Pros & Cons of Various Varicose Vein Treatments
Surgery remains the GOLD STANDARD against which other techniques must be evaluated.
Radio Frequency Ablation (RFA) and Endovenous Laser(EVLT) though they do not physically remove the vein seem to be effective in the short to medium term, although not every pattern of varicose veins is suitable for these treatments.
There is now reasonable evidence that radiofrequency ablation, is a slightly superior procedure especially for perioperative bruising and pain when compared with endovenous laser (Nordon IM, 2011, Shepherd Et Al 2010) but the durability of these procedures in the longer term is still unclear (Sharif Et Al 2006,Mundy Et Al, 2005). The other difficulty peculiar to endovenous laser is that there are many competing products with different laser wavelengths all claiming better clinical results on the basis of inadequate evidence.
A randomised trial in Denmark has compared results in a group of 500 patients comparing surgery, EVLT, RFA and foam sclerotherapy. At one year the highest failure was in those patients who underwent sclerotherapy (16{013d8e26d07b1afe015c72520babcb8884609227f71e52264d03663af3c2f983}) whereas the surgery and RFA had similar recurrences (both 4.8{013d8e26d07b1afe015c72520babcb8884609227f71e52264d03663af3c2f983}). However it is important to remember that neither EVLT or RFA can treat the remaining varicose veins. They only replace the stripping(removal of vein) of conventional surgery. Therefore patients with perforator incompetence , remaining varicosities and other veins still require either surgical removal or sclerotherapy.
Appropriate treatment after an accurate and extensive color duplex scanning of the venous system of the leg, the amount of damage to the leg, duration of varicose veins, risk of recurrence especially due to occupational hazards are some of the factors which lead to a successful result. Regular follow up and use of compression stockings are what prevent recurrences.
Globally, many clinicians are involved in treatment of varicose veins. These include sclerotherapy specialists, dermatologists, appearance medicine practitioners , cosmetic surgeons, interventional radiologists &general surgeons.
There is a risk of recurrent varicose veins, irrespective of whoever is involved in your care and whatever claims they may make.
There are two main reasons for this.
- The nature of the disease – It is a life-long inherited tendency and over years new veins can appear whatever the treatment, no matter how carefully performed.
- Some techniques if not applied correctly may lead to increased risk of recurrence.
The presence and/or appearance of spider veins after any treatment for varicose veins is common and should not be construed to be a recurrence. If required they can be treated by sclerotherapy.
It is recommended that patients should carefully weigh the benefits and risks with their doctor before deciding on the best treatment strategy. It is NOT TRUE that ONE SIZE FITS ALL…especially in the case of varicose vein treatment. The optimum treatment plan keeping in mind the cause and the degree of damage to the legs is what leads to better long term results.
Patient compliance in wearing compression stockings, avoiding weight gain,and regular exercise goes a long way in preventing recurrence.
Compliance in wearing the compression garments is one of the most important factors in preventing vein problems.
I often tell my patients ” you can either wear the stockings and live a healthier life or come back later with more vein and leg problems”
How Soon After Surgery/Intervention can I walk?
Irrespective of the procedure you undergo, whether surgery or Laser or RFA or Sclerotherapy, most patients are able to walk on the day of procedure itself.
In the case of Laser/RFA/Sclerotherapy patients are discharged on the same day . Post surgery, depending on the stage of the problem in which you have presented to us, you may be discharged one day after the surgery or in case you have an ulcer you may be discharged from hospital a few days later. Most patients do not need a stay of more than 4-6 days in hospital even if they are ulcerated with leg infection.
Will I have pain afterwards?
Pain is normal after any procedure. However modern surgery using minimal invasive techniques is a far cry from the older techniques which used to cause major bruising to the leg. You may get sensations of burning/tingling after EVLT/RFA. Slight pain may be felt in the surgical sites in case of surgery which usually settles down in a day or less. Till then you are covered with pain killers and most patients do not experience anything more than a slight discomfort in the area.
A sensation of pulling along the course of the vein in the leg may be felt which reduces over a few days as you start walking. Most patients with uncomplicated veins can go back to work within 10-15 days depending on whether one or both legs were operated.
After EVLT/RFA also the sensation of pulling, burning along the vein may occur which also gradually settles. With these procedures the patient can be back to work within 2-4 days. However patient selection for these procedures is of paramount importance in achieving better long term results.