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Leg vein therapies

Leg veins can be unsightly and may sometimes ache, feel heavy or cause cramps. Varicose veins may increase the risk of gravitational eczema, lipodermatosclerosis (a hardening of the tissues of the lower leg), swelling (lymphoedema) and leg ulceration.

Methods of removing leg veins include:

• Surgery for larger varicose veins
  If these involve the inner thigh (the greater saphenous vein), the vein in the groin should be tied off and the veins stripped out usually under general anaesthetic. Veins in the lower leg can be pulled out under local anaesthetic (ambulatory phlebectomy). The perforator veins that connect the superficial veins with deeper ones are tied off.
• Endovenous laser and radiofrequency occlusion therapy
  These are new techniques to remove large veins without surgery. A small tube is inserted into the vein and energy is delivered inside it to heat up the blood vessel wall so that it collapses and seals shut. This can be done under local anaesthetic.
• Sclerotherapy
  In sclerotherapy, a small amount of a solution such as hypertonic saline, sodium tetradecyl sulphate or polidocanol is injected into the superficial leg veins and perforator vessels. The vein shuts down and disappears over the next few weeks. One to five treatments may be required. Ultrasound guided sclerotherapy is used for larger veins, using a foam solution of sclerosant. Microsclerotherapy uses very fine needles to inject smaller thread veins, when ultrasound guidance is not necessary.
• Vascular lasers and light devices
  There are several vascular lasers and pulsed light devices used for removing thread veins. To date, they are not as effective as microsclerosclerotherapy. However, they may be useful in patients who cannot undergo these procedures.