Could a new ‘superglue’ end the pain?
Could a new ‘superglue’ end the pain?
A new procedure is promising to seal up veins pain free and in minutes. We look at the options available
Varicose veins look unsightly, can ruin your self-confidence and are a problem for between 30-40% of adults.
But it isn’t easy getting treatment on the NHS when many view them as just a cosmetic problem.
And, if you can get treatment, you’re likely to be offered a painful “stripping” procedure.
However, that could be about to change.
New guidelines on their diagnosis and management will be published next month by The National Institute for Health and Care Excellence, NICE,
According to Professor Mark Whiteley, consultant surgeon and clinical ?director of The Whiteley Clinic, they can’t come soon enough.
“Around 70% of all varicose vein surgery carried out in the UK is vein stripping. But I think this should be the last option,” he says.
“It simply isn’t effective. Research has shown the veins grow back in 80% of cases within five years.”
WHAT ARE THEY?
In a healthy vein, blood flows to the heart smoothly and is prevented from flowing backwards by tiny valves that open and close to let blood through.
If the valves weaken or are damaged, the blood can flow backwards and can collect in the vein, causing it to swell and sometimes bulge up.
Varicose veins are most common in the legs as the blood has the biggest struggle against gravity to return to the heart from the bottom the body.
HOW DO YOU KNOW IF YOU HAVE THEM?
“The 15-20% of people who have visible varicose veins are lucky because they can see they have a problem,” says Prof Whiteley.
More worrying are the hidden kind of varicose veins affecting another 15-20% of people.
“The tell-tale signs are legs that ache when you stand but get better when you sit,” he explains.
“But you may also have swelling, a condition called venous eczema that gives you itchy skin and red/brown stains on the lower leg, all caused by blood pooling under the skin. If these are left untreated, they can result in leg ulcers.”
Hidden varicose veins are ?impossible to see, so doctors shouldn’t dismiss symptoms.
A venous duplex ?ultrasound scan is needed to show which valves have failed.
To assess your risk of varicose veins, see www.veinsscreening.co.uk and fill in the questionnaire.
IS THERE ANY WAY TO PREVENT THEM OR REDUCE THEIR SIZE?
No, because they’re ?hereditary and you can’t prevent them. While exercise is good for the vascular system, it doesn’t prevent or help visible or hidden veins, says Prof Whiteley.
“Research also shows that support stockings should not be recommended as a treatment,” he adds.
“While they can improve the symptoms, they have no effect when you take them off.”
No single treatment will help ?everybody.
But the team at Prof Whiteley’s clinic, has come up with a protocol to tailor the treatment to each patient, depending on scan results.
But, Prof Whiteley says, all varicose vein treatments should be done under local anaesthetic as walk-in, walk-out procedures.
The first choice of treatments are “heat” procedures. In well over 90% of patients, the vein is killed under a local anaesthetic so the problem can’t return.
Endovenous Laser Ablation, EVLA, is a set of techniques that uses heat from a laser.
The vein disintegrates so it cannot grow back and blood flow is then naturally redirected through other healthy veins in the leg.
Radiofrequency ablation is another “heat” treatment similar to the laser technique. A thin catheter is inserted into the vein under local anaesthetic. A shot of electricity is used to seal the vein, which will then ?disintegrate.
The latest treatment, called ?Venaseal, involves no heat and only one local anaesthetic injection. A “medical ?superglue” is injected into the vein, which sets, sticking it together and killing it. The glue is then ingested by the body over time.
Foam Sclerotherapy injections are the next tier of treatment options, says Prof Whiteley. This is a technique where a liquid – or foam – is injected into a vein to destroy it.
Vein stripping involves making ?incisions above the groin and near the knee. The vein is tied to seal off the blood supply then a wire “stripper” is passed through the vein to remove it.
This needs to be performed under general anaesthetic, leaves the patient with two scars, is painful and, in most cases, the vein grows back.
CHOOSING A SURGEON
Although NICE guidelines state that heat treatments should be ?recommended for varicose veins, there’s still the issue of funding, training and finding the right surgeon, says Prof Whiteley.
“Vascular surgeons are experts in arteries – not veins,” he explains.
“So, trained vein surgeons are not ?necessarily vascular surgeons working in hospitals.
“The right expert will work at a clinic that has all equipment, as well as Colour Flow Duplex ultrasound to diagnose the problem.
"Questions you should ask are: Has the surgeon been doing laser treatment for at least five years? Is the procedure carried out under local anaesthetic
Cafe manager Louise Stoker, 43, a married mum of two from ?Croydon, London, had the ?Venaseal procedure last June.
My dad had terrible varicose veins and had them stripped twice so, as they’re hereditary, I ?decided to see if I was at risk.
Although I had no visible big veins, I had little spidery ones, a small lump at the back of my right knee and my legs, particularly my right leg, would ache at the end of a busy day.
I had my legs scanned by Professor Whiteley and a dodgy valve was found in a big vein in my right leg.
He explained the new Venaseal ‘superglue’ ?procedure would remove the ?hidden varicose vein and I agreed to have it done.
It was painless, simple and took 25 ?minutes.
I only needed one small local anaesthetic injection where the canula was inserted and I could feel a little tugging as the glue went in but had no discomfort as I watched the whole thing on the ultrasound scan.
I then drove home on the M25!
There was a small amount of bruising ?afterwards, but a follow-up scan ?revealed that the procedure had been a complete success |
