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Venous disease. What are varicose veins? Main treatments for varicose vein removal

Patología venosa. ¿Qué son las varices?

Main treatments for varicose vein removal

Currently there are numerous treatments to remove varicose veins and spider veins: conventional surgery, endolaser, radiofrequency, CHIVA method. They all have their indications and most of them still require an operating theatre. Currently the less aggressive, less disabling treatment and which has the broadest indications is a ultrasound guided sclerotherapy with polidocanol foam (ESPF).

Ultrasound guided foam sclerotherapy treatment of varicose veins is the least invasive treatment so far described as it can be done in a medical office, completely ambulatory, and without surgery.
For more information, the following sections describe in detail the main treatments for removing varicose veins:

Conventional surgery: varicose vein removal

It is known as conventional because the surgical removal of varicose veins is the most common treatment among most vascular surgeons and is the method that has been going on the longest. The surgery for varicose vein is based on the removal of all visible varicose veins as well as the removal of the internal or external saphenous vein. The veins and small saphenous veins are located on the surface of the leg and are usually the source of most varicose veins. The varicose vein operation is becoming increasingly obsolete, for both its radical approach and because less invasive techniques provide equally good results but are less aggressive.

Types of anaesthesia. Spinal or intradural: through a small injection in the spinal column, anaesthesia is achieved. This helps the surgeon to work comfortably and the patient will avoid the hassles of the repeated jabs needed in local anaesthesia.
Beginning of surgery. If ambulation (starting to walk) is early (2 to 3 hours after surgery), a postoperative period should follow (7 to 15 days) during which a series of medical advice must be followed which will be explained further on. Incorporation into working life is estimated at between 10 to 20 days.
Disadvantages. It is an aggressive surgery as many veins are removed, some of which may have an important role in the future. Although the short-term outcome is excellent, sometimes, if the patient has a relapse (the flowering of new varices) the treatment is difficult and must be radical.

The hemodynamic strategy or CHIVA technique

This procedure is based on the knowledge that is given by a Doppler study, a painless diagnostic test that shows the functioning of the circulatory system.
Through this exploration, which shows venous function in real time, we can plan a less aggressive, more conservative therapeutic strategy which favours an earlier return to normal life.
Before the operation, the venous system is mapped and the approach points are marked.
The main objective is to keep the saphenous vein permeable and / or external to ensure correct venous drainage.
Types of anaesthesia. Local with or without sedation. This consists of making different puncture points with a fine gauge needle where the local anaesthesia is introduced into the marked areas. Recently the tumescence anaesthesia procedure which prevents repeated punctures has been introduced. Optimally this anaesthesia is complemented with sedation thus making the patient very comfortable.
Starting physical activity. Immediate. It is considered part of treatment to start walking immediately after the intervention. The incorporation into working life depends on each case and the extent of the small injection sites. Incorporation can take place from the first day or up to 10 to 15 days.
Disadvantages. Sometimes, it is considered appropriate to perform the treatment in two stages. The philosophy of the treatment requires frequent monitoring: at least once a year.

Endoluminal treatments: endolaser and radiofrequency.

These treatments are based on sclerosis or fibrosis inside the internal or external saphenous vein by applying an endoluminal occlusion system within the vessel wall.
Both endolaser and radiofrequency seek to avoid the wrenching of the saphenous vein and act upon vein catheterization:the insertion of a catheter inside the vein. Energy in the form of heat is then released causing the thrombosis of the hematic content and then the subsequent retraction of the walls. Finally, the walls collapse and become fibrous.
This procedure is equivalent to conventional therapy although it avoids the aggressive avulsion of the saphenous vein and thereby avoids certain injuries.

Types of anaesthesia. It can be done with tumescent local anaesthesia and sedation or spinal anaesthesia.

Starting physical activity. It can be very early. The incorporation into working life depends on each individual case as well as the extent of the small injection sites. Incorporation can occur in some cases from the first day or up 10 to 15 days.
Disadvantages. Not all patients are suitable for this treatment. It is necessary to meet a number of requirements to be candidate for endolaser or radiofrequency therapy. Given that it is necessary to introduce a catheter into the vein not all patients have veins that will allow it.
The removal of accompanying venous bundles should be added to the ablation procedure of the saphenous vein, which are partially minimally invasive techniques.


The varicose veins disappear by repeated injections in which an irritating and sclerosing agent is introduced. The foam used has significant limitations such as volume and concentration that can be used.

Sclerosis is a well-known technique and has long history as a procedure. The introduction of foam in this technique has represented a major breakthrough in results. The foam multiplies the irritating effect of the injected product, which favours a more rapid and effective occlusion by the spasming of the treated vein. This procedure is very useful in the treatment of varicose veins relapses. Find more detailed information about this nonsurgical treatment for varicose veins in the sclerotherapy section.
Type of anaesthesia. Anaesthesia is not necessary since injections are made with a very fine gauge needle.
Starting physical activity. This technique does not require stopping day activities or normal living habits. Swimming at the beach or in the pool in the days after the treatment, however, is not recommended.
Disadvantages. The foam manufactured in the Tessari method has some limitations in volume and concentration. While it is a very safe technique, there have been complications related to air embolism (the injected gas can pass into arterial circulation and cause embolisms). This is extremely rare, but it exists. It has specific indications and it is necessary to plan a continuous treatment.
To treat varicose veins, or telangiectasia (spiders veins) the most effective treatments are traditional sclerotherapy associated with percutaneous laser.

Aesthetic sclerosis

Aesthetic sclerosis consists in disguising or making the small venules, spider veins or telangiectasias disappear by an unaggressive method. It is based on performing injections inside veinsso that the sclerosing material produces an intraluminal inflammatory reaction (within the vein) thereby achieving that the circulating blood clots or thromboses. The result sought is the collapse of the capillary walls and thus disguising gradually the small venules and spider veins.

The results vary depending on the type of vessels to be treated, the region, the skin type of the patient, pigmentation and individual sensitivity. Therefore, and as with almost all medical procedures it is impossible to guarantee the result and a total absence of side effects.
A recent addition is the percutaneous laser, whose best indications are in the application of the finest leg veins (those which cannot be injected given their small diameter) and the residual veins that have not completely disappeared followed classic sclerotherapy.
The effect of the laser is the heating and thrombosing inside the vein. This treatment can treat vessels of a very small calibre, those which are impossible to inject. It is also necessary to have repeated sessions so as to get the desired result.
Experience has shown that the best results are obtained by combining these two procedures: sclerotherapy and percutaneous laser.

Sclerotherapyis a technique suitable for the elimination of all forms of varicose veins.

Jeringuillas para la espuma esclerosante
Syringes for applying sclerosing foam
Aplicación del tratamiento de las varices con escleroterapia con espuma de polidocanol que no necesita cirugía alguna, bastan unas simples punciones
Ultrasound guided foam sclerotherapy
Radiofrecuencia y espuma esclerosante, tratamiento real a un paciente con varices
Radiofrequency treatment video
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