The Vein Clinic

Providing optimum treatment for your varicose veins

Over the last few years there has been a revolution in the way that varicose veins can be treated. Three alternatives to conventional surgery are now well established and may be performed under local anaesthetic as an outpatient. Radiofrequency ablation, Laser ablation and foam sclerotherapy are all techniques to destroy varicose veins from the inside. Thus they are called endovenous procedures and are performed under ultrasound guidance. We have considerable expertise and experience in all of these techniques.

At TVC your diagnostic colour venous duplex scan, performed personally by your surgeon, will determine the sometimes subtle nature and relationships of your visible varicose veins to the underlying valve problem in the main truncal veins.

We will explain the scan findings and their implications and together, we will determine the treatment option(s) that will best resolve your particular varicose vein problem. The full range of varicose vein treatments, including catheter ablation procedures (laser ablation and VNUS closureFAST radiofrequency ablation), foam sclerotherapy and micro-incision varicose vein surgery will be available to you and your choice of treatment will be determined by what you want from treatment – outpatient treatment or a general anaesthetic, quick recovery or optimal cosmetic result, minimal intervention or lowest risk of future recurrence (or all of the above!). You will be able to choose a bespoke treatment package that is sensitive to your individual needs, personal priorities and lifestyle.

At TVC we believe that because we perform our own duplex ultrasound scans, perform all our treatments under ultrasound control and carry out the full range of treatments, we are able to accurately assess you and your veins and offer the treatment option that is perfect for you.

Vein Mapping and Catheter Insertion at The Vein Clinic (TVC)

For all catheter ablation procedures, your varicose veins are again imaged on the day of treatment and intervention sites marked, using the colour duplex ultrasound. This allows the cause of your veins to be located on the skin surface. This ‘vein mapping’ (similar to, but quicker than diagnostic imaging) is important in allowing us to determine where on the leg and into which veins we place our micro-punctures for insertion of the specific device to be used (Foam Sclerotherapy cannula, VNUS closureFAST catheter or Laser fibre).

Vein mapping is done with you standing and with your legs in a lowered (dependent) position and with the veins fully filled. You are then positioned on the procedure table and with the veins still filled we infiltrate local anaesthetic into the skin and make a small skin puncture through which we achieve cannulation under ultrasound control. This is all that is need for Foam Sclerotherapy. For VNUS closureFAST and Laser the catheter/ laser fibre is then carefully advanced along the vein to the point in the groin or behind the knee where the varicose veins originate. Then, with the leg elevated so that the veins become as empty as possible, we inject lots of dilute anaesthetic fluid to surround the entire length of vein to be treated. This process, known as tumescent anaesthesia, surrounds the vein with a ‘halo’ of cool fluid that numbs the part of the leg around the target vein and helps to further squeeze any remaining blood out of the vein. It also pushes the vein away the surrounding structures and protects any sensitive tissue from the heat energy that the closure FAST and Laser procedures deliver in order to treat the vein. The ablation procedure is then performed (see below).

The whole procedure is completed in approximately 30 minutes. Any other large veins that significantly contribute to your varicose veins may also be treated in the same way. The visible varicose veins may be left to shrink or actively treated by removal (phlebectomies) under local anaesthesia or by Foam Sclerotherapy. Synchronous phlebectomies are more readily undertaken where the ablation procedure has been performed under general anaesthesia.

After treatment your leg is rescanned with duplex ultrasound to confirm successful ablation (closure) of the treated vein(s). With time, the treated and narrowed vein gradually shrinks and its remnant is eventually resorbed by the body.

The VNUS ClosureFAST Procedure (radiofrequency ablation)

VNUS ClosureFAST treatment is a minimally invasive or "key hole" procedure used to treat the faulty truncal veins that have caused your visible varicose veins (usually the long saphenous vein from the knee to the groin). It is used as an alternative to surgical stripping. ClosureFAST may be performed under local anaesthetic as "walk in, walk out" procedure without the need to be admitted to a hospital bed, or under general anaesthesia, for those who do not like the idea of needles.

After duplex ultrasound had been used to ensure that the closureFAST catheter tip is positioned at the start of the main varicose vein, the vein is compressed at this site and the radiofrequency generator is activated. The heating end of the catheter then heats the vein wall to the target temperature over a 7 centimetre length and for a 20 second interval. This heat shrinks the vein and thickens the vein wall to close the vein completely. The catheter is then withdrawn to treat the next 7 centimetres. This process is continued until the whole length of the abnormal vein has been treated.

EndoVenous Laser Ablation

Endovenous Laser treatment is another minimally invasive approach for the treatment of the underlying truncal veins. It has much in common with Radiofrequency Ablation (VNUS closureFAST) and may also be performed under local anaesthetic, without need for hospital stay or under general anaesthesia.

After inserting the thin laser fibre into the vein through a tiny needle prick on the leg, usually near the knee, and achieving duplex confirmation that the Laser fibre tip is accurately positioned, tumescence anaesthesia is administered to compress the vein. The laser generator is then activated. The heating tip of the fibre generates high local temperatures to deliver Laser energy to seal the faulty vein. This heat thickens the vein wall and completely occludes the vein. The Laser fibre is gradually withdrawn until the whole length of the abnormal vein has been treated.

Duplex ultrasound is used to guide the insertion of small plastic needles (cannulas) into the main varicose veins. Smaller needles (butterflies) are used for the varicose veins that lie nearer to the skin. The leg to be treated is raised to empty blood from the veins and foam is slowly injected. The spread of the foam through the varicose veins is monitored with the ultrasound scanner. This ensures that foam fills all the varicosities that are being treated.

After all the injections have been completed your leg will be compressed with bandages and a compression stocking will be rolled over the top. These dressings are usually worn for 5 days. After this time you should remove the bandages and wear the stocking for a period of 2 - 3 weeks. The varicose veins may become hard and then turn brown before shrivelling up over a few weeks

Benefits of Ultrasound-Guided Endovenous Procedures: (ClosureFAST, Endovenous Laser, Foam Sclerotherapy)

TVC Ultrasound-Guided Endovenous Procedures at The Vein Clinic

TVC Ultrasound-Guided Endovenous Procedures at
The Vein Clinic