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In 2013, The National Institute for Health and Care Excellence - NICE- published clinical guideline CG168 and stated that patients with varicose veins should be referred to a vascular service - a team of healthcare professionals who have the skills to undertake a full clinical and duplex ultrasound assessment and who can provide the full range of treatment options. NICE recommends that endothermal ablation should be the first option, ultrasound guided foam sclerotherapy the second option and that surgery is now the last resort. During endothermal ablation, the veins affected by reflux are treated from the inside with heat energy. I perform this under local anaesthetic under ultrasound guidance. With an ultrasound probe on the skin, the unhealthy vein is located and the skin overlying the vein is numbed with local anaesthetic and then a small needle is inserted into this vein. Through the needle a fine catheter is inserted into the vein and advanced along the vein under the skin and positioned accurately to the site where the superficial vein joins the deep vein, confirmed by ultrasound. The vein is then numbed with a series of local anaesthetic injections, again, guided by ultrasound. Thereafter, the vein is heated from the inside - hence the term endothermal ablation - to a temperature at which the vein is closed and cauterised and the cells of the vein are sterilised. Thereafter, thvein cannot recover, re-open or re-join with the deep veins and the superficial venous reflux is effectively cured. After endothermal ablation the varicose veins disperse, varicose eczema or leg ulceration can heal, and any associated spider veins will also disperse. Large varicose veins can be extracted at the same time, a procedure called Phlebectomy. Ultrasound Guided Foam Sclerotherapy is appropriate for those people who are not suitable for various reasons for endothermal ablation. Usually, they are not suitable because the vein is tortuous, or there is some other feature on the ultrasound that means that endothermal ablation cannot be performed. Ultrasound Guided Foam Sclerotherapy involves the injection of a prescription medicine called a sclerosant into the vein guided by ultrasound. The sclerosant is prepared and transformed into foam. When injected, the foam sclerosant removes the delicate lining of the vein, called the endothelium and the veins close, over the following weeks.
The results of endothermal ablation, ultrasound guided foam sclerotherapy and phlebectomy at my clinic are excellent. My clinic complies with NICE Clinical Guideline CG168 and it meets the NICE Quality Standard QS67.
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