Accessibility Tools

Healthy Veins

Healthy Veins

Veins carry blood from the legs back to the heart. The return of venous blood to the heart from the lower limbs is aided with one-way valves in the veins. The contraction of the leg muscles produces a pumping action which squeezes the blood towards the heart during walking or muscular contraction. The valves prevent the blood coming down the leg again.

The venous system in the lower limb is made up of a network of veins consisting of:

Introduction to Varicose Veins

Introduction to Varicose Veins

Varicose veins affect approximately 25% of western adult population. The treatment of varicose veins and their complications accounts for 2% of the NHS expenditure. There are about 40,000 varicose vein procedures performed in the UK every year, up to 20% are re-operations. The very early stage of varicose veins is venous reflux.

Venous Reflux

Venous Reflux develops when the valves (within the veins) become ‘incompetent’ and the valve leaflets are no longer able to meet in the middle. Therefore, some of the blood being returned to the heart by the pumping action of the muscles simply returns down the leg.

With increasing reflux, the vein becomes progressively distended, tortuous, and therefore more visible. This process also makes reflux worse and as the vein increases in diameter it becomes varicosed.

Non-Surgical Treatment of Varicose Veins

Compression hosiery

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.

However, there are ways to alleviate the symptoms for those who do not wish to undergo surgery. You can leave varicose veins alone; many people have varicose veins for many years without almost any ill effect. The NHS websites indicate that most varicose veins require no treatment and varicose veins rarely cause complications.

The main approach in conservative (Non-Surgical) treatment is to reduce the high pressure of the blood in the veins by wearing compression stockings. This will help prevent your veins getting worse and relieve your symptoms. However, it leaves the primary cause of symptoms (i.e.; the varicose vein) untreated.

Medical compression hosiery are available in made to measure standards.

Traditional Open Surgery for Varicose Veins

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.

The traditional method was open surgery but newer techniques of minimally invasive endovenous surgery (Laser EVLT, or radiofrequency VNUS ablation techniques) have largely replaced open surgery now. Open surgery may still have a role to play in selected patients with recurrent varicose veins or if multiple tributaries of the main superficial vein require removal.

Minimally invasive Treatment of Varicose Veins

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.

Minimally invasive Treatment of Varicose Veins - Endovenous Laser Ablation

EVLT Procedure

The laser fibre is introduced into the main leaky varicose vein (at the level of the inner side of the knee) through a very small opening in the skin. The fibre is then passed up the vein in the thigh through the long saphnoeus vein to the level of the junction with the deep vein (sapheno-femoral junction). Local anaesthetic is injected around the vein along its length in the thigh. This has the effect of dissipating the heat produced by the laser catheter and reduces pain.

The surgeon will then position the closure fibre into the diseased varicose vein under ultrasound guidance. The fibre will deliver laser light (heat) to the diseased varicose vein wall leading to shrinkage and complete closure of the varicose veins. After the diseased vein segment is closed the fibre is pulled back and the cycle repeated all the way down the thigh to the point of entry into the skin. Once the long truncal vein (long saphenous vein) is closed blood flow is re-routed to other healthy veins in the limb.

Following the procedure, full length compression hosiery (stockings) is applied and worn for 2 weeks, removed only for showering. Immediate ambulation is encouraged and the patients return to normal activities within 24 hours.

The occluded varicose veins will, with time, be obliterated and slowly removed by the body in the following months.

Minimally Invasive Treatment of Varicose Veins - Radiofrequency (VNUS) Ablation

VNUS Procedure

A disposable catheter (fine tube) is introduced into the main leaky varicose vein (at the level of the inner side of the knee) through a small opening in the skin. The catheter is then passed up the vein in the thigh to the level of the junction with the deep vein (sapheno-femoral junction). Local anaesthetic is injected around the vein along its length in the thigh. This has the effect of dissipating the heat produced by the VNUS catheter and reduces pain.

The surgeon will position the closure catheter into the diseased vein under ultrasound guidance. The tiny radiofrequency powered catheter will deliver a computer controlled high frequency electrical current (heat) to the diseased vein wall leading to shrinkage and complete closure of the varicose veins. After the diseased vein segment is closed the catheter is pulled back and the cycle repeated all the way down the thigh to the point of entry of the catheter into the skin. Once the long truncal vein (long saphenous vein) is closed blood flow is re-routed to other healthy veins in the limb.

Following the procedure, full length compression hosiery (stockings) is applied and worn for 2 weeks, removed only for showering. Immediate ambulation is encouraged and the patients return to normal activities within 24 hours.

The occluded varicose veins will, with time, be obliterated and slowly removed by the body in the following months.

Minimally invasive Treatment of Varicose Veins - Foam Sclerotherapy

Foam Sclerotherapy

Sclerotherapy has been in use in the UK mainly for treatment of spider or reticular veins(smaller skin veins unrelated to varicose veins). Its use for larger truncal varicosities has received some attention in recent years.

The sclerosant solution, usually Sodium Tetradecyl Sulphate (STD) 1-3% or Polydocanol 0.5-1%, causes an occlusion(thrombosis) of the veins by inducing inflammation of the inner lining of the vein wall. Using it as a foam allows a smaller volume of the solution being used to avoid toxicity.

Foam sclerotherapy is usually carried out under local anaesthetic with patient lying down flat. Using ultrasound the position of the vein is determined and a cannula (a fine needle) is placed through the skin into the vein. The foam solution is introduced in the vein under and followed using ultrasound as it fills the vein up. More than one cannula may need to be inserted if different veins are being sclerosed.

Once the long truncal vein (long saphenous vein) is closed blood flow is re-routed to other healthy veins in the limb. The occluded varicose veins will then be obliterated and slowly removed by the body in the following months.

Minimally invasive Treatment of Varicose Veins - Venaseal Glue

VenaSeal Procedure

The catheter is introduced into the main leaky varicose vein through a very small opening in the skin. The catheter is then passed up the vein to just below the level of the junction with the deep vein (sapheno-femoral junction or sapheno-popliteal) under ultrasound guidance.

The catheter will deliver the glue to the diseased varicose vein wall leading to complete closure of the varicose vein. After the diseased vein segment is closed the catheter is pulled back and the cycle repeated all the way down the thigh to the point of entry into the skin. Once the long truncal vein (long saphenous vein or short saphenous vein) is closed, blood flow is re-routed to other healthy veins in the limb. Following the procedure Immediate ambulation is encouraged and the patients return to normal activities within 24 hours.

Immediate ambulation is encouraged and the patients return to normal activities within 24 hours. The occluded varicose veins will then be obliterated and slowly removed by the body in the following months.

The main advantages of the VenaSeal technique are avoidance of multiple local anaesthetic injections and need for compression stockings after the procedure.

Comparisons of Surgical Treatments for Varicose Veins

The main advantages of the VenaSeal technique are avoidance of multiple local anaesthetic injections and need for compression stockings after the procedure.

  • Alleviation of symptoms of varicose veins
  • Effective removal of the varicose veins responsible for symptoms
  • Early complications (such as infection, bleeding, pain, deep vein thrombosis, haematoma)
  • Late complications (numbness, scarring, discolouration, nerve damage, and recurrence of veins)
  • Acceptability by patients

Varicose Vein treatment at Chelsea Vascular Clinic

It is our policy to follow and promote good medical practice based on best available evidence. We are committed to continuously maintaining and monitoring our quality of care. We offer personalised high quality medical care in a surgically clean and safe environment with easy access to your treating doctors. We have been visited by the Care Quality Commission and we follow the national standard of care guide lines set out by the National Institute of Clinical Excellence (NICE).

At Chelsea Vascular Clinic, varicose vein treatment is carried out by, Mr Maz Mireskandari who had been qualified and fully trained in the United Kingdom. He is a Consultant Vascular Surgeon at the Royal Brompton & Harefield  NHS Trust and is on the GMC Specialist Register in the UK.

He is trained and experienced in the minimally invasive treatments such as VNUS Radiofrequency Closure FAST and laser (EVLT) ablation as well as the traditional open varicose vein surgery.

You will be assessed and examined during your consultation and an individualised treatment plan for the management of your varicose veins will be drawn up. Once you are satisfied with this plan we will arrange for a convenient appointment to carry out your procedure.

Other Conditions