Unfortunately not uncommonly patients report that this myth has been conveyed to them by their doctor!
It seems to be a “hangover” from the “dark old days’ when stripping was the only available treatment.
I refer to this time as the pre “Endovenous Era”, (not unlike the Age of Enlightenment when thought began to governed by evidence and reason not dogma!).
The stripping operation was unpopular with patients and doctors and so patients were usually discouraged from having surgery by being told “it’s only cosmetic”.
In the scheme of medical ailments varicose veins alone are not a high priority for most doctors as they rarely kill you… unlike diabetes, heart disease, cancer etc. This however is cold comfort to those patients that suffer from real symptoms with varicose veins but are dismissed by their doctors (as I was!).
In the last 15 years the “Endovenous Era” has given us new understanding of the cause and consequence of varicose veins and fantastic non surgical means of treating them.
Varicose veins develop because of faulty or “leaky” valves causing reflux (blood flowing in the wrong direction towards the feet). When left untreated, serious symptoms can occur including, swelling in the leg, itchy and inflamed skin (venous eczema), discoloration and thickening of the skin (pigmentation and lipodermatosclerosis) and ulceration and blood clots (superficial and deep venous thrombosis). Whilst many patients are bothered by the cosmetic appearance a good number suffer from significant symptoms of ache, pain, itch, discomfort after exercise, restless legs, heavy tired legs and of course embarrassment and limitation of lifestyle.
It is very gratifying to be able to “cure” someone that has been suffering with the consequences of undiagnosed and untreated venous reflux with walk in walk out treatment that at times is completed in under an hour.
In the past even if done perfectly “vein stripping” surgery was associated with around a 50% recurrence rate at 5yrs hence the basis for this belief. Also patients frequently has the wrong vein stripped!
The anterior accessory saphenous vein was mistaken for the great saphenous vein or vice versa and often a major refluxing vein was left behind, no wonder surgery got a bad name!
Because ultrasound was not routinely performed by an appropriately skilled expert, “hidden” refluxing veins seen only with ultrasound were not treated. In addition refluxing perforator veins were usually not treated as this involved an invasive operation.
Fast forward 15 years and my how the world has changed as we are well into the Endovenous Era! The latest endovenous laser methods have almost 100% initial success rates and success rates of 97% at 5yrs. There is really no comparison between modern treatment by a skilled phlebolgist and old fashioned surgical stripping. New technologies such as ClariveinTM and VenasealTM (superglue) will offer patients even more options to have their veins fixed once and for all.
By being able to see these hidden refluxing veins, a skilled phlebologist can eliminate the root cause of reflux and prevent many recurrences. Veins treated with laser or effective sclerotherapy will not return but new disease can occur in previously healthy veins, hence why we recommend yearly surveillance scans following your treatment.
With the ease and success of the new treatments there is need to live with painful or unsightly varicose veins anymore.
Some enthusiasts claim that ambulatory phlebectomy is the best way to treat varicose veins.
Once again scientific evidence to support this view is completely lacking, it too is a hangover from the pre “endovenous era”. Without addressing the underlying refluxing veins this is at best a “band- aid” treatment. At the vein clinic we often see patients who have had prior ambulatory phlebectomy treatments at other clinics with initial good cosmetic results only to find that within a few years new veins have appeared. The reason for this is simple, the underlying cause of the problems was not identified and treated. It is only with skilled venous doppler ultrasound that all reflux sources can be identified and eliminated to prevent recurrence.
Despite some advocates claiming that UGS is as good or better than endovenous laser, the bulk of the medical literature and experience of numerous vein experts does not support this view.
A few vein experts in the UK have reported very good results using specialised techniques but not all centres have been able to replicate these results and local experience would suggest this is not the norm. At the vein clinic we often see patients who have had numerous UGS treatments at other clinics over many years with unsatisfactory results. In some cases patients have reported spending in excess of $10,000 over 15yrs of treatments still to be left with untreated disease.
Numerous studies have show endovenous laser ablation (EVLA) to be a superior treatment to both surgery and UGS, success for EVLA seems to be universally around 97-100% and large variations in results between centres is uncommon (unlike UGS).
UGS works well in the branch vessels and small veins but is generally not a reliable treatment for closure of large refluxing trunk veins (i.e. great and small saphenous veins).
Success of UGS depends on a number of factors being optimal (i.e. correct size vein, correct strength scleroscant, correct foam mixture, accurate placement under ultrasound, perfect compliance with wearing of compression stockings etc.). Good results require commitment to excellent technique and compliant patients.
Once again this is old fashioned thinking coming from the “pre endovenous era”!
The ideal time to get treated is BETWEEN pregnancies.
Varicose veins often become most apparent during the last trimester and with each successive pregnancy tend to get worse. During pregnancy they swell and often cause discomfort. In addition, the risk of venous thrombosis in varicose veins is much higher at the end of a pregnancy and immediately after delivery.
Treatment during pregnancy is not advised but if you are planning a pregnancy, there is definite benefit in treating abnormal veins beforehand to reduce complications such as clotting, inflammation and further worsening of venous dysfunction during pregnancy.