Varicose Veins

Our Approach In Managing Varicose Veins

Map the reflux. Close the source. Restore healthy circulation.

Treating varicose veins effectively requires understanding that the visible bulging veins are usually a symptom, not the source of the problem. The true underlying issue is typically reflux - backward flow of blood - in one of the deeper truncal veins, most commonly the great or small saphenous vein, whose damaged valves allow blood to pool under gravity throughout the day. Treating only the visible surface veins without addressing this underlying reflux frequently leads to disappointing results and rapid recurrence.

At Shree Hospitals, our approach to leg vein diagnosis and venous insufficiency management always begins with precise duplex ultrasound mapping of the venous system - identifying exactly where reflux originates before any treatment decision is made. Our vascular surgeon specialists then select the most appropriate combination of techniques to address both the underlying truncal reflux and the visible surface veins comprehensively.

1. Comprehensive Venous Duplex Ultrasound Assessment

• Detailed mapping of the superficial and deep venous systems - identifying the precise source and extent of venous reflux
• Assessment of the great saphenous vein, small saphenous vein, and perforator veins - the common sources of underlying reflux driving visible varicosities
• CEAP classification (Clinical, Etiological, Anatomical, Pathophysiological) - standardised staging guiding treatment planning and severity documentation
• Exclusion of deep vein thrombosis or other vascular pathology that may present with similar leg symptoms
• Identification of perforator vein incompetence contributing to localised skin changes or ulceration in advanced disease

2. Conservative Management
    
   For early-stage or mild venous insufficiency, conservative measures provide meaningful symptom relief:

• Graduated compression stockings - improving venous return and reducing symptoms of aching, swelling, and heaviness
• Leg elevation guidance - particularly beneficial during prolonged periods of standing or sitting
• Regular exercise, particularly walking - activating the calf muscle pump that assists venous return
• Weight management counselling - reducing the venous pressure burden associated with excess body weight
• Clear education on chronic venous insufficiency symptoms progression and when escalation to active treatment is appropriate

3. Endovenous Thermal Ablation

   The modern gold-standard treatment for truncal vein reflux:

• Endovenous laser treatment (EVLA) - a thin laser fibre introduced into the incompetent vein under ultrasound guidance, delivering thermal energy that seals the vein closed from within
• Radiofrequency ablation (RFA) — an alternative thermal technique achieving equally excellent closure rates with a similar minimally invasive approach
• Performed under local or tumescent anaesthesia - avoiding the need for general anaesthesia in the majority of cases
• Same-day discharge with immediate return to most normal activities - a dramatic improvement over traditional vein stripping surgery
• High long-term success rates exceeding 95% vein closure at one year as part of laser ablation and minimally invasive vein surgery in Mumbai

4. Foam Sclerotherapy & Adjunctive Treatments
    
   For residual surface varicosities or smaller veins following truncal ablation:

• Ultrasound-guided foam sclerotherapy - injection of a sclerosing foam agent directly into residual varicose veins, causing them to collapse and be reabsorbed
• Microsclerotherapy for smaller spider veins and reticular veins - addressing cosmetic concerns following definitive treatment of larger veins
• Phlebectomy (ambulatory vein removal) - small incision removal of large surface varicosities through tiny punctures, often combined with thermal ablation in the same session
• Staged treatment approach - addressing truncal reflux first, followed by residual surface vein treatment once the underlying source has been controlled

5. Management of Advanced Venous Disease
    
   For patients with longstanding chronic venous insufficiency symptoms and skin changes:

• Venous ulcer management - comprehensive wound care combined with treatment of underlying venous reflux to promote healing and prevent recurrence
• Compression therapy optimisation - multi-layer bandaging or specialised compression systems for active ulceration
• Perforator vein ablation - addressing localised incompetent perforator veins contributing to skin changes near the ankle
• Coordinated wound care team involvement for complex or slow-healing venous ulcers

6. Post-Treatment Care & Long-Term Outcomes

• Compression stocking wear for a defined period following ablation procedures - optimising vein closure and reducing bruising
• Early walking encouraged immediately following treatment - reducing the small risk of deep vein thrombosis associated with any vascular procedure
• Follow-up duplex ultrasound to confirm successful vein closure and assess for any residual or recurrent reflux
• Long-term lifestyle guidance - maintaining the benefits of treatment through continued activity and weight management as part of comprehensive Varicose Veins treatment in Mumbai, India