Treatment Options to Remove Varicose Veins 

There are a number of different Endovenous methods now to remove varicose veins.  Several methods are safe and well established while with other relatively new techniques we are still awaiting the results of longer term trials to report back and determine their safety and efficacy. 

Thermal methods which involve the concomitant use of Tumescent anaesthetic include Laser, Radiofrequency, Steam and Cryotherapy. 

Non-thermal methods which don't involve the use of Tumescent anaesthetic include Sclerotherapy (foam or liquid), Glue and Mechanicochemical ablation.  

Mechanicochemical ablation (Clarivein™) will require the longer term studies to report before its use can be properly established with the same confidence as Endovenous Laser Ablation and Radiofrequency Ablation. 

Traditional Surgery.  Surgery for varicose veins due to incompetence of the saphenofemoral junction involves a groin incision and dissection down to the junction of Great Saphenous Vein and the main deep vein of the leg ( Femoral vein).  After the Great Saphenous Vein is ligated the main trunk of  is then stripped by inserting a wire down through the length of the vein. An "Olive" is attached to the end of the wire and then the wire is forcefully retracted causing the vein to be inverted back through itself as it is "stripped out". Multiple incisions are then used to remove the remaining varicose veins branches which are visible on the skin.  This procedure needs to be performed in a hospital operating theatre with the patient put to sleep with a general anaesthetic.

New experimental methods.

Superglue or cyanoacrylate has an established record for the treatment of certain vascular malformations. Sapheon™ a superglue technique has recently been used for the treatment of varicose veins.  A few studies have now reported looking at the early data but we await the longer term data.  Prof. Alun Davies group at Imperial College London are expected to publish the results of their large Randomised Controlled Trial in 2016.  The reportedly much higher incidence of superfical thrombophlebitis associated with Sapheon™ would seem to be of some concern at this stage.