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Help! All these treatments!
Which
is is the one for me?
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Finding the right treatment.
The first thing is to seek the advice of a specialist in vein treatments. He will usually examine your legs clinically and undertake
colour duplex ultrasound examination.
In patients with thread veins and little blue veins on the surface of the leg, injection treatment is probably the best solution.
When there are big veins on the surface of the leg which stick out when you stand up, surgical treatment or one of the newer varicose vein treatments is required.
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Thread
veins

These are little pink veins in the skin which often come with small blue veins beneath.
The best thing for this type of veins is injection treatment (sclerotherapy) aimed at the thread veins.
This type of vein is sometimes treated by lasers, but this does not work as well as injections and is also more painful.
Creams and other preparations rubbed on the skin make no difference to this type of vein.
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Varicose
Veins

Large varicose veins of this type have traditionally been treated by surgery. More recently, a number of new methods have been described
Surgery
This treatment is done in hospital, usually under a general anaesthetic. When you wake up, the veins are gone! Afterwards the legs are usually bruised and uncomfortable. This takes 2 – 6 weeks to resolve. Modern
surgery for varicose veins
is done through small incisions so only very small scars remain, and these fade with time. It is usually necessary to be off work for 1 – 2 weeks after an operation for varicose veins.
Medical insurance companies usually cover this type of treatment if it is done for varicose veins causing symptoms.
This treatment is most appropriate for large, extensive varicose veins but can be used in any type of varicose veins.
Vein ablation techniques – radiofrequency ablation or laser ablation
This treatment is done in hospital and can be performed under local or general anaesthesia. A fine catheter is inserted into the main surface vein through a needle. The vein is then heated to destroy it. Afterwards any varicose veins are removed through small incisions made in the leg, in the same way as would be done during surgical treatment.
After the treatment is complete there is still a little bruising but far less than after surgery. The treated leg is much more comfortable and normal activities can be resumed within a day or two.
Medical insurance companies usually cover this type of treatment if it is done for varicose veins causing symptoms.
Vein
ablation is most appropriate for both large, extensive varicose veins as well as more modest varices.
Ultrasound guided foam sclerotherapy
This treatment can be done in the clinic and requires no anaesthesia since it causes only minor discomfort. Injections of foam are made under the guidance of an ultrasound machine which shows the location of the main varicose veins. At the end of the treatment, a firm bandage is applied to the leg. No time off work is required and most activities can be resumed immediately. After the completion of treatment, some lumps and bruising remain and these can take several months to disappear.
Medical insurance companies usually cover this type of treatment if it is done for varicose veins causing symptoms.
Foam
sclerotherapy is most appropriate for all types of varicose veins but is best for small or modest varicose veins. It is especially useful in people who have previously had varicose vein surgery or who have medical reasons for avoiding any treatment under general anaesthetic.
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Help!
I have big varicose veins AND thread veins!
In
this case it is best to treat the big
varicose veins first using one of the
techniques described above. Large varicose
veins encourage thread veins to develop.
Afterwards, the thread veins can be managed
by injection treatment.
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Hand
Veins

Many
people have prominent hand veins, but this
is normal. These become more obvious with
age and some people find them unsightly.
They may be removed by foam sclerotherapy or
surgical treatment. These treatments are
discussed in more detail in: www.veins-on-hands.com.
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Mr
Philip Coleridge Smith DM FRCS
Reader in Surgery, UCL Medical School, London .
Consultant Vascular Surgeon – BVI Medical
Director
The West London Vein Clinic: 0800 7836106
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