Varicose Veins

Varicosis is caused by the weakening of the superficial vein walls and by the ineffectiveness of the valve system. A blood leakage occurs, especially in a standing position. This leakage comes from the depth of the limb to the surface. This happens in the superficial veins, which gradually dilate to become real pockets of blood.

Several factors can cause the development of varicose vein disease. Heredity is a factor, but also a trauma or an accident. Some aggravating factors (obesity, prolonged standing position, pregnancies) can also cause the appearance of varicose veins. Heat (heated blankets, prolonged hot baths) also causes 

This blood reflux can result in the following symptoms:

• Pain and heaviness, tingling and, more rarely, cramps
• Swelling of the ankles
• Cutaneous disorders: eczema and varicose ulcers, brown patches, scars and induration (hardening of tissues)
• Development of thrombosis and even pulmonary embolism

Treating these varicose veins and closing the “leaks” improves venous circulation of the limb.

To choose the right type of treatment for you, Dr. Elise Bernier thoroughly examines the affected veins. This examination is assisted by ultrasound and allows the assessment of incompetent veins, their depth, and location. This preliminary examination is essential to determine the appropriate treatment.

Whether in Montreal or Sherbrooke, different treatment options are available :

• Microsclerosis
• Surface sclerosis
• Echosclerosis

Lasers, surface laser and phototherapy are also treatment alternatives offered at our Sherbrooke clinic. You can read our blog post to learn more about endoveinous laser treatment for varicose veins.

Dr. Bernier usually starts with large varicose veins, which are very often the cause of varicosities.

They are used in sclerotherapy, which consists of injecting an irritant substance into the affected vein.

Classified according to their strength (light, medium, strong) or their action mode (chemical, detergent, osmotic), sclerosing agents can change strength depending on their form: liquid or foam.

Sclerosing foam is obtained by mixing gas (usually air) and sclerosing liquid. The foam form allows us to increase the sclerosing effect and get better results quickly while using less product.

Microsclerosis is the recommended treatment for telangiectasias (varicosities, small red or bluish vessels visible under the skin). Magnifying glasses and tiny needles are used to inject the sclerosing product.

Sclerotherapy or sclerosis is the safest technique because it is the least invasive for treating varicose veins. It does not require recovery or post-treatment care and gives little or no discomfort.

Surface sclerotherapy is used when it is possible to treat visible veins by simple injection without ultrasound guidance. However, the doctor must have ensured that they are not fed by leaks (reflux) from deeper veins using a Doppler examination.

This treatment consists of injecting a sclerosing agent into the vein to be treated. This sclerosing agent can be : 

• liquid (for smaller veins) 
• foam (for more prominent varicose veins).

 The treatment takes about 10 to 20 minutes and doesn’t require any special care. Depending on the extent of the varicose problem, the treatment may need to be repeated, and the same vein may require several injection points along its path.

The sclerosing agent irritates the inner wall of the diseased vein. Its diameter will thicken and become blocked. It will then turn into a fibrous and hard cord called sclerosis. The vein will decrease in volume and disappear. The blood that circulated there then takes the path of the normal veins.

Foam echosclerosis is effective in controlling the disease’s progression when it comes to large dysfunctional vessels. It is less invasive and less expensive than other endovenous techniques.

Echosclerosis uses an echo-Doppler device to identify leakage points and venous insufficiencies. This device confirms the intravascular presence of the sclerosing agent during injection and tracks its progress.

If the vein is not easily accessible or not visible, the injection is done under ultrasound control.  This is referred to as echosclerotherapy or ultrasound-guided sclerotherapy. For the treatment of saphenous veins, ultrasound guidance is mandatory, and the recommended sclerosing agent is foam (if there are no contraindications).

Post-treatment care is minimal and consists of avoiding high physical effort for a few days. Therefore, no recovery (time off work) is necessary. 

Endovenous techniques such as laser, radiofrequency, cryotherapy and glue injections require more elaborate preparation and are more invasive. They, therefore, have the potential to cause more significant complications, recovery, and pain. Usually reserved for more prominent veins, these techniques are also more expensive.

Since they are likely to cause complications, surgical treatments such as ligation, stripping, phlebectomy are nowadays considered as last resort treatments and are practically abandoned. These are much more invasive and prone to recurrence.