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