Varicose veins: what are my options?

Written by: Mr Paul Moxey
Published: | Updated: 07/01/2021
Edited by: Cal Murphy

Varicose veins are an unsightly and sometimes painful problem. How can we be rid of these swollen, lumpy veins? Consultant vascular surgeon, Mr Paul Moxey has the answers.



Varicose veins treatment strategy

Varicose vein surgery consists of three key steps:


  • An ultrasound scan to diagnose the underlying pathology
  • Treatment of truncal reflux in the saphenous veins (if detected).
  • Removal of the unsightly and often painful veins that are visible on the surface of the skin


In many cases, simply treating the truncal reflux will be sufficient to lower the pressure within the varicose veins, reducing swelling and discomfort.


Phlebectomy and sclerotherapy procedures to remove the visible varicose veins help to achieve a pleasing cosmetic result.


Thermal techniques

Thermal techniques involve passing endovenous laser or radiofrequency fibres through the saphenous veins to ablate the truncal veins. There is substantial medium-term follow-up data that indicate that these techniques are safe, effective, and deliver good patient satisfaction.


The surrounding tissues must be protected from the heating process and this is achieved by creating a “tumescence blanket”. This is basically cold water and local anaesthetic, delivered by a number of injections. However, the down side is that this can be uncomfortable.


Non-thermal techniques

There are new, modern procedures that do not use heat. This means that the “blanket” of cold water is not necessary and the truncal vein can be ablated by a single injection.


ClariVein® delivers a liquid sclerosant using a spinning catheter to “rough up” the lining of the vein. This makes the treatment more effective. VenaSeal™, on the other hand, is a glue that seals the vein off. Both of these treatments seem encouraging in the short term, but there is no long-term data – only time will tell how they compare to thermal techniques in the long run.


A tailored approach to varicose vein treatment

In all of the above techniques, the surface veins may need to be removed first. This is done either by phlebectomy (small incisions to avulse the vein) or sclerotherapy (injecting liquid or foam sclerosant).


The techniques chosen vary case by case, as each patient is different. By tailoring treatment to each individual case, combining clinical assessment, ultrasound mapping, and selecting the most suitable options from the range of available procedures, an expert vascular surgeon can deliver high-quality varicose vein treatment with great results.


Visit Mr Moxey’s Top Doctors profile to book an appointment.

By Mr Paul Moxey
Vascular surgery

Mr Paul Moxey is a consultant vascular surgeon specialising in varicose veins, spider veins (thread veins) and aortic aneurysms alongside peripheral arterial disease, carotid artery disease and leg ulcers. He has an NHS practice based at the prestigious St George's Hospital, London, where he is the clinical lead for major lower limb amputation, and Kingston Hospital in Surrey. He also privately practices at New Victoria Hospital and Spire St Anthony's Hospital. 

He is also experienced in endovascular surgery procedures and diabetic foot problems. Mr Moxey has a strong interest in teaching and was appointed as an honorary senior lecturer at St George's, University of London in 2018, teaching undergraduates and postgraduates.  In June 2019 he was elected to the Council of the British Society of Endovascular Therapy.

Mr Moxey completed his medical training at Imperial College London in 2002 and went on to higher surgical training across the south-east Thames region, gaining his Certificate of Completion of Training in General and Vascular Surgery in 2017. He was awarded a fellowship in the last two years of training where Mr Moxey gained expertise in keyhole angioplasty techniques to restore blood flow to the lower limbs. Mr Moxey has published widely on this subject of lower limb revascularisation and limb salvage, and remains active in research within this field.

Further to this, he completed a Masters in Surgical Education (MEd) from Imperial College in 2015.

Wherever possible, Mr Moxey uses minimally-invasive techniques to treat vascular disease and problems, frequently using angioplasty, endovenous laser, radiofrequency ablation and sclerotherapy. He also specialises in hybrid techniques that combine keyhole techniques with open surgery to restore blood flow.

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