Vascular Consultation and Treatments
Mr Keith Rose has specialised in the treatment of venous disease for 20 years, with a particular interest in the treatment of recurrent varicose veins. He is avaliable for consultation and treatments at the clinic.
What are thread veins?
Thread veins or telangiectasias are enlarged bluish blood vessels in the skin surface. They are very common, vary in size and extend and usually affect the outer thigh and inner knee areas, although they can arise anywhere.
Thread veins are an inherited condition but can also follow deep bruising after trauma or surgery. They can start in pregnancy and may disappear afterwards. They are often associated with varicose veins which will need treating first.
How are they treated?
Sclerotherapy of these tiny vessels has been shown to be the most successful treatment. A dilute irritant solution is injected using a very fine needle. This damages the vessel lining causing it to close off. The body treats this as damaged tissue which is slowly absorbed over about 3 months.
How successful is Sclerotherapy?
Sometimes all the thread veins disappear. An improvement on 80-90% is more usual.
Thread veins look worse to begin with and large vessels may go black. Fading starts after 3 weeks and it will be 3 months before the main benefit is seen. For this reason it is a good idea to plan treatment some time before your holiday.
The treatment will last for several years but other thread veins will often develop over time.
Are there any complications?
Great care is needed when injecting, especially very small veins as the sclerosing solution can damage the overlying skin.
Large veins may leave a faint browm mark which will fade over the year but is easily concealed with a light tan or stockings.
An allergy to the solution is very rare. It can cause a drop in blood pressure as well as a general reaction.
What should I do before treatment?
Please avoid aspirin, Vitamin E and Aloe Vera preparations for at least 10 days. If you also suffer from varicose veins you will need these assessed by Doppler ultrasound before your treatment can be planned.
What happens afterwards?
Cotton wool will be taped over the injection sites but can be removed the same evening.
You will be given a pair of support stockings which should be worn for 3 days and nights. You might want to wear trousers to cover these. For this reason, sclerotherapy is best avoided in hot weather.
You will be able to drive and return to normal activities immediately afterwards. However, please avoid hot baths or vigorous physical activity for about 1 week to allow the thread veins to close off.
Foam Sclerotherapy for Varicose Veins
What causes varicose veins?
Varicose veins occur when the one way valves in the veins in the leg fail allowing blood under pressure to flow the wrong way. The veins are not designed to cope with this increased pressure so they enlarge and become prominent and more visible.
Who gets varicose veins?
Venous disease is largely inherited. It affects men and women equally but starts earlier in women often beginning in pregnancy. It is not caused by standing for long periods but the symptoms may be increased. They are not related to weight, blood pressure or smoking, nor are they caused by crossing the legs.
What is Foam Sclerotherapy?
Injections to close off the veins have been used to treat varicose veins for decades but poor long term results meant that the technique fell out of favour. We now know that if the fluid is mixed with a gas such as air to form a foam the results of treatment are much improved.
It is performed as an out-patient procedure so avoiding the inconvenience, discomfort and expense of an admission to hospital.
The results are at least equivalent to surgery and other minimally invasive techniques such as laser (EVLA).
It is painless and you can drive home and return to normal activities immediately afterwards.
How is Foam Sclerotherapy performed?
The cause of the varicose veins is identified by colour duplex ultrasound examination.
A cannula is inserted into the main vein and a small volume of foam injected. This may need to be done at three or four sites to completely fill the veins. The foam damages the lining of the vein wall. A firm stocking keeps the vein compressed while the vein closes off. The stocking must be worn continuously for at least a week and then during the day for a further two weeks.
What happens afterwards?
You will be able to drive home or back to work immediately. Painkillers are almost always unnecessary. The leg will be bandaged and a stocking applied.
You will be asked to return for a follow up appointment when an ultrasound will be repeated to assess your progress.
Are there any complications?
No procedure is complication free but they are less than with surgery. In particular, bruising is less and Foam Sclerotherapy is virtually pain free so you can return to normal activities immediately. A light copper coloured skin staining over the treated vein can occur in up to 40% of legs which will fade over the year but may be permanent.
Is Sclerotherapy safe?
Yes, the solution has been used for years in millions of patients and as a foam only a very small amount is needed.
What are the alternatives?
Conventional surgery or Endovenous Laser therapy are also effective methods of treating incompetence of the main vein. However, both these techniques are more invasive and have complications although they are usually minor.
Will the veins come back?
With surgery more varicose veins will occur in about 20% of legs over 5 years. Foam Sclerotherapy is likely to be about the same.
Is Foam Sclerotherapy successful?
This treatment is not suitable in all cases, especially very large veins. It is particularly appropriate for recurrent veins that have been treated before.
The vein is closed off in more than 90% of people. If not, the injections are repeated. After five years the vein remains closed in over three quarters of legs.