Sclerotherapy is the gold standard used for the treatment of spider and varicose veins. Sclerotherapy is an ultrasound-guided procedure that involves cannulating the vein and injecting a sclerosant as liquid or foam (for example, sodium tetradecyl sulfate) or a glue (for example, cyanoacrylate adhesive). The sclerosant leads to occlusion of the vein wall, causing blood to be transported to other, healthier veins. The collapsed vein should be reabsorbed into local tissue and fade over time.
This ambulatory and short procedure does not require anesthesia and patients are able to walk around soon afterwards. Post-procedure leg movement is important to prevent formation of blood clots. In addition, patients are usually advised to wear compression stockings or bandages for a certain duration. Depending on the size and location of veins, several sclerotherapy treatments may be required.
Phlebectomy is a minimally invasive ambulatory procedure used to remove superficial varicose veins under local anesthesia. First, several small punctures or incisions are made in the skin close to the respective varicose vein by using a scalpel or needle. A phlebectomy hook is then inserted to remove the varicose vein through the tiny incision.
The duration of this procedure is relatively short – between 30 minutes to one hour. Patients are able to perform daily activities soon after the phlebectomy, but they are advised to refrain from aerobic exercise and to wear compression garments for at least two weeks.
Endothermal laser ablation and endothermal radiofrequency ablation are endovascular techniques that use an energy source (laser or radio waves) to generate thermal energy in order to damage and contract the venous wall, thereby closing the respective varicose vein.
Blood supply is redirected to healthier veins and the sealed vein is eventually reabsorbed by local tissue. Both methods are less invasive than conventional surgery and take approximately 30 minutes to one hour. Patients are able to walk around soon after treatment, with reduced pain, faster recovery and similar cosmetic results in comparison to conventional vein surgery.
Vein stripping is a surgical procedure performed under general anesthesia or local anesthetic to remove a refluxing deep vein. First, very small incisions are made (usually in the groin and medial thigh), then a thin, flexible plastic wire is inserted into the vein through the upper incision and guided through the vein toward the other incision farther down the leg. The vein is attached to the wire and then pulled, or “stripped” out, from the body.
Finally, incisions are stitched and pressure dressings are applied. In some cases, an overnight hospital stay is required. Compression garments or bandages are recommended for a certain duration after the procedure. The recovery phase usually takes two to four weeks during which patients are advised to avoid heavy physical exercise.