What are varicose veins?
Varicose veins are incompetent and dilated veins. We say they are incompetent because they do not perform their function correctly: to carry blood back to the heart. The reason for this is that there is a failure of their “non-return” valve system accompanied by an increase in the diameter of the vein, a dilatation.
These dilated veins with valve failure are not able to carry the blood back to the heart so that, depending on the severity of the problem, it can accumulate in the lower part of the legs causing swelling at the end of the day, cramps, pain and other discomforts well known to people suffering from what we call “venous insufficiency”.
Depending on the degree of dilatation we distinguish three types of insufficient veins in the skin:
- Spider veins: also called telangiectasias, are veins that have less than one millimeter of dilatation.
- Reticular veins: If they are between 1 and 3 millimeters. These are the blue or greenish veins seen on the thighs and calves, often connecting the areas with the most spider veins.
- Varicose veins: the largest veins that we all know and that are larger than 3 millimeters.
What are the techniques for the treatment of varicose veins without surgery and how are they performed?
Varicose veins are often part of a larger problem that originates in veins that are not visible in the leg or even inside the abdomen. They are called saphenous veins and there are two main ones: the great or internal saphenous vein and the lesser or external saphenous vein.
In order to determine the correct treatment it is necessary to make an accurate diagnosis of the origin of the problem by performing a Doppler ultrasound of the venous system. This study is essential before any treatment.
For outpatient treatment of saphenous veins we have systems that seal them by heat, such as radiofrequency or laser. They can also be treated by injecting foam with ultrasound guidance inside. More sophisticated devices have recently appeared, such as the Clarivein®, which combines mechanical injury to the wall with the injection of a sclerosing substance. The latest system to be incorporated uses a surgical adhesive to seal the vein. This method, called Venaseal®, is not very uncomfortable and does not usually require compressive bandaging after application.
With so many systems at our disposal it is logical that it is necessary to study each case carefully in order to offer the most appropriate treatment method.
Once the source of the problem has been solved, we can move on to treat the visible part, the varicose vein.
For this we can use sclerotherapy with liquid or foam or microphlebectomy with local anesthesia in which the vein is removed through small punctures. It does not require stitches and the aesthetic results are excellent. In any of these two methods the reincorporation of the treated person to normal activity is immediate.
Treatment of varicose veins vs. treatment by surgery: advantages and disadvantages
First of all it is important to point out that varicose veins are a chronic pathology; we must be aware that in most cases the disease will evolve so that over time dilated veins will be seen again to a greater or lesser degree.
That is why the international guidelines for venous treatment do not consider surgery as the first or even the second option for the treatment of varicose veins. Surgery is currently the third option, so the techniques of choice are the minimally invasive ones listed above.
There are various surgical methods with different short and long term evolution. In general, the potential advantage of surgery is that it is usually performed at once: you enter the operating room and leave with the problem “solved”. The disadvantages are that there is greater discomfort after the procedure and that the esthetic results are usually worse if sutures are used.
Minimally invasive techniques usually do not involve incisions that require sutures. For saphenous vein treatment techniques (Clarivein®, Venaseal®, ultrasound-guided foam sclerosis), access to the vein to be treated is by means of a small puncture, generally with a small amount of local anesthesia. Through this access, different catheters are moved inside the vein to release the foam or glue, depending on the device. At the end, except with Venaseal®, a compressive bandage is usually applied and the treated person walks normally.
The disadvantage of these methods is that they usually require more sessions to obtain definitive results, depending to a large extent on the size of the problem and the objectives pursued.
The return to normal activity is immediate and post-intervention discomfort is minimal. The aesthetic results are usually much better than surgical ones and in the long term the evolution is similar. We must never lose sight of the fact that venous insufficiency in any of its expressions is a chronic problem and that it will require follow-up and most probably more treatments to avoid the reappearance of unsightly and annoying varicose veins.