Embarrassing Illnesses

Are there alternatives to ligation and stripping?
If varicose veins are not troublesome you can often alleviate aching and heaviness by wearing support stockings or tights. If ordinary support stockings or tights don't help, your GP can prescribe firmer (class 2) ones and more effective graduated compression stockings.

Varicose veins can also be treated by injection sclerotherapy, in which a glue-like substance or sclerosant is injected into your veins to seal them off. You'll then need to wear bandages for about two weeks. This works well for small varicose veins. However, larger ones with damaged valves and high pressure inside them usually reappear after a period of time and for this reason this treatment is now used very little in the NHS.

A number of new treatments have recently become available. Most of these are simply ways of closing off the long saphenous vein (LSV) in your thigh without the need for the usual incision. This may be less uncomfortable and cause less bruising than conventional ligation. However, you'll still need to have visible veins removed by avulsion (phlebectomy) and many surgeons believe the long-term results are no better than with thorough conventional surgery. They include:

• Foam sclerotherapy, also called ultrasound guided foam sclerotherapy (UGFS) and foam compression sclerotherapy. This increasingly popular technique involves injecting a foam to shrivel up your veins. You may need more than one treatment. 
• Radiofrequency ablation, sometimes known as VNUS. This is a technique that's usually carried out on larger varicose veins. A probe (thin instrument) is inserted into your vein, heating it and sealing (ablating) it off. It's a very successful treatment method, and 90% of people who've had it were pleased with the results.
• Laser treatment, also known as endovenous laser ablation or therapy EVLA/EVLT. Yet another way of sealing off (ablating) the LSV, it's carried out under local anaesthetic. A thin catheter (tube) is inserted into your vein, and a laser is used to heat it up and close it off. You may have pain and bruising afterwards. Studies carried out to date show that laser treatment is successful for most people.
• Transilluminated powered phlebectomy. This can be carried out using either a general or local anaesthetic. A special device is used to suck out bits of your vein from your leg. After the procedure, you may experience some pain, bruising and bleeding, and there's a very small risk of nerve damage.