Varicose Veins Modern Minimally Invasive Treatment Options

Understanding Varicose Veins

Varicose veins are enlarged, twisted, and dilated veins that appear just beneath the skin surface, most commonly in the legs. They develop when the one-way valves within the veins become incompetent failing to prevent blood from flowing backwards (reflux). This causes blood to pool in the veins, increasing venous pressure and causing the characteristic bulging, rope-like appearance. Risk factors include prolonged standing, obesity, pregnancy, family history, increasing age, and female sex.

• Affect up to 30% of adults
• Can cause pain, heaviness, swelling, and skin changes
• May lead to venous ulcers if untreated
• Modern treatments are minimally invasive and highly effective
• Day procedures no hospitalisation required

Symptoms and Complications

Many people with varicose veins experience aching, heaviness, throbbing, and fatigue in the affected leg especially after prolonged standing or sitting. Other symptoms include itching around the vein, swelling of the ankle and foot, and skin discolouration. In severe or long-standing cases, complications can develop including superficial thrombophlebitis, deep vein thrombosis (DVT), bleeding from surface varicosities, and venous skin ulcers which are painful, difficult to heal, and significantly impact quality of life.

GLUE Embolisation of Varicose Veins

GLUE embolisation is a minimally invasive technique used to treat varicose veins by sealing the diseased vein using medical adhesive (cyanoacrylate). Under ultrasound guidance, a small catheter is used to deliver the glue directly into the target vein, leading to immediate closure without the need for thermal energy. This technique avoids heat-related nerve injury, eliminates the need for tumescent anesthesia, and allows faster recovery with minimal discomfort. It is a safe and effective alternative to thermal ablation methods, especially in suitable vein anatomy and patient profiles. The choice of treatment depends on clinical evaluation and individual patient needs.

Endovenous Laser Ablation (EVLA)

Endovenous Laser Ablation is the gold standard treatment for great saphenous vein (GSV) incompetence the most common cause of varicose veins. Under ultrasound guidance, a thin laser fibre is inserted into the diseased vein through a needle puncture at the knee or lower leg. Tumescent local anaesthesia is then infiltrated around the vein. The laser fibre is activated and slowly withdrawn, delivering controlled thermal energy that permanently seals the vein. The sealed vein is gradually absorbed by the body. The procedure takes approximately 45–60 minutes and patients can walk immediately after.

• Performed under tumescent local anaesthesia
• No general anaesthesia required
• Walk-in, walk-out procedure
• Return to normal activities within 24–48 hours
• Recurrence rate significantly lower than surgical stripping
• 85–95% success rate at 5 years

Foam Sclerotherapy

Foam sclerotherapy involves the injection of a foamed sclerosant agent (typically sodium tetradecyl sulphate or polidocanol) directly into varicose veins under ultrasound guidance. The foam damages the inner lining of the vein, causing it to scar and close. Foam sclerotherapy is particularly useful for treating residual or recurrent varicosities after thermal ablation, tributaries, and smaller varicose veins not suitable for thermal ablation. Multiple treatment sessions may be required for optimal results. Patients wear compression stockings for 1–2 weeks after treatment.

Which Treatment is Right for You?

The most appropriate treatment depends on the pattern of venous insufficiency identified on duplex ultrasound assessment, the size and distribution of varicosities, the presence of previous treatments, and patient factors such as pregnancy or coagulation disorders. Dr. Shetty performs a thorough colour duplex ultrasound assessment of the venous system before recommending treatment. In many patients, a combination approach for example, EVLA for the main trunk followed by foam sclerotherapy for tributaries achieves the best aesthetic and functional outcome.