Treating the Source Vein

Starting Where the Problem Starts

This stage addresses saphenous vein reflux — where the problem begins.

Correcting the cause comes first. Treating only the visible vessels leaves the cause in place; closing the source vein also reduces how much work the later stages require.

Diagnosis Comes First

We first map the veins with Doppler ultrasound to determine which vessel is refluxing and to what degree, then close that vein to stop the reflux. The method depends on the vein's location, diameter, and condition.

• Precision ultrasound — Duplex ultrasound locates reflux and measures its severity. The scan is performed by the surgeon, not delegated.
• 1:1 explanation — We review your ultrasound images together and first determine whether treatment is needed at all.

Methods

A full spectrum of first-line treatments is available, so each vessel segment can be matched to a suitable technique.

• Endovenous laser / radiofrequency ablation (EVLA · RFA) — Radiofrequency or endovenous laser energy closes the refluxing vein. The first-line standard recommended in international guidelines.
• Adhesive closure (VenaSeal) — A medical adhesive seals the vein without heat, reducing the need for compression stockings after the procedure.
• Mechanochemical ablation (ClariVein · Flebogrif · MOCA) — Combines mechanical stimulation with a sclerosing agent, without heat.
• Hybrid vein closure — Two or more closure techniques combined in a single session, applying a suitable method to each vessel segment.

How the Method Is Chosen

Which method suits a given patient is determined by diagnosis, and in many cases two or more methods are combined in a single treatment plan.

Planning is tailored 1:1 to vessel diameter, anatomy, and immune response, and combined into a hybrid procedure when needed.

Treating the Tributaries Together, or in Stages

Once the saphenous trunk is closed, many of the tributary varicosities below it shrink over time. So there is a decision to make: remove them in the same session (concomitant), or wait and treat only what remains (staged).

Randomised trials found the two approaches equivalent at five years. The difference lies in between — concomitant treatment showed a clearer improvement in symptoms and quality of life during early recovery, while a substantial share of patients treated in stages went on to have a further procedure.

We decide based on the size and spread of the tributaries, your symptoms and how easily you can return, and we go through the ultrasound findings with you first.

After This Stage

Even after the source vein is closed, reticular veins branching from it often remain, and the fine vessels visible through the skin are treated in a separate stage.