Sclerotherapy for Varicose Veins

Causes of Varicose Veins:

• Long-standing hours increase the pressure in the veins of the lower body.
• Obesity
• Pregnancy
• Family history of varicose veins
• menopause
• age > 50

Signs and Symptoms:

• Bulging of legs
• Bluish veins
• Swelling of thighs and/or calves
• Aching pain
• A feeling of heaviness in the legs and feet
• Itching in legs
• Changes in skin colour
• Nighttime leg cramps

Sometimes, varicose veins can limit your activities. Your symptoms may get worse when you sit or are on your feet for long periods, and they may get better when you lie down or put your feet up.

Indications:

Initially, conservative management is advisable, like wearing compression socks or stockings, avoiding long sitting/standing hours, exercising regularly/losing weight to increase blood circulation, keeping legs elevated to increase the reverse flow of blood to the heart.

A doctor should be consulted if symptoms persist and worsen, such as,

• The continuous pain, burning, and tenderness in the legs
• Skin sores and ulcers.
• Blood clots.
• Bleeding from the veins
• Surgery is also advisable if there is distress and concerns about aesthetics.
• Early surgery is always better to prevent complications.

What to expect if surgery is delayed

If untreated, varicose veins may cause severe complications like,

• Vein rupture or collapse, which can cause bleeding and loss of blood
• Deep vein thrombosis (DVT) - It is a medical condition that occurs when there is a blood clot in one or more of the deep veins in the body causing pain and swelling in the affected region. The blood clot can rupture and travel to the lungs, causing a pulmonary embolism (blockage in lungs), causing difficulty in breathing, increased heartbeat, and may be life-threatening.
• Thrombophlebitis - Enlarged deep veins of the leg cause pain, swelling, and redness, indicating the formation of blood clots that needs immediate medical attention.
• Skin discolouration - Affected skin area may appear reddish-brown due to increased pressure and fluid leakage to surrounding tissues.

Varicose veins can be treated by:

1. Sclerotherapy: A liquid solution (sclerosant) or foam is injected directly into the vein, which will collapse the vein gradually. The sclerosant used is sodium tetradecyl sulphate which scars the vein, and it gradually disappears. No incision or anaesthesia is required. It is used for spider veins(tiny varicose veins on the surface of the skin). For large veins, the sclerosant is converted into foam and injected into the veins to cover a large surface area.

2. Surgical removal of the affected veins: Surgery is one of the most effective ways to relieve varicose vein symptoms. Anaesthesia is required for surgery, and in most cases, it is an outpatient procedure. Standard Surgical procedures are:

• Vein Ligation and stripping: In this procedure, veins are tied with a flexible wire and removed through small incisions made at 2 or 3 levels in your thigh. Veins in your leg (below the knee) are not stripped to prevent injury to nerves of the lower limb. Damaged Varicose veins are tied at one end by a thin, flexible plastic wire which is inserted from the groin incision and then pulled out from the incision near the ankle area.
• Phlebectomy (Not done these days): Multiple minor cuts are made along the vein, and then the vein is pulled out using hooks and removed by cutting the vein into several pieces.
   

3. Minimal invasive techniques 

The vein is sealed from inside instead of complete removal. A thin tube (catheter) is inserted and pushed along the vein, and thermal energy is used to seal the vein. Heat can be produced in two ways:

• Endovenous Laser Ablation (EVLA): In this procedure, laser energy is used to produce heat. A laser fibre is inserted into the catheter (with the help of an ultrasound) to produce heat and destroy the wall of the vein. The damaged veins collapse, get absorbed by the body and disappear slowly with minimal discomfort.
• Radiofrequency Ablation (RFA): In this procedure, electromagnetic waves(Radio waves) are used to produce heat. Here a fibre is inserted into the catheter(with the help of an ultrasound), which emits radio waves and destroys the wall of the vein. The veins collapse and are gradually reabsorbed by the body. Compared to EVLA, the temperature of heat produced to destroy the vein is much lower here, which results in lesser discomfort.
• Laser Treatment: High-intensity laser beams are used to destroy the veins. No incision is required.
• Endoscopic vein surgery: This procedure is used in advanced cases associated with leg ulcers where other techniques fail. A small video camera is mounted at the end of a thin tube and inserted into the vein through a  small cut in your skin near a varicose vein. A surgical device at the end of the camera is used to close the vein.

What to expect/plan before surgery

• A physical examination will be performed by the doctor to locate the damaged veins.
• The doctor may use an Ultrasound device and Duplex scans for a detailed view.
• Consent has to be signed prior to the surgery.
• Fasting (nil by mouth) is advised for 6-8 hours prior to the surgery if the surgery has to be performed in general anaesthesia.
• Appropriate travel arrangements should be made for going home after the procedure.

What to Expect During Surgery 

• Varicose vein stripping usually takes 60-90 minutes and is an outpatient procedure (patient is discharged the same day or the next day)
• A hospital gown is provided for a dress change.
• Either general anaesthesia (patient will be unconscious during the entire procedure) or spinal anaesthesia (patient will be conscious but only the lower body will be numb) is given before the procedure.
• Anti-anxiety medication may be given before the procedure to ease nervousness.
• In this procedure, small incisions (cuts) will be made on the top and bottom of damaged veins. The top one will be near the groin, and the other one will be behind the ankle or knee. Damaged Varicose veins are tied at one end by a thin, flexible plastic wire which is inserted from the groin incision and then pulled out from the incision near the ankle area.
• Bandages and compression stockings will be placed on the leg.

Varicose vein stripping is a safe and low-risk surgical procedure. However, there are a few potential risks associated with surgeries:

• An allergic reaction to anaesthesia
• Skin infection 
• Heavy bleeding
• Blood clots
• Scarring
• Bruising
• Nerve injury leading to numbness and tingling or foot drop (very rare).