Vein Treatment Options
Varicose veins have been treated many different ways over the years. The treatment of varicose veins has evolved and advanced over the years into a speciality in medicine, called Phlebology, the study and treatment of vein disease.
At The Vein Clinic, our treatment team is trained in phlebology, ultrasound assessment, and attend advanced vein treatment training and education annually. Dr Pinette has completed a fellowship in Phlebology with the Canadian Society of Phlebology and remains active in that organization as a Board Director and trainer for new physicians in Canada. Treatment of veins is our job.
Although there are many options available for varicose vein treatment, there are basically 6 main treatments that can be considered.
- Compression Stockings
These are good for all veins. They help prevent varicose veins from developing or worsening. They help your legs feel better at the end of the day. And they are used to help more advanced vein disease such as sores and swelling get better. If you have varicose veins and do not wish to have any procedure done to correct them, you can manage any symptoms and reduce their progression by wearing compression stockings daily. It is important to have your legs evaluated before starting compression wear to ensure that you get the best fit. At The Vein Clinic, we will do a full vein assessment and make recommendations on the proper compression stockings. For your convenience, all our staff are certified fitters for compression stockings and we carry the full line of Sigvaris and MEDI stockings which we can provide to you.
Using tiny needles, we inject liquid or foam into the leg veins to irritate the veins. Then with compression on the veins, the veins will sclerose (close down) and the blood flow will be redirected to healthy deeper veins. Sclerosed veins will eventually be reabsorbed by the body. Sclerotherapy is the most common vein treatment done in North America. Liquid sclerotherapy can be used for all sizes of veins in the legs and body. However, for larger or more resistant varicose veins, foam sclerotherapy can be used. The long term vein closure rates with foam sclerotherapy are 80-85%. Sclerotherapy has no down time and can be easily repeated if veins recur over the years.
Liquid sclerotherapy. At The Vein Clinic we use sclerodex (salt & sugar solution) or Tromboject (mild fatty acid) to close down your veins. Each session might require 10-50 injections and you might require a few visits to get best results. This procedure is well tolerated with minimal discomfort and great results. There is no downtime and you can return to work the same day. The cost of sclerotherapy for symptomatic varicose veins may be covered by Manitoba Health.
Foam sclerotherapy. By simply mixing the liquid Tromboject with saline and air, we are able to create a foam solution that can be injected into the veins. This works great for larger veins and is done under ultrasound guidance. Each session lasts about 30 minutes and the procedure is well tolerated with minimal discomfort. There is no downtime and you can return to work the following day. The cost of sclerotherapy for symptomatic varicose veins may be covered by Manitoba Health.
- Endovenous Procedures
Great new treatments have been developed, tested, and used for hundreds of thousands of people in the last 20 years. Endovenous means “inside the vein”. These procedures are usually used for the larger saphenous veins of the legs. An endovenous treatment involves threading a small wire into the varicose vein using ultrasound to monitor where the wire is. Then the vein is closed from the inside by using either heat or mechanical energy or glue. Endovenous treatments are very successful in long-term closure of the large varicose veins, achieving 90-95% long term closure rates. The cost of endovenous procedures is not covered by Manitoba Health. The cost ranges from $2000-4000 per leg depending on the type of treatment being done.
EVLT (endovenous laser therapy) uses a laser inside the vein to cook the veins walls and close them for good. VNUS (venous ultrasound therapy) uses ultrasound waves to heat the vein and cook it from the inside. Both of these heat based procedures require preparing the leg first with anaesthesia (numbing) by injecting along the vein several times all the way up the leg. After the heat based procedures, you may have bruising and discomfort and must wear stockings for 1-2 weeks afterwards. Rare side effects include nerve sensation damage, skin burns, open sores, or clots. Only one leg can be treated at a time.
Clarivein treatment is a mechanical closure of the vein. Using a small wire that is threaded into the large vein, and under ultrasound guidance, a spinning wire is moved backwards through the vein which irritates the vein wall, while at the same time a thin stream of sclerosant liquid is injected into the vein. This combined mechanical (spinning wire) and chemical (sclerotherapy) is highly effective at closing the vein wall longer term. The benefit of this procedure over the heat based treatments is that you do not have to anaesthetize (numb) the leg first as there is no discomfort as the treatment is done. Compression stockings will have to be worn after treatment for 2 weeks and to date there have not been any significant side effects of treatment. Only one leg can be treated at a time.
Venaseal™ is the latest treatment to enter the Canadian market having received approval in 2012. This endovenous glue procedure has been developed and used for many years in Europe. In this procedure, a small guide wire is again placed into the vein under ultrasound guidance. Then we place a small amount of a specially designed glue for veins inside the vein and put pressure on to seal the vein closed. This is continued down the vein until the whole vein has been sealed shut. This procedure requires no anaesthesia (numbing) in the leg and has no discomfort. To date, there have not been any significant side effects of treatment. The advantage of Venaseal™ over other endovenous treatments is that both legs can be treated at the same time, there is no discomfort, no need for leg anaesthesia, and you can resume all normal activities the next day. You do not have to wear compression stockings after the Venaseal™ treatment to get vein closure as the glue effects are immediate.
- Vein Surgery
In years past, vein ligation (cutting) and stripping (pulling out veins) was the most common treatment for varicose veins. Vein stripping is still performed today by most vascular surgeons. In experienced hands, a procedure called high ligation and stripping can likely give you a 75% chance of getting rid of the veins long term. This procedure involves being put under anaesthesia and at least two weeks of downtime, bruising, and pain. Stripping is usually only done for the larger saphenous veins of the legs. All other varicosed veins will need to be treated with other methods afterwards (such as sclerotherapy). Afterwards, your legs may have scars that last your lifetime and you may have recurrence 25% of the time. In Manitoba, we refer to the vascular surgeons if you wish to have this done and the wait time to see these specialists just for your initial consultation is usually 6-10 years or longer. The cost of surgical stripping for symptomatic varicose veins is covered in Manitoba by Manitoba Health.
- Laser Vein Removal
Typically we would only suggest using laser vein removal for smaller veins on the trunk and face and for cherry spots anywhere on the body. From experience, we know that veins in the legs will respond better and quicker to sclerotherapy rather than laser vein removal so we will usually suggest the best options for you. However, for people who cannot have sclerotherapy or prefer to have laser vein removal done on their leg veins, we can refer you for this procedure.
- Flavonoid remedies
For decades, homeopathic flavonoid medications have been used in Europe to treat the symptoms of vein disease. In Canada, Venixxa ™ has now been made available in the market. It is available at most pharmacies without a prescription and can help reduce the symptoms and swelling associated with vein disease.