Once superficial veins become varicosed as a result of incompetent / refluxing valves, and thereby causing reflux, the only definitive way to manage things is by removing the incompetent vein either by traditional (open) or endovenous (minimally invasive) surgery.
Therefore, the surgical treatment of varicose veins is by removing or obliterating these superficial veins.
Newer techniques of minimally invasive endovenous surgery (Laser EVLT, or radiofrequency VNUS ablation techniques) are the standard now.
The concept of minimally invasive surgery (endovenous surgery), is to replicate the effect of surgery in removing the source of increased pressure (venous reflux) within the superficial veins. They do this by obliterating the junction between the superficial and deep veins (Sapheno-femoral junction) and stopping the flow within the main trunk of the superficial vein in the leg (long saphenous vein). Successful endovenous ablation requires irreversible injury to the inside of the vein leading to occlusion. The occluded vein shrinks and eventually disappears with time.
Very occasionally there might be trouble with transient inflammation of the treated varicose veins (thrombophlebitis) which normally responds well to anti-inflammatory drugs such as Voltarol or Nurofen.
What are the advantages of the minimally invasive techniques?
The minimally methods (such as EVLT, Radiofrequency, Venaseal techniques) of treating veins are generally less invasive and have the following potential benefits:
- Procedure can be carried out under local anaesthesia.
- Patients experience less postoperative pain and bruising than compared to surgery.
- The patients are allowed (and in fact are encouraged) to start walking almost as soon as the procedure is completed.
- Good cosmetic outcome with no surgical scarring in the groin.
Criticisms of minimally invasive procedures
One of the criticisms of endovenous ablation is that if phlebectomies (removal of the varicosed tributaries or side branches) are also required, a more extensive procedure needs to be planned possibly in an operating suite using general anaesthetic.
Arguably however, in many cases extensive multiple phlebectomies may not be required as many disappear once the pressure within the venous system is reduced by removing the source of reflux i.e.; the truncal vein (long or short saphenous vein). It is a point to bear in mind that the more extensive the varicosities are (specially if tortuous) the less likely that they will be suitable to endovenous methods.