Surgery has been the standard approach for treating varicose veins for many years. International guidelines now suggest that non-surgical treatments for varicose veins should be considered as the treatment of choice.
In most cases, surgery involves a cut in the groin to cut and tie the GSV (Greater Saphenous Vein) just below the junction with the Deep Vein (the Femoral Vein) and multiple smaller cuts further down the leg, removing short segments of the GSV.
Surgery is also performed on the Short Saphenous Vein, which runs from the outer ankle to the region behind the knee. Surgery behind the knee can be very demanding, and requires considerable surgical skill in order to obtain good, lasting results.
The risks of nerve damage for surgery to both the GSV and SSV are significant. There are surgical techniques for interrupting perforator veins by either open surgery or endoscopic means which are very dependent on operator skill. There is a recent trend in some centres to undertake surgical removal of minor varicose veins under local anaesthetic called Ambulatory Phlebectomy. Again, in skilled hands, this can be a useful technique.
Recurrence rates, the cost, resultant surgical scars, the need for a general anaesthetic and hospital stay in most cases, has resulted in a trend towards less invasive “user friendly” treatments which can have a more rapid recovery time.
Can varicose veins be treated “conservatively” without the need for surgery, or non-surgical treatments?
The answer is yes; under certain circumstances, wearing compression stockings can be a viable option.
Compression stockings come in 4 grades, with grade 1 offering the least compression to the leg and typically useful as a travel stocking, for long plane trips overseas. Grade 3 and 4 stockings are not used routinely at Fraser Clinic. Their application is more for specialised hospital based clinics dealing with patients with long standing leg swelling called Lymphedema, and for some patients with long standing problems with their deep veins.
At Fraser Clinic, we mainly use grade 2 stockings for patients with varicose and spider veins. These specially manufactured stockings replace the older method of applying elastic bandages in our practice and are much easier for patients to put on and remove. They offer graduated compression, with the weave being most dense around the ankle with typical pressures of 20-30 mm hg, becoming “thinner” as the stocking progresses up the leg.
At Fraser Clinic we find thigh high stockings are most popular with both men and women, having a self adhesive band which holds the stocking up about mid thigh level. Compression stockings need to be fitted to the patient, and come in a variety of sizes. We take circumference measurements around the ankle, below the knee and upper thigh in order to get the best fit for you at the clinic. The perfect stocking is yet to be designed. It is important to make sure that the stocking doesn’t bunch up behind the knee or form creases, as left unattended, these can cause chafing of the skin and blisters.
In addition, patients who have very poor arterial circulation, do not tolerate compression stockings so we are very careful to ensure patients get the correct stockings for the leg shape and general health. There are some patients who, because of poor general health, or deep vein incompetence, are not good candidates for surgical or non-surgical treatments for their veins, and these patients will do better with compression stockings alone.
How do I prevent my veins from becoming worse?
Wearing surgical graduated compression stockings compresses and supports the veins and can delay the onset or progression of established varicose veins. Avoiding prolonged standing occupations may help, as well as regular walking and keeping your weight down to within normal limits. None of these activities, however, will alter the ultimate progression of varicose vein disease, and for definitive long term improvement, treatment must be considered.