and strip

Pros:

  • It’s been done for about 100 years.
  • 2/3 of NHS patients still get this treatment.

Cons:

  • Requires general anaesthetic and several incisions in the leg.
  • 30% recurrence rate at 5 years after surgery.
  • 20% incidence of injury to the saphenous nerve in the thigh.
  • Risk of wound infection between 1 and 5%, depending on the case.
  • Most patients take 6 weeks to recover from a high tie and strip.

2. Heat-based techniques

These include Endovenous Laser Ablation (EVLT) and Radiofrequency ablation / VnuS closure (RF).

Pros:

  • Good track record – over 10 years of successful use worldwide. They are the most commonly used minimally invasive techniques.
  • They can treat 90% of leaky veins.
  • They can be done under local anaesthetic.
  • Quick recovery (just 2 weeks).
  • Low complication rate.
  • Low risk of recurrence.

Cons:

  • Local anaesthetic needs injections in the leg and some patients find it uncomfortable.
  • Some post – operation bruising and pain occurs for about 2 -3 days.
  • The cost is around £2500-£3000 per leg.

3. Foam sclerotherapy

Pros:

  • Easy to do – it can be done in a consulting room environment rather than in an operating theatre.
  • It’s cheaper than lasering.
  • It’s almost painless.
  • Very good for recurrent veins that can’t be treated by lasers.
  • It can be performed under local anaesthetic.
  • Quick recovery (2 weeks only).

Cons:

  • Need of heavy bandaging afterwards.
  • Some patients get painful inflammation afterwards.
  • High rate of recurrence – about 30% at 2 years so may need retreatment.
  • Skin staining – usually patients see a brown bruise-like mark on the skin that can last several months.
  • May need several treatment sessions
  • Some safety concerns have been reported relating to injecting air into the circulation, although there is no convincing evidence that patients are harmed by this procedure.

4. Clarivein

Pros:

  • Almost painless – no injections needed.
  • It’s very quick to perform (takes about 15 minutes).
  • Very little post-operative pain.
  • Very quick recovery (less than a week).
  • Can be done under local anaesthetic.

Cons:

  • Long-term data is still not available – first cases done in the UK in 2010.
  • So far it has a higher reported recurrence rate than Laser treatment at one year.
  • Some patients get painful inflammation afterwards, like with foam sclerotherapy.
  • Main insurance companies have not yet approved it.
  • The cost is about the same as for laser treatments.

5. The Sapheon glue system

Pros:

  • Almost painless – no injections needed.
  • Very quick to do (takes about 15 minutes).
  • Very little post-operative pain.
  • Very quick recovery (less than a week).
  • Can be done under local anaesthetic.

Cons:

  • Very new – only a handful of cases done in the UK to date with no longer term follow-up available
  • The cost is over £4,000 per leg currently.

Get the best treatment option for you

In conclusion, in my opinion, the minimally invasive treatments are superior to the traditional high tie and strip operation, which is still widely used in the NHS. I use most of the newer techniques in my practice Radiance Health, depending on the medical case. The technique I use the most is the laser method with either an 810 nm or a 1470 nm laser. I occasionally use VnUS closure and have done about 250 cases using Clarivein. I am currently evaluating the results. I usually use foam sclerotherapy to treat recurrent veins and find it works very well for this problem.

If you notice varicose veins on your legs and are thinking about private treatment, make sure to choose a specialist that will perform the best technique for you and not just the one they are more familiar with. Look for a surgeon who is up-to-date with new techniques and can recommend the best option available for your case.

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