In the last 15 years, traditional invasive surgeries like the open stripping of varicose veins have been replaced with non-invasive, needle-based procedures that don’t require any incisions or general anaesthetics, and can be easily performed in the clinic. Here, Dr John Tan, general and vascular surgeon, shares his top picks for minimally invasive varicose vein treatment options.
Endovenous laser therapy (EVLT)
A one-time outpatient procedure under local anaesthesia, EVLT involves inserting a fibre optic wire into the vein to deliver heat, thus shrinking the varicose veins. According to Dr Tan, this is the best treatment for varicose veins as it eliminates all the veins without any surgery, general anaesthesia or hospitalisation, and the patient can walk immediately after the procedure. There are no visible scars once the needle marks have healed.
Available since early 2015, this non-heat-based treatment promises less post-procedural bruising and virtually no chance of nerve injury. According to Dr Tan, this non-surgical method quickly and effectively closes varicose veins by coating and sealing them with a medical “superglue” that’s introduced through a tiny catheter. Once the diseased vein is sealed, blood is redirected through other healthy veins in the leg.
Ultrasound-guided foam sclerotherapy
During this non-surgical, minimally invasive procedure, a strong chemical in the form of foam is injected into varicose veins to close and ultimately eliminate the veins. It uses the same chemical as liquid injection sclerotherapy (used for spider veins) but, in the foamy state, the chemical does not get diluted by the blood and is able to stay in the vein longer. This makes it far more effective in closing the veins, explains Dr Tan.
“The use of ultrasound imaging helps treat those deep veins not visible to the naked eye, and guides the needle into the vein for better accuracy, says Dr Tan. “As the fine needle is not much bigger than an acupuncture needle, there is no pain and therefore no anaesthesia is required.”
He adds that the procedure is often the preferred choice for treating remnant veins left behind after a successful endovenous ablation. It’s also used in cases of recurrence, where varicose veins are tortuous and not remedied by endovenous ablation techniques.
While ultrasound-guided foam sclerotherapy is attractive because it’s more affordable and non-invasive, the downside, says Dr Tan, is that it requires many treatment sessions and it has a very high recurrence rate.
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