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Varicose veins occur when the small valves in the veins of the legs no longer work properly, causing blood to collect in the vein, causing them to become swollen and painful (photo of the file)

Varicose veins are a plague that affects millions of us, with three in ten adults suffering from the condition.

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It occurs when the small valves in the veins of the legs no longer work properly, causing blood to collect in the veins, causing them to swell and become painful. Increased pressure in the veins can also make the skin purple, dry and flaky.

In addition to being ugly, if left untreated, complications can occur such as bleeding when the vein is beaten, chronic venous insufficiency (where blood pressure rises because the valves are not working properly, making blood collected because it is difficult to return to the heart of the legs) and skin ulcers.

Varicose veins occur when the small valves in the veins of the legs no longer work properly, causing blood to collect in the vein, causing them to become swollen and painful (photo of the file)

Varicose veins occur when the small valves in the veins of the legs no longer work properly, causing blood to collect in the vein, causing them to become swollen and painful (photo of the file)

When it comes to treatment, the NHS has a strict assessment system: only people with varicose veins at the top of the scale from one to six (one is mild while six is ​​advanced) are eligible. Many turn to the private sector for treatment.

Here Costas Kyriakides, a vascular surgeon consultant at Barts Health NHS Trust and The Private Clinic in London, and David Lewis, a vascular surgeon consultant at The Royal Gwent Hospital in Newport and Spire Cardiff Hospital, explain the different options – from traditional to high-tech.

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SURGICAL STRIPES

HOW IT WORKS: Ligation and stripping has been the traditional way of treating varicose veins for decades.

Under general anesthesia, two small incisions are made and a flexible wire is inserted into the vein and then pulled out, thereby removing the vein in one section. A compression bandage is worn for up to a week to promote healing and patients are advised to stay out of work for two weeks.

EXPERTISE: Kyriakides says, "About a fifth of surgeons still use this technique, which is suitable for most fit patients. However, there is a 10 percent risk of infection and bleeding and a 5 percent risk of damage to surrounding deeper veins, arteries and nerves. It is also associated with a higher rate of recurrence due to new vein formation or incomplete vein stripping.

"Recovery time is longer than other options and leaves a scar of about 2 inches."

AVAILABILTY: NHS and private.

COST: From £ 3,000.

A possible treatment is endothermic ablation that is minimally invasive and available both on the NHS and in private (file photo)
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A possible treatment is endothermic ablation that is minimally invasive and available both on the NHS and in private (file photo)

A possible treatment is endothermic ablation that is minimally invasive and available both on the NHS and in private (file photo)

ENDOTHERMAL ABLATION OR ENDOVENOUS LASER

HOW IT WORKS: These 20-minute minimally invasive techniques use heat to destroy the varicose vein with high-frequency radio waves or a laser.

In any case, the patient has a local anesthetic before making a small incision above or below the knee. A catheter – a thin tube – is then inserted into the problematic vein and through it radio waves or a laser are used to heat the walls of the vein, causing it to collapse and shut off the blood supply. (The vein eventually withers and is absorbed by the body.) Blood immediately starts flowing through another vein.

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EXPERTISE: Kyriakides says: "In 2013, the National Institute for Health and Care Excellence (Nice) recommended endothermic ablation as a first-line treatment for varicose veins, and it is now considered the gold standard treatment followed by foam sclerotherapy.

"Both options were introduced about 20 years ago and are about 98 percent effective. They are most suitable for patients with straight veins (which are good for 95 percent of varicose veins).

"Because it is a minimally invasive treatment, the risk of bleeding and infection is rare. The 1-2 mm incision does not have to be stitched; self-adhesive strips can be used, leaving only a small scar. Patients may be working the next day, although they may feel stiffness for three days. & # 39;

AVAILABILTY: NHS and private.

COST: From £ 2,000.

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ULTRASOUND GUIDED FOAM CLEROTHERAPY

HOW IT WORKS: This chemically destroys the vein lining, causing it to collapse. Guided by ultrasound, a fine foam is injected directly into the vein, leaving scars on the inside and the walls of the vein sticking together, sealing it off.

The procedure lasts 30 to 60 minutes, and then dressings and compression stockings are worn to reduce lump formation with the vein occluded. The patient can be back to work the same day.

In a Nice study, this was successful in 84 out of 100 cases, which is a lower success rate than other minimally invasive procedures – but it can be repeated.

EXPERTISE: Lewis says: "A form of this treatment has been around for decades. Now foam is used instead of liquid, leading to more predictable results and fewer complications; the vein disappears after six to 12 weeks.

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& # 39; It is used to veins & # 39; clean up & that are not treated by endothermic ablation. However, using too much foam can increase the risk of complications such as headache, visual disturbances and strokes, although I have never had any problems with it.

"There is a 5 to 10 percent risk of" spots ", where the vein that has been destroyed leaves a mark on the skin. This usually fades after three months, but can last up to a year.

"Patients can return to normal activities within 24 hours."

AVAILABILTY: NHS and private.

COST: Between £ 1,000 and £ 3,000.

People can also try untrasound-guided foam sclerotherapy that chemically destroys the vein lining, causing it to collapse (photo of the file)

People can also try untrasound-guided foam sclerotherapy that chemically destroys the vein lining, causing it to collapse (photo of the file)

People can also try untrasound-guided foam sclerotherapy that chemically destroys the vein lining, causing it to collapse (photo of the file)

phlebectomy

HOW IT WORKS: Under general or local anesthesia, a surgical instrument, called a phlebectomy hook, is used to extract the vein into segments. The incisions are closed with glue or paper "sutures".

EXPERTISE: Lewis says: "Although we can treat the main strains of varicose veins with endothermic ablation, many surgeons have multiple phlebectomies for smaller, side branches, because the procedure is demonstrably less technically challenging than some other techniques.

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"A phlebectomy can be fast, depending on how many veins have been removed, but afterwards it can cause more discomfort due to cuts and bruises. Patients must wear compression stockings for around a week and can return to work within a week.

& # 39; As with all treatments, varicose veins may return, although phlebectomies have a success rate of 84 percent. This is better than other cleanup & # 39; techniques & # 39; if more tortuous veins remain after ablation has been used to remove straight. & # 39;

AVAILABILTY: NHS and private.

COST: From £ 1,000.

CLARIVEIN

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HOW IT WORKS: First used in 2009, this is a combination of two techniques known as mechanochemical ablation.

A flexible wire is inserted into the vein under local anesthesia and using ultrasound. The thread then turns very quickly and damages the lining. At the same time, a chemical fluid is introduced into the vein. This destroys the liner, thereby sealing it.

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Other research from the University of Manchester has shown that although women have fewer nights of passion as they get older, they enjoy it more.

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Patients must wear surgical stockings for one to two weeks, but can return to daily life almost immediately.

EXPERTISE: Lewis says: "Another minimally invasive technique that destroys the vein in two ways, some of which claim it is better sealed. It takes less than an hour to treat each leg.

& # 39; Because it uses no heat, there is no risk of damage to other tissue as opposed to endothermic ablation or endovenous laser. A study with 121 patients, published in 2018, showed that it had a success rate of 85 percent. & # 39;

AVAILABILTY: Private only.

COST: From £ 2,000.

VENASEAL

HOW IT WORKS: This 30-minute procedure uses medical grade glue to stick the vein together through a hollow tube called an introducer. The maker says it is painless, with a recovery time of 72 hours, without the risk of thermal injury.

EXPERTISE: Kyriakides says: "This treatment has been widely used for about five years and looks like applying super glue to the veins to close them off. The dead vein and hardened glue are then broken down and absorbed into the body.

"One of the most important benefits is that you only need a small amount of local anesthesia where the catheter enters and not along the length of the vein.

"Published clinical studies showed an initial success rate of 94 to 98 percent six months after treatment.

"It is very effective – although perhaps not so for varicose veins with a large diameter (more than 9 mm) because they may not seal. The costs can be prohibitive. But since no local anesthesia is needed in the thigh, it is more pleasant for some patients compared to, for example, endothermic ablation. & # 39;

AVAILABILTY: Private only.

COST: From £ 3,500.

SONOVEIN

HOW IT WORKS: A hand-held device delivers a high-intensity ultrasound beam directly to the varicose vein below the skin surface, shrinks and closes it.

The maker says it can treat even the most difficult veins, such as those in the ankle where some other treatments can cause damage to the sensory nerves.

It was first performed in the UK this year. It requires no anesthesia and leaves no scars.

EXPERTISE: Lewis says: "This uses high-intensity ultrasound. It sounds good because it is non-invasive, so there is no risk of infection. However, research based on 50 treated legs warned that it is not suitable for veins close to the surface due to the risk of skin burns. And most varicose veins are close to the surface.

"For now, this technology should only be used in large-scale, well-designed, unbiased clinical trials, so that we get high-quality data."

AVAILABILTY: Private only.

COST: From £ 2,100.

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