What’s new in varicose veins?

Written by: Mr Philip Coleridge Smith
Published: | Updated: 15/03/2019
Edited by: Cal Murphy

In the last 20 years, vascular surgery has undergone a revolution. Traditional surgical methods have been joined by new minimally invasive techniques. How do heat, foam, and even lasers treat varicose veins? And how effective are they compared to surgery? Expert vascular surgeon Mr Philip Coleridge Smith is here to explain:

Varicose veins are swollen veins that are usually highly visible and may be bulging or twisted in appearance. They usually occur in the legs and can cause aching and discomfort, with the affected leg feeling heavy. Patients may experience muscle cramps and burning or itching sensations as well as swelling in the feet.

Discover the connection between varicose veins and leg ulcers

What is the traditional treatment for varicose veins?

Until recently, the preferred varicose vein treatment has been surgery. Since the beginning of the 20th century, varicose vein surgery has involved removing the diseased veins completely (a process known as “varicose vein stripping”). The patient is put under general anaesthesia during the procedure. Full recovery from the surgery typically takes around a month, and the long-term results are generally good. However, there is usually significant post-operative pain.

Learn more about varicose vein surgery here

What are the new options for varicose vein treatments?

Over the last couple of decades, several new varicose vein treatments have been introduced. They are all minimally invasive techniques (they don’t require open surgery), and can be performed under local anaesthetic, rather than putting the patient to sleep. The main methods include:

  • Thermal ablation – heat is used to destroy the vein inside the body. The vein is anaesthetised and a tube is passed through a section of 20-50 cm. The tube is equipped with either a laser fibre optic, a device to deliver superheated steam, or an electrically-heated catheter, all of which provide the heat necessary to destroy the vein.
  • Ultrasound guided foam sclerotherapy – foam is injected into the diseased saphenous veins and associated varices. Ultrasound is used to guide the surgeon.
  • Mechanico-chemical ablation – a recent technique, which treats the veins with a rotating catheter system and cyanoacrylate glue.

All of these treatments are similarly effective, yielding results comparable to traditional surgical techniques. However, they carry two distinct advantages:

  • Most patients experience less post-operative pain.
  • The recovery period is much shorter, with the majority of patients returning to work within 1-3 days, rather than after several weeks.

So, are these modern techniques better? Guidelines from the National Institute for Health and Care Excellence (NICE) seem to indicate that this is the case. NICE Clinical Guideline 168 (July 2013) recommended thermal ablation methods as the first line of treatment, with ultrasound-guided foam sclerotherapy advised where the former isn’t possible. If it is not feasible to perform any of the modern techniques, conventional varicose veins surgery is recommended. This all seems to support the idea that all methods, including surgery, are acceptable treatments, but the newer techniques that allow faster recovery are emphasised.

Find out more about varicose vein treatment

Visit Mr Coleridge Smith's Top Doctors profile to learn more or book an appointment!

By Mr Philip Coleridge Smith
Vascular surgery

Mr Philip Coleridge Smith is one of London's leading vascular surgeons. Operating at the British Vein Institute, he is an expert in the treatment of varicose veins, and also specialises in venous insufficiency, venous ulcer, thrombosis, spider veins, as well as deep vein thrombosis

Mr Coleridge Smith, who successfully completed an FRCS at Oxford University and St Thomas’ Hospital London Medical Schools, currently lectures at University College London, and has also previously been the editor of the medical journals, ‘Phlebology’ and ‘The European Journal of Vascular and Endovascular Surgery’. He is president of the British Association of Sclerotherapists, and is acknowledged as an international authority and expert in venous disease, including the management of vein problems using ultrasound-guided sclerotherapy and other modern methods of vein ablation.

Throughout his illustrious medical career to-date, he has treated several thousand patients using various different injection techniques, and has published extensively in established peer-reviewed medical journals. Impressively, he has gained more than 40 years worth of experience as a vascular surgeon. 

View Profile

Overall assessment of their patients

  • Related procedures
  • Cryo-sclerotherapy
    Botulinum toxin (Botox™)
    Vascular disease
    Surgery and vascular testing
    Pathology of the carotid arteries
    Acute limb ischaemia
    This website uses our own and third-party Cookies to compile information with the aim of improving our services, to show you advertising related to your preferences as well analysing your browsing habits. You can change your settings HERE.