Treatment FAQs

If you’re considering one of our minimally invasive vein treatments, such as endovenous laser ablation (EVLA) for your varicose veins, or microsclerotherapy for thread veins on your legs, you might have a few questions.

We’ve tried to answer the most frequently asked questions about our treatments here. Alternatively, check out our conditions FAQs for all your questions about varicose veins, thread veins and leg ulcers, or our general FAQs for questions about terminology, clinic policies and payment information.

If you have any other questions, please do not hesitate to contact our clinic team, who will be happy to help.

Endovenous laser ablation (EVLA)

The aim of EVLA is first, to destroy the underlying cause of your vein problems (faulty valves in feeder veins) and then the actual visible varicose veins.

Perforator veins connect the deep and superficial (just beneath the surface of the skin) venous systems, allowing the passage of blood between them. 

EVLA is the usual first line treatment for perforator veins. If EVLA is not possible for any reason, we would treat perforators with foam sclerotherapy. Only on rare occasions would open ligation be required for perforators.

At UKVC we treat perforator veins at the same time as any other veins being treated with EVLA, so there is no additional charge for these. Our EVLA prices are fixed per leg, regardless of the total number of veins or the types of veins needing EVLA.

Pelvic varicose veins usually have a different cause to varicose veins in the legs. Pelvic varicose veins, such as those found on the vulva, perineum and buttocks, are caused by valve failure within the veins of the pelvis, including the veins that drain the ovaries.

Pelvic veins are usually treated with a combination of foam sclerotherapy and embolisation. Pelvic vein embolisation (PVE) uses specialist X-ray equipment to guide a catheter into the vein that drains the ovary or other faulty veins in the pelvis.

Whilst this is a relatively  quick and simple procedure to have done,  it involves the use of expensive fixed X-ray equipment that is only available in hospitals rather than outpatient clinics. If you need this procedure, we will recommend a local private hospital for you.  

Undergoing EVLA treatment should alleviate any symptoms related to your varicose veins, including itching, as it addresses the underlying cause and prevents further skin changes originating from the same source.

Nevertheless, a colour duplex ultrasound scan is necessary to precisely identify the cause of your varicose veins and determine the appropriate treatment.

For the majority of patients, the EVLA procedure is uncomfortable rather than painful.

EVLA treatment involves local anaesthetic injections along the length of the lasered vein, which may cause a slight stinging sensation. As the leg is numbed by the anaesthetic, the firing of the laser typically results in minimal discomfort. Some individuals may experience slight aching, and a few might notice unusual tastes and smells.

While a small percentage (less than 5%) of patients may find the injection of local anaesthetic and lasering painful, most describe the procedure as uncomfortable or the sensation of the laser moving through the vein as peculiar. If you encounter any pain or wish to pause or stop the procedure at any point, please discuss this with the nurse or your consultant.

Although there is no clear explanation for why a few patients find it painful, the general advice is to anticipate the worst and then the majority of patients are pleasantly surprised.

In experienced hands, EVLA takes about 20 minutes per leg.

Over 99% of our patients have EVLA performed on one or both legs in just one visit. 80% require just one follow-up visit. 20% will require a second follow up.

We generally don’t recommend that patients take time off work after EVLA treatment. Some individuals may experience discomfort around a week after the procedure, but it’s uncommon for patients to report the need to take time off. Most people find that they can resume their everyday activities immediately.

We recommend that you wait until your thrombophlebitis is resolved before having EVLA treatment. However, EVLA can certainly be used and is still effective after thrombophlebitis.

We recommend waiting at least 6 weeks after any other surgical intervention before you have EVLA treatment for varicose veins.

While very few complications have been observed from EVLA, it’s important to acknowledge that there are inherent risks with any medical treatment, as well as with not undergoing treatment. The assessment of risks and benefits should be done on an individual basis, and for the vast majority of patients, the benefits significantly outweigh the risks.

Possible complications may include deep vein thrombosis (DVT), deep vein trauma, skin burns, nerve injuries, and laser eye injuries. However, in practice, these are extremely rare or have never been reported. Detailed information on potential treatment risks can be found in our risks section.

A common challenge with all interventional radiological procedures is the occasional difficulty in accessing the vein, leading to the need for procedure cancellation and rescheduling. While this can be inconvenient, it does not result in lasting damage. With our extensive experience spanning more than a decade, such occurrences are highly unlikely in our hands, and any repeat procedure required would not incur additional charges. (Clinics with limited experience are more likely to abandon the procedure and schedule a second appointment.)

You can resume normal activities right after leaving the clinic, following your EVLA treatment, with the only restriction being the requirement to wear a compression stocking on your leg.

For an optimal recovery, it is recommended that you engage in at least 20 minutes of walking daily and avoid prolonged periods of sitting or standing, exceeding 2 hours. Most other normal activities can be resumed immediately.

Exercise should be based on how your legs feel, and while wearing stockings, swimming is not advised. The only exercises restricted for one week post-treatment are horse riding and heavy weight lifting. It is advisable to avoid long-haul flights (over 4 hours) for the next 4 weeks.

On the day of the procedure, driving yourself home is not allowed. However, you can resume driving the following day.

If an underlying valve issue is detected during your initial consultation and scan, your treatment plan is likely to involve prioritising EVLA over foam sclerotherapy alone.

While some physicians may opt for foam sclerotherapy as the primary treatment for larger veins, its results are not as effective or enduring as EVLA. Our goal is to ensure that your treatment yields lasting results, addressing the core problem of venous insufficiency while also diminishing the visibility of varicose veins.

Consequently, we generally do not recommend foam sclerotherapy as the primary treatment for varicose veins in the majority of cases. Foam sclerotherapy is reserved for addressing any remaining varicosities identified after EVLA or during a follow-up appointment.

In instances where varicose veins reoccur after EVLA, some patients may benefit from targeted foam sclerotherapy as a supplementary measure.

For the vast majority of patients, EVLA is the appropriate treatment. For a minority, foam sclerotherapy is the best alternative.

There are other treatments available, including some more modern treatments that avoid the need for local anaesthetic injections. However, there is a lack of evidence of the long term benefits of some of these treatments and several of them are far more expensive.

We have provided some information on alternative treatments below, so that you can fully consider your options, but please note that we do not offer these treatments at UK Veincentre (UKVC).

Sclerotherapy

Foam sclerotherapy is a common treatment for varicose veins.

Administered under the guidance of ultrasound, a drug, also known as a sclerosant, is introduced into the veins. This sclerosant (Sodium Tetradecyl Sulphate) disrupts the inner lining of the veins, leading to the demise and gradual disappearance of the veins themselves. To enhance efficacy, the sclerosant is often combined with gas to create foam, which is more effective on larger veins.

While some practitioners utilise foam sclerotherapy as the sole treatment for varicose veins, it is notably less effective than EVLA in eliminating the larger veins, typically underlying the issue for most patients. Consequently, our standard approach involves employing the more potent EVLA as the primary treatment and utilising foam sclerotherapy as a secondary measure post-laser treatment, targeting the actual visible varicose veins rather than their origin. This approach aligns with the guidelines provided by the National Institute for Health and Care Excellence (NICE).

In many cases, a combined approach involving both treatments in a single session is deemed necessary for optimal results.

Foam sclerotherapy is used to destroy any feeder veins and then the varicose veins, reticular or thread veins themselves.

The sclerosant employed in foam sclerotherapy comprises a drug known as sodium tetradecyl sulphate (STS). STS, a prescription-only licensed drug, has a long-standing history of safe usage in the treatment of varicose veins. Its administration is strictly regulated, requiring a doctor’s prescription and supervision due to a defined safety limit on the dosage administered in a single session.

STS works by targeting and eliminating the cells that constitute the lining of the vein wall. By depriving the vein of its protective lining, the vein undergoes cell death. While sclerosants, such as STS, demonstrate efficacy for small veins, particularly below the knee where effective compression can be applied, addressing the underlying reflux is essential to prevent the recurrence of varicose veins. The introduction of air or CO2, to create foam, enhances the closure effectiveness of larger veins.

The best medications for sclerotherapy are exclusively available by prescription, necessitating authorisation from a doctor and supervision during administration. Cosmetic clinics frequently provide thread vein injections, but these often involve less potent chemicals permissible for use by beauticians without a doctor’s prescription.

In our sclerotherapy procedures, we use sodium tetradecyl sulphate (STS) as a liquid sclerosant. For foam sclerotherapy, the drug is combined with water and air to generate foam, which is more effective on larger veins.

STS is a licensed drug and is considered exceptionally safe when employed as a sclerosant. Nevertheless, like all medications, there exists a limit to the dosage permissible in a single session. All our sclerotherapy sessions adhere rigorously to prescribed guidelines regarding the maximum allowable doses of the sclerosant.

The drug used in microsclerotherapy is the same as used in foam sclerotherapy. The difference is that in foam sclerotherapy the drug is mixed with air to create foam, and is used to treat larger veins, whilst microsclerotherapy is used to treat smaller varicose veins and thread veins.

Microsclerotherapy should not be used to treat facial thread veins. This is due to the small risk that the injected liquid could enter blood vessels that are linked to the eyes or brain. Microsclerotherapy also carries a risk of skin staining, which could last for many months and would appear unsightly on the face.

For treatment of thread veins on the face, we would recommend thermocoagulation.

A session refers to a single appointment for the treatment of your veins, utilising either foam sclerotherapy (for varicose veins) or microsclerotherapy (for thread veins).

Typically, patients undergo between 2 and 4 sclerotherapy sessions, highlighting the importance of understanding that the complete resolution of visible varicose veins or thread veins may take some time. In certain cases, only one session may be sufficient.

Notably, thread veins, particularly when widespread, may require more treatment sessions compared to larger varicose veins.

During your initial consultation, we will provide an estimate of the likely number of sessions based on our experiences with past patients. Additionally, prior to scheduling a consultation, you are encouraged to share images of your legs, allowing us to forward them to a consultant for review.

Typically, patients require 2 to 4 sessions of sclerotherapy to resolve all visible varicosities.

While our preference is to address all your veins in a single session, extensive veins may make this impractical due to the maximum allowed dose of the sclerosant. Additional sessions of foam sclerotherapy or microsclerotherapy may be necessary to treat any remaining veins after the initial session. All our sclerotherapy sessions strictly adhere to guidelines regarding the maximum allowable doses of the sclerosant.

During your initial treatment, we recommend identifying the veins causing the most concern. Whenever possible, our specialists prioritise treating those veins first to ensure optimal results within the safety limits. The number of sessions required depends on two primary factors: the initial quantity of veins and the responsiveness of your veins to treatment, with some veins potentially needing retreatment.

Upon initial consultation, we endeavor to provide an estimate of the likely number of sessions required, based on experiences with past patients. Prior to scheduling an appointment, we welcome the opportunity to send photos of your veins to a consultant for review, allowing for advice on the potential number of sessions needed.

Whilst foam sclerotherapy treatment is cheaper than EVLA treatment, in the majority of patients, EVLA is far more effective and long lasting.

The success rate of treating the underlying cause of varicose veins solely with foam sclerotherapy is low. It is therefore only suitable as the primary treatment option for a small minority of patients. A colour duplex ultrasound scan is necessary to determine whether you are suitable for treatment by foam sclerotherapy alone.

Foam sclerotherapy has a 20% risk of causing skin staining. This staining can last for many months and although it almost always fades completely with time, we cannot guarantee that it will. Please see the section on risks for further details.

The simple answer is as soon as you feel ready to exercise following your foam sclerotherapy treatment. Our advice would be to listen to your body, and to not exceed your body’s limits whilst exercising.

Avulsions

Avulsions involve the physical removal of varicose veins from the body, whilst foam sclerotherapy involves killing off the vein with a chemical sclerosant, after which the dead tissue is absorbed by the body.

Although avulsions and foam sclerotherapy each have their own pros and cons, most of our patients are treated with foam sclerotherapy, because the latter is a simpler and quicker procedure to undertake, with less post-procedure discomfort in most cases.

The main advantage of avulsions is the speed of resolution of the varicose veins. It is particularly useful, therefore, if there is a forthcoming event like a wedding that you wish to be ready for in a short time.

Whilst avulsions are still a surgical method for removing varicose veins, the procedure is minimally invasive and requires far less recovery time.

Traditional vein stripping surgery is performed under general anaesthetic. It involves significant incisions in the groin and either behind the knee or at the ankle, through which the saphenous veins are tied off and removed using a special stripping tool.

In contrast avulsions are performed under local anaesthetic, the incisions are tiny, the healing is fast, and the physical removal of the shallow veins is not as destructive as deep vein stripping.

Thermocoagulation

ThermaVein® is a brand name for the machines that are used to perform thermocoagulation. We use ThermaVein-branded machines, so you may see or hear “thermocoagulation” and “ThermaVein®” used interchangeably to describe the same thing. 

For thermocoagulation appointments you will need to attend with no face makeup, or be willing to remove it just before treatment for face veins. 

Each patient is given a 45-minute slot for treatment of facial veins, which includes both consultation and thermocoagulation treatment in the same appointment. 

The majority of patients do not experience any pain from thermocoagulation treatment for facial thread veins. The sensation is similar to a warm pin prick, or possibly a small electric shock. Only the top layers of skin are breached; the vein itself is not pierced. 

Thermocoagulation is generally very safe. However, as with any medical treatment there are some risks. Reported and known risks associated include bruising or scarring. No major side effects have been reported. A full list of risks and possible side effects can be found in our risks section below.

Minimal aftercare is needed following thermocoagulation treatment for facial veins, but it’s crucial to observe some essential precautions. In the first 48 hours after treatment, gently cleanse the treated area without scrubbing, avoid frequent touching and steer clear of vigorous exercise, or activities that induce sweating or capillary dilation. If prone to flushing, it’s also advisable to avoid alcohol and spicy foods.

We advise that you do not apply face makeup for at least 24 hours after treatment, preferably waiting 48 hours. To soothe irritated skin, we recommend using aloe vera gel.

After the healing process, protect the skin with a high-quality broad-spectrum SPF and avoid using sunbeds. When bathing or showering, use tepid water on the face and a moderate temperature on the body.

During the initial week following treatment, refrain from harsh cleansing, steaming and skin exfoliation. Additionally, avoid stretching or pulling the skin during this period to promote optimal healing.

There is no reason why you should not go out in the sun following thermocoagulation treatment, but you are advised to apply a good, broad-spectrum sun protector, suitable for sensitive skin.

However, we do recommend avoiding sun beds, as they can contribute to the development of thread veins on the face.

Please do not wear makeup for at least 24 hours after thermocoagulation treatment for face veins, if possible leaving it 48 hours for optimum recovery.

Suitability for treatment

Certainly, you can undergo EVLA treatment even if you have undergone ‘surgical stripping’ of veins in the past. A significant proportion of our patients have previously experienced vein stripping, due to the higher recurrence rates associated with the traditional surgical method for varicose vein removal.

EVLA boasts much lower recurrence rates, successfully closing treated veins in 99% of patients during the initial treatment session. It’s important to note that we can only treat veins exhibiting reflux (blood flowing in the wrong direction due to faulty valves) during your appointment. However, there is a potential for healthy veins to develop reflux after treatment, with a risk of approximately 1-2% per year.

The overall likelihood of requiring further treatment for veins developing new reflux is around 10% after 10 years.

While it is common for veins to ‘grow back’ after traditional surgery, this occurrence is fortunately very rare after properly performed EVLA treatment that has effectively targeted all sources of the problematic veins.

We have successfully treated numerous patients on warfarin without encountering any issues.

The only potential restrictions are if your doctor suggests avulsions instead of foam sclerotherapy (usually following EVLA treatment). We will discuss this with you if this is the case.

If you are currently on any other blood thinners, please inform us so that we can update your records accordingly.

It is certainly possible to have treatment for varicose veins or thread veins whilst on HRT. However, it’s important to note that there is a slightly elevated risk of deep vein thrombosis (DVT). In cases where additional risk factors are present, your healthcare provider may prescribe a blood thinner to mitigate the increased risk.

It’s worth mentioning that many of our patients continue with their HRT regimen during the course of treatment.

Yes, it is perfectly safe to receive our vein treatments alongside chemotherapy. We have successfully treated many patients who were also receiving chemotherapy treatments.

It is certainly feasible to have vein treatment if you have a protein deficiency, such as protein S or protein C. However, it’s crucial to be mindful of the heightened risks of blood clots.

During your initial consultation, the consultant will conduct a thorough blood clot risk assessment with you. Based on the assessment, it will be determined whether you would require Apixaban or Clexane post-treatment to prevent the occurrence of a blood clot.

We treat patients of all shapes and sizes. While the potential risks may be slightly elevated, we ensure that every patient receives the same comprehensive information regarding risks and potential side effects. Ultimately, the decision to proceed with treatment is entirely yours.

It’s worth noting that, in many cases, individuals tend to lose weight after undergoing EVLA, as they often experience increased confidence in their appearance or find themselves more capable of engaging in regular exercise, or both.

Varicose veins do not normally affect patients under the age of 18. Anyone over the age of 18 is welcome to book a consultation with us.

There is no upper age limit for the treatments that we offer. We have treated several patients in their nineties, all of whom experienced symptomatic relief as a result of treatment, as well as cosmetic improvement in some cases.

There is no upper age limit for our vein treatments. We have treated several patients in their nineties.

It is common for us to see and successfully treat patients whose varicose veins have reoccurred following previous treatment. This is particularly common in the case of patients who’ve had surgical stripping (as the recurrence rates are so high) or those who have had treatment for their visible varicose veins, without having had the underlying cause of their vein problems fixed first.

You can have treatment at any time following a miscarriage, as long as you’re not pregnant again.

We advise that you do not drive yourself anywhere on the same day as EVLA treatment. This is due to the local anaesthesia used to numb your skin during the procedure. You are able to resume driving the day after your treatment. If you are undergoing foam sclerotherapy, microsclerotherapy, or thermocoagulation treatment you can drive yourself home.

Following EVLA, you can breastfeed immediately.

After foam sclerotherapy or microsclerotherapy, you must wait 24 hours before breastfeeding due to the chemical sclerosant that is used during the treatment. Any milk expressed within 24 hours following this treatment would need to be discarded. You would therefore have to either express enough milk to cover this time frame, or use a suitable alternative (e.g. formula). You may decide it is better to wait until you have stopped breastfeeding to have this treatment.

Recovery

You are generally encouraged to return to most normal activities immediately following treatment. However, for certain specific activities like swimming, horse riding, or weightlifting, it may be advisable to wait a bit longer. If avulsions are part of your treatment, the consultant may provide additional guidance on any necessary precautions.

We recommend refraining from long-haul flights (over 4 hours) for a duration of 4 weeks following either EVLA or foam sclerotherapy treatment. This is to minimise the risk of deep vein thrombosis (DVT). Short-haul flights (less than 4 hours) are generally considered acceptable.

Since you’ll be required to wear a support stocking for a week after any leg treatment, swimming is not advisable during this period, which may also affect any holiday plans.

You will need to wear a compression stocking on each treated leg for at least 7 days after treatment. We therefore do not advise going swimming during this period.

We do not advise that you go horse riding for at least 7 days following treatment due to the strain on your legs.

We suggest that you avoid heavy weightlifting (more than 20kg) for at least 7 days after treatment due to the strain on your legs.

There are no specific restrictions on exercise post treatment – you can return to the gym as early as the day after your procedure. The only factor to consider is the level of post-treatment pain, which can vary significantly among patients.

We recommend tuning into your body’s signals and gradually reintroducing yourself to previous exercise levels.

We recommend waiting at least 7 days following treatment before applying any fake tanning products. This is due both to the importance of keeping the treated areas clean and free of infection, and the need to wear compression stockings on the treated leg(s) for at least 7 days post treatment.

We recommend that you wait at least 7 days before using a tanning bed, as you will be wearing compression stockings post treatment.

We recommend that you wait at least 7 days before using a hot tub, as you will be wearing compression stockings post treatment.

Yes, if you choose to do so please drink in moderation.

Compression stockings

After any vein treatment on your legs, you will need to wear a Class II compression stocking on each treated leg continuously for a full week (7 days).

Whilst wearing the stocking(s) we suggest you do not go swimming as you should avoid getting the stocking(s) wet. We also recommend abstaining from horse riding and weightlifting for one week post-treatment, due to the strain on your legs.

Apart from these restrictions, you are free to resume your normal daily activities.

Medical compression stockings serve as a therapeutic measure to enhance venous blood return. These stockings apply active pressure along the leg, facilitating improved venous circulation and augmenting the flow of blood back to the heart.

Following any vein treatment, you are required to wear a Class II compression stocking, on each treated leg, continuously for one week. Many individuals find it convenient to keep the stockings on throughout the entire week, day and night. You can shower or bathe in them after 48 hours, and they dry quickly on your person.

If you decide to remove the stockings for washing, it’s important not to stand up without them. In such cases, it’s recommended to take baths, sit on the floor upon exiting the bath, dry your legs, and then put the stockings back on.

You will be provided with one pair of Class II compression stockings. If you wish to order an additional pair at a discounted price of AED 390, kindly inform us before your treatment date, and we will ensure the extra pair is available at the clinic for your appointment. Please note that for insured patients, the cost of additional stockings will not be covered by the insurance company.

N.B. Please note that the following guidelines are specifically for toe-less stockings.

You are required to wear a Class II compression stocking on each treated leg continuously for a minimum of 7 days following treatment. If there is any gauze dressing on your legs, you can remove it after 48 hours while sitting or lying down. Avoid standing up without the stockings during the initial 7 days post-treatment.

When it comes to bathing while wearing the stocking(s), you have three options, and the method you choose will not impact the results of the treatment. Select the option that suits you best:

  1. Strip-wash: This avoids the need to remove and reapply your stockings.

  2. Bath: Once the dressings have been removed, you can have a bath. While sitting down, remove the stockings, immediately get into the bath, and when you get out, sit down to dry yourself before putting the stockings back on. Ensure not to stand up until the stocking is properly fitted. To reapply the stocking, turn it inside out up to the heel, put your foot in first, and then roll it up gradually without any creases or wrinkles. Note: Patients may find it challenging to reapply the stockings, so handle them gently to avoid laddering.

  3. Shower while wearing the stockings: You can wear wet stockings until they air dry. Alternatively, use a hairdryer on a cool setting while wearing the stockings. If you choose this option, make sure no soap residue is left on the top of the stocking, as it may cause them to fall down. If needed, wipe the top down, and they should stay up again.

At this stage, it’s common for your veins to exhibit some changes, and, in fact, they may appear worse than they did initially. This is a normal occurrence, as the treatment typically follows a staged procedure. Initially, the focus is on addressing the underlying cause (via EVLA treatment), and at a later follow-up, attention is given to the visible veins and the cosmetic appearance of the legs (using foam sclerotherapy).

One week post-treatment the veins may be inflamed and feel firm and lumpy. Extensive bruising from the top to the bottom of the legs (depending on the treated area) is also a frequent occurrence. Therefore, when you remove your stocking, don’t be alarmed by the appearance. Bruising might take a few days to become evident and can last for several weeks, displaying various shades from purple to yellow.

It may be several weeks after removing your stockings that you start to see visible results, but we would expect to see some changes before the follow-up appointment 6-8 weeks later.

Although it is extremely rare for patients to develop an allergy to the stockings, as they are hypoallergenic and do not contain latex, some individuals may experience a rash or small blisters at the stocking top.

This can occur if the stocking is positioned too high, causing the stocking to ‘drag down’ on the leg and potentially result in a rash or blisters. If this happens, adjust the stocking slightly lower on the leg to prevent pulling or dragging on the skin. Avoid the temptation to pull the stockings up too high.

If the rash persists, consider placing a barrier between the stocking and your leg, such as a piece of bandage or a small fabric patch. If the stockings struggle to stay up, try using bandages wrapped under the stocking top, wearing cycling shorts underneath, or using a suspender belt or tights over the stockings to keep them securely in place.

To prevent the stockings from slipping down, it’s essential to maintain the cleanliness of the top part. Dead skin cells and soap residues can adhere to the top, causing it to lose its grip on the leg and potentially fall down.

We recommend that you wipe down the top of the stocking with a damp cloth at least once a day. Fold over the top ‘plasticky looking bit’ of the stocking and use a damp cloth or alcohol gel to wipe away any accumulated dead skin cells and soap residue. This build-up is more likely to occur if you choose to shower while wearing the stockings.

If the stockings continue to slip down, consider tying a piece of fabric around the stocking top, wearing a suspender belt, or wearing a pair of tights over the stockings to secure them in place.

Treat the stockings delicately, similar to a thin pair of tights. Be cautious whilst pulling them up or adjusting them to avoid putting your fingers through them.

In the event that they do develop a ladder or get a hole, please rest assured that this will not impact the effectiveness of the treatment.

We recommend wearing compression stockings continuously for a minimum of 7 days following treatment.

If you still experience post-treatment pain after this period, the support stockings may help alleviate it. However, wearing them beyond this initial week is only necessary if they continue to provide relief from post-treatment symptoms or if your consultant specifically advises you to do so.

Alternative treatments

For most patients EVLA is the optimal treatment for varicose veins, proving effective in nearly all cases. Extensive scientific studies have contributed to a wealth of literature showcasing outstanding clinical outcomes, an impeccable safety record, and the sustained durability of results spanning many years.

This compelling evidence is the basis for the National Institute for Health and Care Excellence (NICE) in the UK recommending EVLA as the preferred approach for treating varicose veins.

However, there are a number of alternative treatment options:

1. Conservative management (watch and wait)

While persistent varicose veins can result in skin discoloration and ulceration, many individuals seek treatment primarily for cosmetic reasons.

After your consultation, you may choose not to undergo any treatment in cases where the primary concern is cosmetic. The drawback of opting for conservative management (doing nothing) is that varicose veins typically progress slowly over time. However, there are instances where it is prudent or necessary to postpone treatment, such as when patients have contraindications (medical reasons not to treat, e.g. pregnancy).

In such situations, your consultant may provide guidance, including the recommendation to wear Class II compression stockings, aiming to temporarily alleviate any discomfort caused by varicose veins. It’s important to note that wearing stockings is not a permanent solution, and varicose veins will not spontaneously disappear without active treatment.

2. Surgical Stripping

Historically, surgical stripping was the conventional approach for addressing the root cause of varicose veins. However, with the advent of alternative minimally invasive methods, the NICE no longer advocates surgical stripping as the primary treatment option.

According to NICE, surgical stripping comes with several drawbacks when compared to minimally invasive treatments. These drawbacks encompass a significantly higher recurrence rate, an extended recovery period that entails more time away from work and daily activities, and increased risks such as deep vein thrombosis (DVT), infection, nerve damage, and bleeding.

As a result, UKVC does not provide surgical stripping as a treatment option.

3. Radiofrequency Ablation (RFA)

Radiofrequency Ablation (RFA) employs a thermal method similar to EVLA to obliterate veins, resulting in both treatments boasting outstanding results and safety profiles. NICE recommends either procedure as the gold standard treatment. However, the RFA device, distinguished by its rigidity in comparison to the flexible laser fibres utilised in EVLA, may not be suitable for short perforator veins, very small veins, or those with intricate twists that can be effectively addressed by the laser.

At UKVC, we prioritise EVLA over RFA due to its versatility, providing excellent treatment outcomes for over 95% of patients, irrespective of the distribution, shape, or size of varicose veins.

Therefore UKVC does not offer radiofrequency ablation.

4. Microwave Ablation

Comparable to EVLA and RFA, microwave ablation is another thermal method employed for treating varicose veins, involving the destruction of veins through heat. However, it does not present any discernible advantages over EVLA.

Consequently, UKVC does not provide microwave ablation as part of its treatment options.

5. ClariVein®

Clarivein® treatment entails the insertion of a specialist device into the vein, featuring a rotating wire at its end. The spinning wire gently scratches the vein wall lining while simultaneously administering a sclerosant drug (sodium tetradecyl sulphate (STS), the same drug utilised in sclerotherapy) to induce scarring of the vein wall. This combined approach is thought to be more effective than foam sclerotherapy alone. The entire procedure is conducted through a single, tiny skin puncture and is virtually painless, so it does not require local anaesthetic. However, due to studies indicating a 10-15% recurrence rate of treated veins, UKVC currently does not currently offer this treatment.

6. VenaSeal®

VenaSeal® (or Sapheon) involves injecting adhesive globules (similar to super glue) at intervals along the vein, effectively bonding the walls together and causing the vein to close. Like other advanced treatments, this procedure requires only a single, small skin puncture and is typically painless, removing the need for local anaesthetic. Another potential advantage is that compression stockings may not be necessary post-procedure.

Although a recent study published in the Journal of Vascular Surgery showed promising results, the technique has been associated with a notably higher risk of painful phlebitis. Furthermore, it hasn’t been as extensively researched for efficacy and safety as EVLA, RFA, and foam sclerotherapy. Due to these considerations, UKVC does not currently provide VenaSeal® treatment.

7. Cermavein (Steam)

Steam (Cermavein) introduces a unique approach by utilising steam, delivered through a catheter, as an alternative to a laser fibre. While initially intriguing, this technique still involves local anaesthetic injections, presenting no clear advantages over EVLA.

Several drawbacks should be considered:

  • Preliminary study results are not as impressive as those of EVLA
  • Long-term results are yet to be published
  • Despite appearing potentially cost-effective, the devices employed are considerably more expensive than EVLA devices

Given these factors, Cermavein is not currently endorsed as a viable option for varicose vein treatment by UKVC.

8. High Intensity Focused Ultrasound (HIFU)

Another novel technique in varicose vein treatment is High Intensity Focused Ultrasound (HIFU). While initially promising, HIFU comes with several limitations. It employs high-power ultrasound, akin to what a physiotherapist might use for musculoskeletal injuries but at even higher power, to heat and destroy the vein. Unlike other methods, HIFU doesn’t involve any instrumentation of the veins; instead, the device is held against the skin during the procedure.

Although there was hope that this approach would eliminate the need for local anesthetic injections, the generated heat can cause pain, and injections may still be necessary in some cases. Additionally, HIFU treatments tend to be lengthier and more expensive than EVLA.

Due to these considerations, UKVC does not currently offer HIFU.

9. Homeopathic remedies

As expected for such a common condition, there are a whole host of homeopathic remedies proposed for varicose veins.

At UKVC we do not offer or endorse any homeopathic remedies in the management of, or symptom relief for, varicose veins. We also strongly advise against any patient using any alternative medicine, diet, device or physical therapy of any sort to directly treat their varicose veins without first consulting a medical professional.

Some of the homeopathic remedies proposed to treat varicose veins include:

  • Butcher’s broom (ruscus aculeatus), also known as box holly, knee holly, pettigree, or sweet broom. It contains ruscogenins, which proponents say strengthens collagen in blood vessel walls and improves circulation.
  • Horse chestnut extract (aesculus hippocastanum). Limited studies have shown the active constituent in horse chestnut, called aescin, effective in reducing leg pain and swelling in those with venous insufficiency. However, there is no evidence to suggest it is helpful in reducing the appearance of varicose veins.
  • Grape Seed Extract (vitis vinifera) and Pine Bark Extract (Pinus maritima) both contain oligomeric proanthocyanidin complexes (OPCs) – antioxidants that appear to strengthen the connective tissue structure of blood vessels and reduce inflammation.
  • Sweet clover (melilotus officinalis) contains ingredients that might thin the blood and help wounds heal. It is commonly used for varicose veins, to relieve symptoms of poor blood circulation (chronic venous insufficiency) including leg pain and heaviness, night cramps, itchiness, and fluid retention (oedema).
  • Witch hazel is a popular home remedy that has been used for centuries to help with swelling. It’s an astringent, which are substances that cause body tissues to shrink. It’s thought that witch hazel may improve circulation and strengthen venous connective tissue, both of which could be beneficial for varicose veins.
  • Rutin (also known as rutosides) is a bioflavonoid, or plant pigment, that is found in certain vegetables and fruits. Traditionally, rutin has long been used to aid circulation. It’s also thought that rutin can help strengthen and increase flexibility in blood vessels, such as your arteries and capillaries.
  • Gotu kola (centella asiatica) has been used to treat many conditions for thousands of years in India, China, and Indonesia. Several small studies suggest gotu kola may help reduce swelling and improve blood flow.
  • Foods containing flavonoids, including vegetables such as onions, bell peppers, spinach and broccoli, fruits such as citrus fruits, apples and blueberries, and cocoa are all proven to improve blood circulation, which helps to keep blood flowing and make it less likely to pool in the veins. They also help to reduce blood pressure in the arteries and can relax blood vessels, all of which can help to reduce varicose veins.
  • A high-fibre diet has been shown to help improve blood circulation. It also reduces the likelihood of constipation, which can put added pressure on veins, particularly in the legs where they are already working harder to push blood back up to the heart.
  • Water therapy uses exposure to both warm and cold water to improve circulation. Cold temperatures shrink veins and help push blood back up to the heart. As the blood leaves your varicose veins, it allows the swelling to go down and reduces discomfort in the legs. Cold water swimming has also been especially linked to symptom relief, likely due to the effects of cold water on increasing blood vessel tone and constriction, and the relief of gravity, which means it is easier for blood to flow back up to your heart. Even drinking more water has been noted to help, as this helps to make the blood thinner and easier to circulate than thicker blood, as it needs less effort.

Regrettably, there is insufficient evidence supporting the efficacy of various alternative treatments for varicose veins, and some may even pose risks such as allergies and side effects. If contemplating the use of any homeopathic remedies, even for temporary relief, it is strongly advised that you consult with a medical professional first, as self-treatment, especially if delaying standard treatment, can have serious consequences.

It is essential to recognise that each vein treatment method comes with its own set of advantages, disadvantages and risks. Patient assessment is crucial, enabling individuals to decide, based on the evidence specific to their case, which technique is most suitable. Varied veins and patients necessitate individualised approaches, and not all veins are amenable to every treatment.

While newer methods like Venaseal® and Clarivein® alleviate the discomfort of local anaesthetic needles, post-procedural pain, particularly with superglue, may still occur, leading to phlebitis. One significant drawback is the limited long-term evidence regarding effectiveness and safety compared to thermal ablation. The effectiveness, durability, and safety of techniques, such as Venaseal® and Clarivein®, in comparison to EVLA, are still uncertain.

Inevitably, many alternative treatments may also incur higher costs than EVLA, which remains recommended as the primary treatment for chronic venous insufficiency, including varicose veins and leg ulcers.

While lifestyle changes like regular exercise, weight reduction, leg elevation, a healthy diet, salt reduction and smoking cessation can help manage symptoms, they alone cannot reverse the effects of unhealthy valves in affected veins.

For symptom relief and addressing the underlying cause of venous insufficiency, recommended minimally invasive procedures such as EVLA are the most effective. Wearing a compression stocking may also provide symptom relief while awaiting treatment.

Treatment risks

No individual should undergo any medical treatment without being fully informed about the potential risks alongside the benefits. At UKVC, we adopt an open and honest approach, considering it essential to apprise prospective patients of the slight, yet tangible, risks of side effects associated with our treatments, allowing for an informed decision-making process.

While the contemporary, minimally invasive varicose vein treatments, such as EVLA and foam sclerotherapy, offered at UKVC are highly effective and safe, compared to traditional surgical stripping, occasional issues have been documented. It is crucial to acknowledge these rare instances when deliberating on whether to pursue treatment.

Additionally, recognising the risk of taking no action is imperative, as, in many cases, the hazards of untreated conditions surpass those associated with the treatments. Without intervention, venous insufficiency can result in heightened leg pressure, leading to skin changes, and, in severe instances, ulceration.

During your consultation, we will provide detailed information about the risks of any proposed treatment(s). If specific risks are more pertinent to your case, we will discuss these with you so that you can make a fully informed decision about how to proceed.

1.     Bruising

Bruising typically appears a few days post-treatment and in certain instances can appear quite pronounced, especially if you regularly take or are prescribed blood thinners. However, even severe bruising should subside over the course of a few weeks and should not be a cause for alarm.

2.     Phlebitis

Phlebitis, or inflammation in a treated vein, is a common occurrence after EVLA and/or sclerotherapy. In most cases, it is self-limiting and accompanied by only mild discomfort. However, on occasion, there may be more intense pain, and this can manifest several weeks or months after the initial treatment.

Managing such discomfort is typically achieved with either ibuprofen gel or tablets (but not both). In some instances, the removal of trapped blood from the affected vein may be considered.

While the area might feel warm to the touch, antibiotics are rarely necessary, and resolution can usually be achieved with anti-inflammatory medication.

3. Stocking top reactions

Skin reactions at the top of the compression stockings are quite common and are usually due to the stocking(s) being pulled too high on the leg, so that the elastic pulls on the skin every time the leg is bent. If there is skin irritation at the stocking top, this can be turned down, or a piece of gauze or fabric can be placed between the stocking and the skin for added comfort.

4. Allergic reactions

This might be an allergic response to local anaesthetic or to the chemical sclerosant administered during sclerotherapy treatment.

Any encounter with a new drug carries a potential risk of triggering an allergic reaction, although severe reactions are uncommon. All clinics are equipped with emergency drugs to address and manage any potential allergic reactions.

5.     Bleeding/Haematoma

Although EVLA is performed through a ‘pinhole’ skin access, we sometimes see oozing onto the stocking from this small puncture site.

If your treatment involves avulsions, there can sometimes be more significant bleeding or haematoma formation following this procedure.

6. Infection

As the majority of minimally invasive treatments at UKVC require only needle punctures, rather than surgical incisions, the risk of infection is very low.

If your treatment plan includes avulsions, the size of your incisions may range from needle punctures to 3mm cuts, which carry slightly higher risks of infection.

7. New thread veins

It is possible for new thread veins to occur along the length of a vein treated with EVLA, or following foam sclerotherapy or microsclerotherapy treatment. We can mostly improve appearances with further microsclerotherapy injections.

There is also a rare condition called telangiectatic matting, which occurs if fragile blood vessels are injured during treatment, leaving a mat of tiny veins that look like a bluish or red bruise, most commonly on the inside of the knees.

Telangiectatic matting usually disappears completely after 6 – 12 months, but if it persists, it can be treated with additional microsclerotherapy, using a very fine needle to treat these veins.

As with all thread veins though, some can be resistant to any further treatment.

8. Skin Staining

Skin staining may develop after undergoing either foam sclerotherapy or microsclerotherapy. While not posing a health risk, it can lead to an unsatisfactory cosmetic appearance, especially in the short term. Typically manifesting within 4-6 weeks of treatment, it usually resolves within 6 months in 60% of cases and within 1 year in 95% of cases. However, in 1-2% of cases, it may take 12-18 months to fade. While we cannot guarantee the absence of permanent marks, such occurrences are fortunately rare.

9. Venous thromboembolism (VTE)

Deep vein thrombosis (DVT) and pulmonary embolus (PE) are rare occurrences following EVLA and/or foam sclerotherapy. Based on data from Veincentre Ltd in the UK, derived from 40,000 patients, our rates stand at just one in 1,000 for DVT and one in 2,000 for PE. These figures are notably lower than those reported in published studies, where typical rates are one in 200 for DVT and one in 1,000 for PE.

DVT manifests as a swollen calf (with an increase of 3cm or more compared to pre-treatment) and intense pain. Urgent review in an out-of-hours doctor or emergency department is essential, with immediate administration of a blood-thinner and a subsequent scan arranged.

PE is a serious condition that requires urgent diagnosis and treatment and can occur without leg swelling. Any sudden onset of shortness of breath is a red-flag symptom, necessitating urgent review at the nearest Emergency Department (ED).

If, during your initial consultation, you are identified as being at higher risk of developing VTE, your consultant may administer a single dose of injected blood-thinner during your vein treatment procedure. Highest-risk patients might also be prescribed an additional week of blood-thinner medication. However, it’s crucial to note that while these measures aim to minimise the risk of blood clots, they do not provide complete assurance, and there is also a very small risk of significant bleeding associated with these medications.

10. Visual disturbance/migraine

Approximately 1 in 400 patients may experience a transient visual disturbance resembling a migraine aura (flashing lights) immediately after treatment. Typically, this phenomenon takes about 10 minutes to resolve, and our clinic will closely monitor and provide support. Reassurance and monitoring are usually sufficient for management.

These disturbances are likely attributed to tiny bubbles of sclerosant entering the blood supply to the brain. While this may sound concerning, it’s important to note that we have not observed any persistent visual problems resulting from these occurrences. The likelihood of such reactions is higher in individuals with a history of migraines.

Additionally, it’s worth mentioning that foam sclerotherapy has the potential to trigger migraine attacks, although stress related to undergoing a medical procedure can also be a contributing factor.

11. Skin ulceration

Skin markings, including blisters or, in rare instances, ulceration, may occur due to skin breakdown over a treated vein or irritation caused by any of the treatments. While such occurrences are rare, they usually necessitate local dressings and may potentially lead to scarring in the affected area.

12. Skin burns

Whilst it is theoretically possible for skin burns to occur during or after EVLA treatment, we have never seen any cases of this in practice.

13. Nerve damage

We have never observed any damage to nerves responsible for muscle movement in the legs; this occurrence is highly improbable. However, nerves transmitting sensations from the skin, particularly with EVLA below the knee, can be affected, resulting in numbness or tingling on the inner part of the lower leg. Typically, this condition improves within 3-4 months and is not disabling, although in some cases, it may persist, leaving a permanent numb patch of skin.

 

If your consultant has concerns about any other risks associated with your procedure, they will discuss with you in clinic, prior to your treatment.

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