Varicose veins are an extremely common problem, affecting up to 50% of the population. Factors that make certain people prone to develop varicose veins include heredity, multiple pregnancies, female gender, and work that involves prolonged standing or heavy lifting. Varicose veins also become more common as we age, as the one-way valves in our veins can suffer from wear and tear over the years.
Many people with varicose veins do not seek treatment for this disease, even if they suffer from aching and heavy legs, because they have heard that treatment involves general anesthetic and painful recovery after surgical stripping. Many patients do not even know that treatment is available. It has been found in multiple studies than varicose veins progress with time. The diseased veins become larger and more and more associated veins become damaged, until there is a road map of varicose veins. Varicose veins allow blood to pool in the legs, leading to swelling, poor nutrition to the overlying skin, possible ulceration of the skin and a negative impact on quality of life.
Thankfully there have been many advances in minimally invasive methods to close varicose veins, which are associated with little post treatment pain and almost immediate return to work and usual activities. Sclerotherapy, a treatment that involves injecting a medication into diseased veins, has been used for over 100 years. In the last 15 years, sclerotherapy has become much more effective in treating all sizes of varicose veins. This is thanks to the use of an ultrasound to diagnose the source of the problem, as well as the discovery that foaming up the medication produces a much better result. In BC, sclerotherapy treatments are partially covered by our provincial health care plan and many studies all over the world has found this to be the most cost effective method of treatment.
Newer minimally invasive treatments include endovenous laser ablation (EVLA or EVLT) and Venaseal glue to treat varicose veins. These treatments are safe, effective and almost painless, allowing rapid return to usual activities. For especially large veins, they do result in a higher closure rate than sclerotherapy. However, there is a hefty out of pocket price tag to the patient associated with these newer treatments. These procedures cost at least 10x more than sclerotherapy.
We have growing evidence now that even though EVLA/EVLT and glue produce a higher closure rate than sclerotherapy, the 5-year improvement in quality of life is no better than sclerotherapy. This has led to the question as to how important is complete closure of veins. As physicians, we should be aiming to improve our patients’ quality of life, which is a better indicator of success of treatment versus an ultrasound appearance.
Varicose vein disease is a chronic disease. Every type of vein treatment is associated with recurrence, and regular maintenance is important even if you pay the hefty price tag for a newer treatment at the outset.
My recommendation to patients is based on the degree of disease in their veins. Most patients that are candidates for surgical treatment have veins of the diameter where sclerotherapy is extremely effective. I offer them the option of sclerotherapy, laser and glue treatment. For the minority of patients where the diseased veins are excessively dilated, I do suggest laser or glue therapy over sclerotherapy.
In summary, ultrasound guided foam sclerotherapy, endovenous laser ablation (EVLA or EVLT) and Venaseal closure by glue are all effective and safe treatments for varicose veins and show equally sustained improvement in quality of life. If you want the highest technical closure rate, and paying for treatment will not cause financial hardship, EVLA/EVLT and Venaseal are wonderful treatments. However, there is no need to break the bank, as ultrasound guided foam sclerotherapy is also a brilliant treatment method.