The ancient Egyptians referred to them as “serpentine windings”, and the origin of the word varicose comes from the Greek word for “grape-like”. Varicose or spider veins have been around for a long time and, despite the poetic descriptions of the ancients, there’s nothing glamorous about them – it’s no wonder sufferers are eager to undergo the latest treatments to erase their issues. Here we take a look at some key vein problems and explore the best treatments on offer.
Historically, vein treatments have been particularly brutal. In ancient Greece, Hippocrates used a method involving puncturing the vein multiple times then applying a compress soaked in oil and wine. In ancient Rome, physicians used techniques such as severing the connections of arteries to veins, making multiple incisions, then cauterising and extracting and dividing the veins. Roman surgeons would occasionally use hooks for this purpose. Taking into consideration the fact that anaesthesia wasn’t an option until the 19th century, “barbaric” is the only way to describe these methods.
Thankfully, modern procedures have now progressed to the stage where patients can feel little or no pain, and treatment can be a quick in and out of the surgery. Dr Cheng from the Pacific Vein & Endovascular Centre (PVEC) highlights some recent developments.
“The biggest advances are in treating varicose veins without making surgical incisions and pulling diseased veins out. All new methods involve introducing treatment devices up the diseased veins via small punctures without the need for general anaesthesia. These devices can be based on heat energy such as laser or radiofrequency (RF), or on injecting medications like the new Clarivein device.”
Given its long history, injection sclerotherapy remains the “workhorse” treatment for spider veins, says Dr Cheng. “Newer methods like laser ablation or RF ablation have the advantage of being able to treat very fine veins, but the costs are higher too.”
With all these methods, patients can go back to work on the same day of the treatment, if they so wish. There is a certain amount of bruising, which can take up to two weeks to subside.
“What has essentially revolutionised varicose vein treatment in the past decade is the use of ultrasound as a guide, and the development of a technique of treating the diseased vein via a small puncture, using different devices,” notes Dr Cheng.
But, he warns, with this proliferation of medical techniques comes the weight of greater responsibility. “Devices are coming out at a bewildering rate, and I do believe the surgeon has to assess the evidence for new treatment methods; ‘new’ does not necessarily mean better or more suitable.”
Case study: Varicose veins
Australian expat Heidi Martin recently underwent Endovenous Closure Treatment (EVT) with Radio Frequency (RF), carried out by Dr Tan at The Vein Clinic & Surgery.
“When I was younger, my mother had a large bulging varicose vein behind one knee, and I remember pressing it and thinking how ugly it looked. I have four children, including three pregnancies here in Singapore, and my veins were in an awful state. I ended up with a varicose vein in exactly the same place as my mother’s and my children thought and did the same as I had done!
I didn’t want to spend the rest of my life feeling this way, and a close friend had recommended The Vein Clinic & Surgery. The whole service and procedure was excellent. I was scared, but if I had known how easy and pain-free the procedure would be, I would have had it done much earlier.
I was put under light sedation before the treatment and I can honestly say I felt no pain. I had to count to 100, but I only made it to five before I was asleep, then I woke up in no pain and walked out of the day surgery less than an hour later. I have no sign of any more veins appearing, so I’m hopeful I won’t be going back. I just wish going to the dentist was this easy and painless!”
The remedy: EVT
The EVT procedure is a minimally invasive treatment with less pain and less bruising than traditional vein-stripping surgery and laser treatment. With the Closure system, a catheter is inserted into the diseased vein to heat the vein wall using temperature-controlled RF energy. This heating causes collagen in the wall to shrink and the vein to close. After the vein has been sealed shut, blood then naturally reroutes to healthy veins.
Case study: Spider veins
Dr Imran Nawaz from the Singapore Vein Centre (SVC) recently treated a female patient for spider veins on her thighs. Here is her feedback.
“The spider veins on my thighs had been developing for the past several years. I sought out treatment purely for aesthetic reasons, since in Singapore I wear shorts and summer dresses above the knees a lot more due to the hot climate, so I’m much more conscious of my legs.
I chose the SVC having seen an advertisement in Expat Living. I then Googled the centre to find out more information. Following the initial consultation, which included an ultrasound of my legs, I had one session of injection sclerotherapy; the injected substance closes down your vein walls. After this I had to wear compression stockings for a few weeks. That was the hard part – in the constant heat and humidity, my legs were incredibly itchy all the time under the stockings, and it was much more bearable if I stayed in air-conditioning. My legs also felt quite bruised for a while.
A few months after the injections, I had transcutaneous laser treatment on the remaining veins. For a couple of weeks, I had some visible damage from the laser, and I had to keep my legs out of the sun after both procedures to minimise long-term scarring. But I now have no scarring at all. The procedure with the needles hurt and the laser also hurt, but the pain was all worthwhile, as my legs are now vein-free.”
The remedies: Injection sclerotherapy and transcutaneous laser treatment
Injection sclerotherapy has been the mainstay of the treatment of spider and reticular veins. About 60 to 70 percent of these veins will disappear after one injection session, but often multiple sessions (usually two to three) may be needed to clear these veins satisfactorily.
Transcutaneous laser treatment treats all spider veins and reticular veins very effectively, with no anaesthesia required. Like sclerotherapy, multiple treatment sessions may be needed to achieve satisfactory results.
Clarivein for varicose veins
Dr Sujit Gill from the Vascular & General Surgery Centre explains the intricacies of one of the latest varicose veins treatments.
“Clarivein is a step up from previous techniques such as those using thermal ablation. This procedure is non-thermal mechanical chemical ablation, using a combination of drugs and a little device that irritates the lining of the vein. This causes spasms, and the drug causes damage to the vein so it goes down.
With this mechanical and chemical technique, there is no risk and no pain; you don’t even need injections. It’s something that can be done in the office after applying a local anaesthetic. When the device starts, the patient may feel a little tickle and maybe a pull, but no after-care is needed. All in all, this is a lot more comfortable for the patient.”
Deep vein thrombosis (DVT)
Rather than merely looking un-aesthetic, this vein condition can be life-threatening. DVT is a serious condition that involves the veins in the body clotting up. It can happen after a prolonged period of immobility; other risk factors include oral contraception and orthopaedic operations on the legs.
The condition can be fatal if a clot moves to the patient’s lungs – especially if the clot is big. Patients normally present with a swollen and painful leg, and are treated with medications to thin out the blood. For large clots, however, PVEC’s Dr Cheng recommends removing the vein using special devices that suck up the clot, rather than making a big cut.
Need more information?
Pacific Vein & Endovascular Centre
A member of Pacific Healthcare
290 Orchard Road #19-01
6238 2966 | pacificvein.com.sg
The Singapore Vein Centre
One Orchard Boulevard
#11-03/04 Camden Medical Centre
6733 0377 | svc.sg
Vascular & General Surgery Centre
190 Orchard Road
#18-05 Paragon Medical Suites
6736 2302 | tvgsc.sg
The Vein Clinic & Surgery
290 Orchard Road
6245 6666 | theveinclinic.com.sg