Varicose vein treatment in Beirut

Start with the scan, not the skin

The single most useful thing to understand about varicose veins is that what you can see is not the problem. It is the consequence of one. A visible, rope-like vein on the calf is usually being fed by a deeper vein whose valves have stopped closing properly, so blood falls back down the leg instead of being pushed up toward the heart. Treat the surface and leave the feeding vein, and the problem returns.

That is why nothing is treated here before a venous duplex ultrasound. It is painless, takes minutes, and it maps which veins have failed, in which direction the blood is running, and how far the problem extends. It is the scan that decides the technique — not the appearance of the leg, and not the patient's guess.

The four techniques, and when each one is used

Almost every case falls into one of four approaches, often in combination across more than one session.

• Sclerotherapy — a solution injected through a very fine needle irritates the vein lining so the vein seals shut and is reabsorbed. Used for spider veins and small to medium varicose veins. More on sclerotherapy.
• Foam sclerotherapy — the same agent turned into a foam, which displaces blood and holds contact with the vein wall for longer. This is what makes larger veins treatable by injection.
• Endovenous laser (EVLA) — a fine fibre is passed inside the failed trunk vein under ultrasound guidance and the vein is closed with heat. For the larger, deeper veins injection alone will not hold. More on laser treatment.
• Phlebectomy — removal of a bulging surface vein through punctures so small they do not need stitches. Usually combined with one of the above rather than used alone.

Surgery, in the sense most people fear it, is now reserved for the minority of cases that genuinely need it. As Dr. Shab puts it in his own patient material: not every varicose vein requires surgery.

What a treatment day looks like

The scan, the explanation and the treatment often happen in the same visit. The injection itself is a matter of minutes. There is no general anaesthetic, nothing is cut, and you walk out afterwards with a compression stocking and instructions to keep moving normally. Mild bruising over the treated veins for one to two weeks is expected and fades.

One patient's summary of that, from the practice's Google reviews: I initially thought I would need two visits, but it was completed in one. He scanned my veins and then performed the procedure.

How many sessions

It depends entirely on how much of the leg is involved. A limited patch of spider veins can be a single session. A leg with a failed trunk vein plus surface branches is usually staged over two or more, because the deep problem is closed first and the surface tidied afterwards, once the pressure feeding it is gone. The number is estimated at the consultation, after the scan, and you are told it before anything begins.

Why it is worth doing before it hurts

Varicose veins do not resolve on their own, and untreated venous disease tends to progress: more aching and heaviness, ankle swelling, skin changes above the ankle, and in advanced cases skin breakdown. The brown discolouration many people dismiss as a cosmetic annoyance is a late sign, not an early one. Earlier assessment means more of the options are still open and fewer sessions are needed.

Coming from outside Lebanon

A number of the practice's patients travel in — from the Gulf, Europe and the United States — usually on a personal recommendation. If you are planning a trip around treatment, send photographs of the legs and a description of the symptoms on WhatsApp first. The likely plan, and how many days it needs, can be discussed before you book anything. The scan on arrival confirms it.