VARICOSE VEINSOPEN EVENING

Mr Andrew SandisonConsultant Vascular Surgeon

Dr Mo FarisConsultant Interventional Radiologist

Aims for the evening

• What are varicose veins?

• Treatment Options and the evidence

behind them

• NICE guidelines

• Commonly asked questions answered

• Meet the Team

What are Varicose Veins?

• Estimated that approximately 1/3 population have visible varicose veins

• Women: Men ratio of 2.5:1

• 3-6% of people with VV will progress to venous ulcers

Causes of Varicose Veins

• Genetics - 70% of patients with varicose veins haveparents with varicose veins

• Pregnancy - 80% of women develop varicose veinsin the first trimester of pregnancy (progesterone related)

• Obesity - strains vein valves

• Ambulatory occupations (standing or chair sitting)

• Twisted & swollen veins

• Swelling, throbbing, or cramping at night (ACHING)

• Difficulty walking

• Itching & burning

• Restless leg

Modified CEAP CLASSIFICATION

• Rated on a 0 – 6 scale

– C0 = no visible venous disease

– C1 = telangiectatic or reticular veins(Spider/Thread Veins)

– C2 = varicose veins +/- aching, throbbing, pain

– C3 = oedema / phlebitis / bleeding

– C4 = skin changes without ulceration

– C5 = skin changes with healed ulceration

– C6 = skin changes with active ulceration

Reticular veins

C3 Oedema

C5: Healed Ulcers

C6: Active Ulcer

• Compression stockings – relief of symptoms

• Surgical vein stripping

• Ultrasound Guided Foam Sclerotherapy

• Avulsions / Phlebectomies

• Endovenous Laser Ablation

For people with confirmed varicose veins and truncal reflux:

Offer Endovenous thermal treatment of the saphenous vein[NICE interventional procedure guidance 52]).

If endothermal ablation is unsuitable, offer ultrasound-guided foam sclerotherapy (see Ultrasound-guided foam sclerotherapy for varicose veins [NICE interventional procedure guidance 440]).

If ultrasound-guided foam sclerotherapy is unsuitable, offer surgery.

Surgical Vein Stripping

• Surgical procedure under general anesthesia

• Painful recovery process

• Complications = infection, nerve damage, bleeding

1% serious complications

DVT, neurovascular damage

15% minor complications

infection, seroma, nerve damage, haematoma

General anaesthetic

Fit to drive 7-14 days, work 14-21 days

Recurrence

Sclerosing agent is injected into incompetent segment

of vein

Pigmentation Skin

Skin ulceration

Deep vein thrombosis

Chest pain

Visual disturbance / Stroke

Complications: Foam Sclerotherapy

• Several small incisions

• Removal of portions ofvein with each incision

• Laser fibre is inserted into vein

• Laser is activated and pulled back

• Blood boils and the vein closes

• Laser terminology:

– Solid state diode laser console

– Power = 10 – 30 Watts

– Wavelength = 1470 nanometers

Varicose vein symptoms

Endovenous laser therapy

Ultrasound Exam and Leg

Marking

Tip of Bright Tip Fiber

Tip of SheathSaphenofemoralJunction

The anaesthetic acts as insulation and to provide pain management during the procedure.

Laser energy is delivered into blood, not the vessel wall

Recommend the use of over the counter analgesics to manage minor post procedure pain.

Walk Out of the Clinic

• Improvements over vein stripping

– 45 minute treatment time

– Immediate walking

– Performed in clinic environment

– No general anaesthetic

• Clinical results are established

– Two, three, and five year follow up success rates at 95% - 98%*

– Complications are mild and infrequent

5 Year Follow Up: Modality Success Rate

Surgical Stripping 75.7%- 95%

Sclerotherapy 73.5%

Radiofrequency 79.9%

Endovenous laser ablation 95.4%

Before After

Before After

BeforeEndovenous laser therapy

5 weeks afterEndovenous laser therapy

Before After