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How we treat Varicose veins at the Cosmex Vein Clinic Cambridge
The basic premise at Cosmex is that we treat patients how we would want to be treated ourselves and we have naturally extended this approach to our vascular service through the Cosmex Vein Clinic. We will take the time to explain to you what we are doing and why and ensure your treatment is completed swiftly, effectively and with minimal discomfort.
Cosmex Clinic has grown into a successful leading clinic through word of mouth, and we fully intend to continue in the same vein. All people in the clinic involved in delivering your vascular treatments from the Consultant Vascular Surgeon to the Vascular Scientist and Nurses, are experienced vascular surgery professionals.
Prior to your consultation you will also be provided with detailed information about what to expect and recommendations for preparation and post operative care.
This will be part of an online pack of information including questions about your current health and medical history. These can all be completed in the comfort of your own home prior to attending your consultation. This gives you time to think of any questions you have regarding the procedure and likely results.
Initial Consultation, Duplex Ultrasound Vein Assessment and Diagnosis
What can be seen on the surface does not tell the whole story. The more in depth view the Consultant Surgeon has of what is really happening, the better they will be equipped to formulate the appropriate treatment, to deliver the best outcome with least invasion.
A major tool to aid with this is duplex enabled ultrasound. This precisely shows the position of the veins and informs the highly trained vascular scientist, how the blood is flowing within them.
Understanding how the blood is flowing is key to understanding where and to what extent the veins are damaged. This in turn will define the type of treatment required and where to apply it.
If left untreated varicose veins tend to worsen with time. This can result in the veins becoming too deformed for a catheter to pass through in which case the only option is the more traditional surgery. It is therefore very much in your interests to have a consultation and treatment as soon as possible.
Radio Frequency Ablation- our primary treatment for Varicose Veins
There are two modern approaches to treating varicose veins. Both are effective and both are endovascular i.e. Both entail inserting an active catheter into the vein being treated.
The laser approach uses a very thin 0.4mm optical fibre through which laser energy is delivered to the tip. The tip heats the vein to cauterise it and is then withdrawn at a steady pace to ensure the whole vein is treated effectively. The fact that only the tip is active, and the catheter needs to be withdrawn at a steady pace is the weakness of this technique.
The alternative which NICE (National Institute for Health and Care Excellence) recommends is radio frequency ablation. This is the version we use at Cosmex Vein Clinic.
As you can see below and in the adjacent video produced by the American manufacturer of the equipment. The radio frequency catheter has an active section at the tip which in the video is 7cm long. This allows a section to be treated then the catheter withdrawn by the precise amount owing to the markings along the length of the catheter.
The tip of the radio frequency catheter is not heated but instead emits radio frequency energy that directly heats the surrounding vein wall tissue by the absorption of this energy. This enables very precise control of the energy delivered.
A Deeper Look at How Radio Frequency Ablation (RFA) Works
For readers who would like a more in-depth explanation. The radio frequency tip is typically 2mm in diameter and if this were heated it would be like an old fashion electric hot plate cooker, which take ages to heat up and ages to cool. That would be almost impossible to control precisely enough to avoid damage to the surrounding tissue.
As an analogy only – the radio frequency tip works more like an induction hob and provides almost instant control. It does this without a hot plate by inducing heating within the pan placed on it.
What actually happens in Radio frequency ablation (RFA)
RFA utilizes molecular vibration energy. It works by applying a high-frequency alternating current to tissue, causing water molecules to vibrate rapidly. This molecular vibration generates frictional heat, leading to tissue heating. The process is based on the principle that oscillating electric fields cause the dipole molecules (like water) in tissues to align with the field, and this alignment is disrupted by the alternating current, leading to vibration and heat generation.)
Patient Comfort
The video glosses over the very important topic of anaesthetic to ensure patient comfort. Before an incision is made the entry point is anesthetised. Then a very small (a couple of millimetres long) incision is made to enable the insertion of the catheter into the vein.
The surgeon uses a fine needle to inject an anaesthetic solution between the vein and its protective sheath (facia) . The solution flows between the vein and facia and using ultrasound guidance the surgeon can judge how far the anaesthetic has spread along the vein.
This injected anaesthetic greatly improves patient comfort both during and after the procedure. It also protects the surrounding tissue and improves the effectiveness of the treatment by pushing the walls of the vein against the catheter.
Any remaining small branches can be easily dealt with through a combination of Foam Sclerotherapy or non-invasive laser
Within a few minutes after the treatment you will be able to walk out of the clinic and resume your normal life.
What is Sclerotherapy and Foam Sclerotherapy
Sclerotherapy and in particular foam sclerotherapy are intermediate treatments relevant to both varicose veins and thread veins.
Foam sclerotherapy is typically used to treat any remaining narrow branches following the treatment of the varicose veins using the radio frequency ablation.
- In foam sclerotherapy we use a fine needle to inject a foaming fluid into the remaining veins. This solution is called a sclerosant and when injected into a vein, damages the lining of the vessel.
- This damage triggers an inflammatory response and eventual closure of the vein. The body then reabsorbs the treated vein over time.
The difference between foam sclerotherapy and sclerotherapy, is that in the foam version, the sclerosant goes through a process to make it into more of a mousse like texture. This enables it to better fill larger veins.
When treating varicose veins, the approach is normally to treat the larger veins first and then progressively treat the smaller veins, if necessary. In some cases, once the pressure is relieved the smaller veins will not need further treatment.
For smaller veins it is not necessary to foam the sclerosant.
For the smallest veins sclerotherapy is not a practical option as it becomes increasingly difficult to inject “into” the veins as they reduce in diameter. For the smaller capillary veins our preferred methods are laser and Intense Pulsed Light as these methods are both easier, faster and more effective for the smaller veins.