Are hooks, foam or lasers the best way to beat varicose veins?

Varicose veins are a blight that affects millions of us, with three in ten adults suffering from the condition.

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When it comes to treatment, the NHS has a strict grading system: only people whose varicose veins are at the higher end of the one-to-six scale (one being mild, while six is advanced) are eligible. Many turn to the private sector for treatment.

Here, Costas Kyriakides, a consultant vascular surgeon at Barts Health NHS Trust and The Private Clinic in London, and David Lewis, a consultant vascular surgeon at The Royal Gwent Hospital in Newport and Spire Cardiff Hospital, explain the different options — from traditional to high-tech.

SURGICAL STRIPPING

HOW IT WORKS: Ligation and stripping has been the traditional way to treat varicose veins for decades.

Under general anaesthetic, two small incisions are made and a flexible wire is inserted into the vein and then pulled out, removing the vein in one section. A compression bandage is worn for up to a week to aid healing and patients are advised to stay off work for two weeks.

EXPERT VERDICT: Mr Kyriakides says: ‘About a fifth of surgeons still use this technique, which is suitable for most fit patients. However, there’s a 10 per cent risk of infection and bleeding, and up to a 5 per cent risk of damage to surrounding deeper veins, arteries and nerves. It’s also associated with a higher rate of recurrence due to new vein formation or incomplete stripping of the vein.

‘Recovery time is longer than other options and it leaves a scar of about 2 in.’

AVAILABILITY: NHS and privately.

COST: From £3,000.

ENDOTHERMAL ABLATION OR ENDOVENOUS LASER

HOW IT WORKS: These minimally-invasive, 20-minute techniques use heat to destroy the varicose vein with either high-frequency radiowaves or a laser.

In each case, the patient has a local anaesthetic before a small incision is made above or below the knee. A catheter — a thin tube — is then inserted into the problematic vein, and via this, radiowaves or a laser are used to heat the walls of the vein, causing it to collapse and closing off its blood supply. (The vein eventually withers away and is absorbed by the body.) Blood immediately starts to flow along a different vein.

EXPERT VERDICT: Mr Kyriakides says: ‘In 2013, The National Institute for Health and Care Excellence (Nice) recommended endothermal ablation as a first-line treatment for varicose veins, and it’s now considered the gold standard treatment, followed by foam sclerotherapy.

‘Both options were introduced about 20 years ago and are around 98 per cent effective. They are best suited to patients with straight veins (which account for 95 per cent of varicose veins).

‘As it’s a minimally-invasive treatment, the risk of bleeding and infection is rare. The 1-2mm incision does not need stitching; adhesive strips can be used, leaving only a tiny scar. Patients can be at work the next day, although they might feel stiffness for three days.’

AVAILABILITY: NHS and privately.

COST: From £2,000.

ULTRASOUND-GUIDED FOAM SCLEROTHERAPY

HOW IT WORKS: This chemically destroys the lining of the vein, causing it to collapse. Guided by ultrasound, it involves a fine foam being injected directly into the vein, which causes it to scar on the inside and the walls of the vein to stick together, closing it off.

The procedure takes 30 to 60 minutes, and afterwards bandages and compression stockings are worn to reduce lumpiness developing where the vein was sealed off. The patient can be back to work the same day.

In a Nice study, this was successful in 84 out of 100 cases, which is a lower success rate than other minimally-invasive procedures — but it can be repeated.

EXPERT VERDICT: Mr …. says: ‘A form of this treatment has been around for decades. Now, foam rather than liquid is used, leading to more predictable results and fewer complications; the vein will disappear in six to 12 weeks.

‘It’s used to “tidy up” veins that aren’t dealt with by endothermal ablation. However, if too much foam is used, it can increase the risk of complications such as headaches, visual disturbance and stroke, although I’ve never had any issues with it.

‘There’s a 5 to 10 per cent risk of “staining”, where the destroyed vein leaves a mark on the skin. This usually fades after three months but can take up to a year.

‘Patients can return to normal activities within 24 hours.’

AVAILABILITY: NHS and privately.

COST: Between £1,000 to £3,000.

For more information or to book a consultation with Mr Constantinos Kyriakides, Consultant Vascular Surgeon at The Private Clinic of Harley Street use our varicose vein online contact form.

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