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Treatment by Endovenous Laser Ablation, Sclerotherapy and Phlebectomy

What is the treatment?

The Treatment:
Treatment of refluxing veins (veins with faulty valves) from the inside with laser energy (Endovenous Laser Ablation) , Injection of veins with a prescription medicine called a sclerosant (Sclerotherapy) and vein extraction by microsurgery (Phlebectomy).
Intended Benefits:
To improve the vein circulation by treating reflux (abnormal reverse flow) and varicose veins. 
The treatment may not cure all symptoms and after treatment there may be residual veins requiring further treatment. 
It cannot guarantee a specific cosmetic outcome, but the treated leg(s) should look and feel a lot better and the risks of complications such as phlebitis, bleeding, varicose eczema and leg ulceration may be reduced.
The treatment is in line with  NICE Guidelines
Interventions to reduce the risk of DVT after this procedure include keeping well hydrated, walking, performing calf exercises and the use of anti-DVT stockings.
Serious or frequently occurring risks:
Serious complications such as Deep Vein Thrombosis (DVT or clots), allergic reactions, major nerve injury or infection are very rare (much less than one in a hundred risk). 
Other complications that may occur are bleeding from the phlebectomy sites, and infection at these sites. 
The treatment may cause brown discolouration (lasting up to 3 years), patches of numbness, and the appearance of new broken veins. These last three usually improve or resolve completely. 
However, numbness and brown discolouration may be permanent and the treatment may cause the appearance of more spider veins. In about 1-2% of cases, the treated areas may look worse.
Occasionally the treatment may cause migraine with headache and visual symptoms for a short period during or immediately after the treatment.  Years after treatment, more veins may develop, but they are usually very minor.
The procedure involves local anaesthesia.
All clinical operations and procedures carry the risk of unsuccessful results, complications, injury or even death from both known and unforeseen consequences. If you should experience significant complications it may require your care to be transferred to the National Health Service.
Due to the prevalence of COVID-19 ,The VeinCare Team has taken recommended steps to reduce the risk to both staff and patients, however there may be some residual risk remaining of contracting COVID-19 while at the clinic.

Treatment Day

On the day of your procedure:

Please arrive promptly, be aware of traffic conditons and plan your journey carefully. 

It is better to arrive early rather than late. There is plenty of car parking at The Clinic, which is situated about six miles south of Yeovil, just off the A37 Yeovil to Dorchester road, at Holt Mill.

Dr Gajraj will confirm your consent to treatment, answer any questions that your may have and then he will mark your veins with a felt pen. He may re-scan your legs and take clinical photographs.

You will be asked to change into a clinic gown and disposable underwear. Your belongings will be stored in a locked annex adjacent to the treatment room.

The procedure is performed under local anaesthetic, so you will be fully awake.

Afterwards you may have some bandages and a medical compression stocking on your leg(s), so please wear comfortable clothes and loose-fitting shoes. Many people like to wear jogging type trousers and trainer shoes.

However fit you feel, you should not drive afterwards, as your leg(s) will be numb. Please therefore arrange for someone to bring you to the Clinic, and to return to take you home afterwards. You will need someone with you overnight for reassurance and in the very unlikely event that you may need assistance. We consider these to be important arrangements and without them we regret the procedure cannot take place.

You should plan to be at the Clinic for up to four hours.

After the procedure when the local anaesthetic wears off, you may have some discomfort. Please arrange to have some Paracetamol and Ibuprofen to take during your recovery. If you are unable to tolerate Ibuprofen, you may wish to obtain Codeine Phosphate and your Chemist can advise.

Before you leave the Clinic, you will be given an appointment for a follow-up consultation with Dr Gajraj.

What happens after treatment?

On the day of your procedure we recommend that you rest with your feet up. Keep the blood flowing by performing regular ankle movements (the sort you might do on a long-haul flight, for example) and get up regularly for a walk around.
The day after your procedure, you can do everything as normally as the bandages and stocking allow.  Walk as much as possible. Walking encourages the healing process and promotes the vein circulation in the legs. You really can’t do too much walking in the first week or two.
After your procedure you will go home wearing a medical stocking with absorbent wool underneath.  We may also place a bandage over the stocking on the outside.  
Check your leg(s) from time to time in the hours after treatment. Sometimes the local anaesthetic solution used leaks into the bandaging and pale pink staining appears on the stocking; please do not be alarmed, this is not a cause for concern. 
In the very unlikely event that there is blood (dark red rather than pale pink) penetration through the bandaging and stocking, do not disturb the stocking and bandaging. Fold a clean tea towel or similar into a firm pad and apply to the bleeding area on top of the stocking. Secure this firmly with some sticky tape, or a bandage. Elevate the leg for minimum of one hour. If the staining persists or becomes larger seek advice using the telephone number below.
We advise that you keep the bandage and stocking in place for 48 hours. 
However, if at any time the bandage feels tight, you can take it off immediately.  After taking the bandage off, if you still feel uncomfortable or if your foot swells or if you have tingling in your toes after the local anaesthetic wears off, remove the stocking completely.
After 48 hours you may remove the bandage, stocking and wool completely if you have not already done so, and it will probably be easier to do this with the help of a partner or friend. Here is some guidance for that person to follow:
1.     Wash your hands with soap and water.
2.     The patient should sit down and elevate the leg(s) supported by, for example, a chair.
3.     Remove the outside bandage.  Pull off the stocking. Unwind the soft wool to reveal sticking plasters on the leg(s) treated. (Don’t be alarmed if these old plasters are blood-stained.)
4.     Throw away the bandages but KEEP the stocking(s) for future appointments. ALWAYS BRING STOCKINGS TO ANY APPOINTMENTS AT THE VEINCARE CENTRE.
5.     Leave the sticky plasters in place and have a warm shower as normal. Have the supply of new plasters nearby. Use a fresh towel to PAT the leg(s) dry, and then gently peel off the old plasters. PAT the skin dry again, and now put new adhesive dressings over the little nicks if they do not appear dried.
6.     If you decide to reapply the stocking, it is easier to do this if a strong plastic bag is placed over the foot to allow the stocking to slide over the foot and ankle. The bag can be removed by pulling it through the open toe of the stocking or alternatively use the stocking aid suppled in the stocking box. Keep the stocking free of wrinkles and pinches, which would be uncomfortable and could impede circulation
Many people find it comfortable to wear the surgical stocking in the daytime for another week or two. However, if you feel more comfortable without the stocking, leave it off. 
Most people have very little discomfort however, if you do need pain relief, Paracetamol or Ibuprofen are usually sufficient (always read the label, and do not take these if you are allergic to them or if you have been advised not to take them for medical reasons).
Don’t be alarmed if your leg(s) is/are bruised or if there are lumpy, tender areas on your leg(s).  These will settle over the course of a few weeks.  You may find that rubbing in Ibuprofen gel and/or Arnica cream into these lumpy, tender areas may help them settle more quickly. You may also experience some numbness, which may take several months to resolve.
From a medical point of view, you can drive when you feel able to perform an emergency stop, usually 48 hours after your treatment when your bandages are removed.  Some people need a bit longer before they feel confident to drive. Do check with your motor insurance company, and don’t drive if you feel uncomfortable.
You can resume exercise, going to the gym and sports when your leg(s) feels comfortable.  We generally advise avoiding contact sports where your leg(s) is/are likely to be knocked for about fourteen days after treatment.  There are often harsh chemicals in swimming pools, so it may be a wise precaution to avoid swimming for fourteen days as well.
Many people ask about flying after their vein treatment, and the concern of deep vein thrombosis.  Fortunately, complications after modern vein treatments are very rare. However, long-haul flights are a known risk factor and it is a wise precaution to avoid taking a long flight for a month afterwards, although there isn’t tany strong evidence in the medical literature to back up this recommendation.
It will also be easier for The VeinCare Centre to offer support if required if you remain closer to home in the first few weeks after treatment.
The wearing of compression hosiery in the longer term is down to the individual. Each person is different and some never wear compression hosiery again. However, if your leg(s) feel more comfortable in compression hosiery, you will not want to wear your post procedure stocking(s) long term. Please ask for our current supplier’s details.
What To Do If You Are Worried
Tenderness and lumpy areas along the course of the treated vein are quite normal. You may also experience tingling, stinging or irritation along the course of the veins treated for about a week.  Continue to rub in Ibuprofen gel to the areas causing you concern.
If the stocking feels uncomfortable,  if your foot swells or if you have tingling in your toes after the local anaesthetic wears off, remove the stocking completely.
Serious complications are very rare indeed. However, if any areas become hot or red, generally swollen (particularly in the calf) or if you develop a fever and feel unwell, please make contact with The VeinCare Centre as soon as possible.
If you develop chest pains or shortness of breath, call 999 or go straight to your local hospital.  
Members of The VeinCare Centre team may not be available out of normal office hours, however we will always do our best to help you if at all possible. If you have concerns and we cannot be contacted, please use the NHS Out of Hours service.
Our contact number is 01935 571030