Is vein varicose treatment better with injections or surgery?

Written by Zhang Xue Min
Vascular Surgery
Updated on September 06, 2024
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Venous sclerotherapy involves injecting a sclerosing agent and is a relatively good and minimally invasive treatment method. Its advantages include being minimally invasive and even suitable for outpatient surgery, with low costs. However, there are drawbacks; one is that the medication might enter the deep veins, causing deep vein thrombosis. If the dosage is too large, it could reach the lungs, causing pulmonary embolism. Additionally, the medication might seep into surrounding tissues, causing inflammatory reactions. Some patients may experience temporary hyperpigmentation. Surgical treatment is a more traditional method, but it depends on the specific situation. Generally, it causes more trauma than sclerotherapy and usually requires some level of anesthesia. Surgery entails a certain amount of blood loss, and like other methods, it cannot prevent recurrence.

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Vascular Surgery
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Can varicose veins cause leg swelling?

Varicose veins are a broad concept that is clinically divided into seven grades, from 0 to 6. Grade 0 is normal, grade 1 involves some capillary dilation, grade 2 is marked by clear varicose veins, and from grade 3 onwards, edema can occur. Generally, the causes of varicose veins vary. Some people suffer from what is called simple superficial varicose veins, primarily due to problems with the valves in the superficial veins. These patients may experience mild edema, limited to the ankle area. Others suffer from secondary varicose veins, following dysfunction of the valves in the deep veins or communicating veins. In deep veins, there can be reflux or obstruction. In such cases, it is possible to cause compressible edema in the front of the lower leg, commonly known as shinbone area.

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Vascular Surgery
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What are the effects of secondary surgery for varicose veins?

If varicose veins recur, we need to carefully investigate the cause of the recurrence and rule out problems in the deep venous system. If there is an obstruction in the deep veins, recurrence can occur quickly even after secondary surgery on the superficial veins. If the deep veins are only involved in venous reflux, surgery can still be performed, but it is hoped that medical compression stockings will be worn for a period of time after surgery. Otherwise, there is still a possibility of recurrence after the secondary surgery.

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Vascular Surgery
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Does varicose veins hurt when pressed?

In most cases, varicose veins are not painful on touch. However, if they are painful when pressed, there are several possibilities. One is that there is an obstruction at the proximal end of the varicose vein, which is closer to the heart. This results in high local tension in the varicose vein, and pressing on it can stimulate the nerves in the surrounding membrane, causing pain on touch. Another possibility is that a blood clot has formed inside the varicose vein. The formation of blood clots is often accompanied by some sterile inflammation. When there is inflammation, symptoms can include redness, warmth, pain, and localized heat. Pressing on such an area can intensify the pain. Additionally, it is particularly important to emphasize that if varicose veins are painful on touch, one must visit a hospital and not press on them themselves. If there is a blood clot, pressing it could dislodge the clot, causing it to travel to the lungs and lead to a pulmonary embolism.

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Vascular Surgery
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What happens if varicose veins worsen?

Varicose veins, when they worsen, can lead to changes in the skin, including thickening of the skin which feels woody to the touch. Additionally, the skin may exhibit pigmentation that can be severe enough to resemble the black color of a belt. More seriously, ulcers can develop, typically near the inner ankle, though they occasionally appear in other locations. These ulcers are referred to medically as “boot ulcers” and are commonly known among the general population as “continuous sore legs.” In extreme cases, these ulcers may persist for many years without healing and could potentially become malignant.

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Can varicose veins occasionally be invisible?

When varicose veins are mild in their early stages, if you wear compression stockings during winter, it's possible that the varicosities are not very noticeable occasionally when you take off the stockings. However, in more advanced stages, when there are clearly widespread and clustered varicose veins, they are difficult to conceal. However, if deep vein thrombosis occurs, causing tissue edema, the swollen surrounding tissues may obscure the varicose veins, making them less visible. Therefore, we need to judge based on the specific circumstances. Generally, just because varicose veins are occasionally not visible does not mean that the condition has healed.