If you have varicose veins, you may have come across the term “endovenous treatments” while researching your options for treating them. These are modern treatments designed to close or treat faulty veins from the inside, with less disruption to the surrounding tissues than traditional surgery.
For many people, this means treatment with a needle, a fine tube called a catheter, ultrasound guidance, and local anaesthetic rather than a larger operation. Recovery is often quicker, scarring is usually minimal, and normal activities can often be resumed sooner than many people expect.
What does “endovenous” mean?
“Endovenous” simply means “inside the vein”. In endovenous treatment, the surgeon targets the unhealthy vein directly, usually using ultrasound to guide the treatment accurately.
The goal is not to remove every visible vein by open surgery. Instead, the aim is to close the faulty vein so that blood is naturally redirected into healthier veins. Over time, the treated vein is absorbed by the body, and the visible bulging veins often improve as a result.
Why are minimally invasive treatments used for varicose veins?
Varicose veins develop when valves inside the veins stop working properly. Instead of blood flowing efficiently back towards the heart, some of it falls backwards and creates extra pressure in the vein. That pressure can lead to bulging veins, aching, heaviness, itching, and swelling.
Minimally invasive treatments are used because they can deal with the source of the problem in a targeted way. Compared with older open surgical stripping, modern endovenous techniques are generally associated with smaller wounds, less tissue trauma, and a faster return to everyday life.
What are the main types of minimally invasive endovenous treatment?
Endothermal ablation
Endothermal ablation is a group of treatments that use heat to seal the faulty vein from the inside. The two best-known examples are endovenous laser ablation, often shortened to EVLA or EVLT, and radiofrequency ablation, often called RFA.
In these treatments, a catheter is placed into the vein under ultrasound guidance. Heat energy is then delivered through the catheter to shrink and seal the vein wall.
Ultrasound-guided foam sclerotherapy
Ultrasound-guided foam sclerotherapy uses a sclerosant, which is a medicine that irritates the inside lining of the vein so that it closes. The medicine is mixed into a foam, which makes it easier to see on ultrasound and helps it displace blood within the vein during treatment.
At Southwest Veins, we recommend this treatment to many patients because we have seen excellent results with it in everyday practice, including complete treatment along the full length of the long saphenous vein. In our experience, foam sclerotherapy is better tolerated, less painful, quicker and easier to carry out, and more cost-effective than many other treatment options.
Other minimally invasive techniques
Some clinics also use other non-thermal or catheter-based treatments, such as cyanoacrylate vein closure, sometimes called vein glue, or mechanochemical ablation. These methods can be helpful in selected cases, although they are not the treatment that every clinic provides.
Is foam sclerotherapy an endovenous treatment?
Yes, it is. Foam sclerotherapy is an endovenous treatment because the treatment is delivered inside the vein. It is also minimally invasive because it avoids the larger cuts associated with invasive surgery.
There is sometimes confusion because some endovenous treatments are catheter-based and some are not. Catheter-based techniques deliver energy through a catheter, while non-catheter-based techniques inject a sclerosant directly into the vein system being treated. Both are minimally invasive approaches.
Are endovenous treatments suitable for everyone?
Not always. Suitability depends on what the ultrasound scan shows. In some people, the main problem lies in a large truncal vein such as the great saphenous vein. In others, the problem may mainly involve tributary veins, recurrent veins, or more complex anatomy.
This is why a proper duplex ultrasound assessment is so important.
Arrange an assessment
Minimally invasive endovenous treatments are modern ways of treating varicose veins from inside the vein, with less disruption than traditional surgery. At Southwest Veins, we offer foam sclerotherapy for suitable patients. If you’d like to find out more about this approach, you can arrange a free face-to-face or Zoom consultation here.
Jamie Barwell is a Consultant Vascular Surgeon who has treated over 1000 patients with varicose vein problems, using open surgical techniques and, since 2007, foam sclerotherapy. He is a graduate of Guy’s Hospital Medical School and a fellow of Royal College of Surgeons of England.