There are a number of options, the merits of which we are happy to discuss at TVC :

Do nothing
If you have minor varicose veins that do not bother you cosmetically and are not causing any symptoms, then this approach may be reasonable. Certainly, you do not have to make an urgent decision and can afford to 'wait and see'. Varicose veins are usually progressive, however, and waiting too long might result in a bigger operation eventually!

Conservative treatment
If you have developed varicose veins, staying slim and active might help to slow down their progression. Walking is good for venous function, as are most forms of exercise. Elevate your legs when resting. The mainstay of conservative treatment is, however, wearing graduated compression stockings. These flatten the varicose veins and help the calf muscles pump to squeeze blood in the veins toward the heart. This helps to counteract the effects of incompetent valves. Below-knee stockings, class I or II are usually adequate and they should ideally be worn all day, taking them off when you go to bed. They are usually comfortable and well tolerated in the winter but some patients find them too much (hot and itchy) in warm weather! Graduated compression stockings are available on prescription, or to buy from Scholl®, pharmacists or specialists such as Medi® (www.Mediuk.co.uk). It is vital to have your arterial circulation checked first and to be carefully measured to obtain the correct size.

Sclerotherapy
This involves injection of a sclerosant substance into the veins. It is only suitable if you have minor varicose veins (reticular veins) with no major valve incompetence, or spider/thread veins (telangectasia). Sclerotherapy for these veins is called microinjection sclerotherapy and uses very small needles and dilute solutions of sclerosant.

Surgery
Surgical treatment remains the 'gold standard'. The varicose veins are reliably removed through very small incisions and the cause of the veins (incompetent valves) is dealt with at the same time.

New treatments
A number of non-surgical treatments are now in fact very well established and have given us more minimally-invasive options to effectively treat varicose veins and have therefore improved patient choice. These include Radiofrequency Ablation (also known as VNUS Closure®) or Endovenous Laser Ablation (EVLA) and Foam Sclerotherapy (FS), which enables sclerotherapy to treat larger varicose veins.

Radiofrequency ablation of the long saphenous vein (LSV) is an attractive alternative to groin surgery and LSV stripping. It may be performed under local or general anaesthetic. A catheter is placed in the LSV (guided by duplex ultrasound) and heat is used to destroy the vein it from within. It avoids a groin incision and is associated with much less thigh bruising and post-operative pain than stripping. Stab incisions and avulsions of the visible varicose veins are still required, or alternatively the veins may be left to shrivel naturally and any residual varicosities subsequently treated by foam sclerotherapy.

EVLA works on similar principles, but uses a laser fibre to close the LSV and is done under local anaesthetic. The visible varicose veins are not treated immediately but usually decrease in size following EVLA. Any residual varicosities will require additional treatment, usually foam sclerotherapy.

Foam sclerotherapy is a non-surgical method of obliterating varicose veins (LSV, SSV and visible varicosities). It involves the injection of sclerosant foam into the veins under duplex imaging. By also treating the varicosities there is no need for avulsions following FS but more than one treatment may be required to achieve the desired effect.

All these “endovenous” procedures are performed under ultrasound control (see ultrasound-guided endovenous procedures) They have now proved themselves to be effective and we routinely perform them at TVC, along with conventional surgery performed carefully, using modern, minimally invasive techniques. All treatment options have some potential advantages and some drawbacks associated with them.

At TVC we are able to consider surgery and all alternative treatments and tailor the treatment that best meets your needs. Following a full clinical consultation your vascular surgeon will personally perform a full duplex ultrasound scan of your leg veins. We will then be in a position to advice you as to which treatment will best meet your requirements in terms of suitability, degree of discomfort, speed of recovery and long term outcome. You will be able to choose the treatment package that is sensitive to your individual needs, priorities and lifestyle.