The first category includes procedures that, for want of a better term, damage the involved veins leaving them sclerosed (scarred) in the thigh and leg.
The most conventional procedure in this category is injection sclerotherapy which does not require anesthetic. A sclerosing (scarring) agent is injected into varicosity creating an inflammatory reaction resulting in thrombosis or clotting of the vein. The inflammatory reaction enzymatically breaks down and reabsorbs the clot. This procedure results in obliteration of the lumen or channel of the vein as well as adherence of the scarred vein to surrounding tissue. Sclerosing agents include such things as hypertonic saline or sugar, sodium tetradecyl sulphate (foam), etc.
The other common procedure in this category of vein sclerosis is laser treatment, which involves the insertion of a laser probe (burning hot light) into a vein and burning the vein. This procedure is done under local anesthetic with the addition of sedation at times. The vein to be treated needs to be relatively straight to allow to pass the probe up the vein.
The downsides to these types of sclerosing procedures include:
- Failure to occlude the vein especially when the treated vein is under high pressure;
- Recanalization (reopening);
- Veins treated with sclerosing procedures are very difficult to remove, if need be, as they have become scarred to surrounding tissue (subcutaneous fat);
- Risk of Deep Venous Thrombosis (DVT) as injected sclerosing agent can end up in the deep venous system and cause clotting;
- Higher incidence of superficial sensory nerve damage by the laser when used for varicosities below the knee.
The second category of varicose vein treatment are those procedures that remove the varicose veins. These methods have been shown to be more effective in the long term than sclerosing techniques.
Historically, removal of varicose veins has been primarily “stripping.” This procedure typically involves removing the Greater Saphenous Vein from the level of the ankle to the saphenofemoral junction in the groin. As this procedure produces considerable pain, it requires either a general anesthetic or a spinal anesthetic in a hospital or an outpatient surgical clinic.
In this procedure two incisions are made, one at the ankle and the other in the groin. A plastic cord is placed in the vein at the ankle and threaded up the Greater Saphenous Vein to the groin incision. A plastic ball is attached to the plastic cord at the ankle. The entire main trunk of the Greater Saphenous Vein is then “ripped” out of the leg and thigh by pulling with considerable force on the cord from the groin. The passage of the ball under the skin from the ankle to the groin causes considerable trauma to surrounding tissues. The venous branches that drain into the Greater Saphenous Vein are torn off by this procedure resulting in significant subcutaneous bleeding creating substantial post-procedural bruising.
“Stripping” the main trunk of the Greater Saphenous Vein in this manner does not deal with dilated branches of this system which require further incisions for removal or sclerosing procedures at a later date.
A second way to remove varicosities from the thighs and legs is to remove the Greater Saphenous Vein and branches using a micro-incision technique under local anesthetic. The abnormal veins can be identified through physical examination and/or ultrasound. The micro incision (2-3 mm) technique allows the removal of veins in a controlled manner. Resected branches can be removed and suture ligated (sewn off) with absorbable sutures to prevent bleeding and bruising. This technique is far less traumatic to surrounding tissues and therefore produces far less post-procedural discomfort.
Weighing the risks and benefits of the above-described procedures, Dr. James Hunter’s primary approach to varicose vein treatment is to remove them under local anesthetic using a micro-incision technique. This procedure is safe, very effective and produces excellent cosmetic results.