Varicose veins affect 30 % of the population and are a common cause of aching and discomfort in the legs. The cause is valve failure in the veins of the legs which creates ‘reflux’ or flow of blood down the leg rather than upwards. Surgery to correct this defect has hitherto centred on removing the damaged vein by stripping it out of the leg.
Treatment for veins has been revolutionised over the last decade by minimally invasive techniques such as the EVLT laser – this means that patients with varicose veins can be successfully treated by a ‘walk in / walk out’ procedure under local anaesthesia with rapid recovery times. The aim of treatment is to seal the vein closed inside the leg, rather than physically removing it.
Laser treatment of veins works brilliantly, with the only slight problem being that the patient has to have some injections of anaesthetic in the leg – this is because the minimally invasive methods such as lasering, all use heat to close the vein.
Some patients find injections quite uncomfortable and indeed, a small number of patients are completely needle phobic and need to be put to sleep at the mere mention of the word ‘injection’!
So the next frontier for the treatment of varicose veins is to eliminate the need to inject anaesthetic into the leg at all, and render the procedure as close to painless as possible.
There are a number of interesting techniques available – the leading candidates being Clarivein and the Sapheon Glue system. Both of these methods attempt to close the leaking vein by not using heat – the Clarivein system uses a combination of a chemical drug and a mechanical rotator and the Sapheon system a type of ‘medical superglue’ to stick the vein walls together.
With every new technique a prolonged period of evaluation is needed to test the results. As the first surgeon to use the Clarivein method in the UK back in 2010, I have had an opportunity to evaluate the technique and observe the results of treatment over several years of follow up in over 200 patients.
There is no doubt that Clarivein can work fantastically well to eliminate major varicose veins – we have had some stunningly good results with it. Doing the operation is virtually painless for patients and it is also very quick to perform. As the technique does not use heat to close the vein, there is no risk of inadvertently damaging sensory nerves next to the vein, which can sometimes happen with other heat based procedures.
On the other hand, there are a few downsides. We have noticed in our experience that the recurrence rate of the veins after treatment is higher than for Laser techniques. This appears particularly so in very large veins or in very large legs. The reasons for this are being debated at the moment – it probably relates to the degree to which the technique damages the vein wall – laser techniques do that very efficiently and reliably. Non heat based methods appear to be less consistent.
This is the reason why new medical devices take a long time to evaluate – we need to be sure that initial beneficial effects are durable and that recurrence rates are sufficiently low to recommend the technique. My own view (at the moment) is that Clarivein is a good option in selected patients with smaller veins, but that the laser is more predictable for larger veins.
At the moment, because Clarivein is still being assessed and trialled against other established techniques, most medical insurance companies in the UK are not prepared to approve it for use and it is not widely available on the NHS. Costs for private treatment in non-insured patients vary from about £2,500 to £3,000.
We are now looking at the Sapheon system where a ‘medical superglue’ is used to seal leaking veins – once again, the initial results look very promising, but we won’t know for sure for some time yet!