CENTRE OF DIAGNOSIS AND TREATMENT OF VEIN CONDITIONS CLINIC OF ATHENS simos_admin
CENTRE OF DIAGNOSIS AND TREATMENT OF VEIN CONDITIONS
PUT AN END TO VENOUS INSUFFICIENCY AND THE ANNOYING VARICOSE VEINS BY ENDOVENOUS LASER TREATMENT
What do we mean by the term venous insufficiency? What exactly are varicose veins?
The term venous insufficiency means the improper closure of some of the valves of the longest mainly vein of the superficial vein network of the legs (major saphenous vein); this results in the backflow of blood, hence the creation of varicose veins (pathologically dilated with a twisted pattern).
Therapeutic choices for venous insufficiency and varicose veins
Without any sort of treatment, venous insufficiency in the lower limbs may lead to pain, feeling pressure and burning, skin distortions, as well as repeated incidents of thrombophlebitis. The blood backflow that worsens as the disease progresses lead to an increase in the internal venous pressure and chronic venous congestion. Beyond of the existence of varicose veins and possibly swelling, the patient may suffer from pain, complain about feeling pressure, cramps, paraesthesia and burning, while in advanced stages the patient might develop skin lesions (pigmentation, chronic dermatitis, erysipelas, atonic ulcer). This condition may spread deeper into the vein, thus increasing the chances for a deep vein thrombosis that might even lead to pulmonary embolism.
Apart from the conservative management, conventional varicose veins surgery of the lower limbs that, as a technique monopolised for many years the interventional management of venous insufficiency, has been recently challenged by the successful introduction of new techniques (endovenous thermal ablation – saphenectomy) that are in the family of minimally-invasive surgical treatments of varicose veins. Endovenous laser is the predominant method in these endovenous thermal techniques. Another tool that can be used by surgeons is foam sclerotherapy (chemical ablation). The choice of treatment for varicose veins depends every time on the patient (personalised treatment). Every therapy has specific indications and contra-indications, as with most medical procedures.
How common is this condition? (epidemiological evidence)
It is estimated that 70% of women and 45% of men above 60 have or will develop varicose veins in their lower limbs.
Are there any risk factors?
Heritability, patient’s age, sex, obesity, pregnancy and low activity.
How is the condition diagnosed?
By taking a detailed history and a thorough clinical examination by a specialised vascular surgeon, as well as performing lower limb triplex US.
What are the indicated modalities for treatment/management?
The aims of any chosen therapeutic management should be as follows:
excellent aesthetic outcome
control of unpleasant sensation
prevention of worsening of skin lesions
healing of ulcers if any
Endovenous laser - thermal ablation
This is carried out using an endovenous laser instrument (ELVeS Radial, Biolitec) under simultaneous US guidance of the fibre optic-bearing catheter, without incisions, with great safety and excellent long-term outlook. In this way, blood backflow can be stopped in the major or minor saphenous vein, without its removal, thus directly benefiting from the absence of skin incisions and surgical complications.
Vein mapping and US measurement of its diameter.
Local anaesthesia in the entry point and percutaneous phlebocentesis, insertion of guide wire and placement of a sheath.
Removal of guide wire and dilator, insertion of laser catheter through the sheath into the saphenous vein up to the saphenofemoral junction under US monitoring.
Placement of the laser catheter end at a distance of 1.5-2 cm to the periphery of the saphenofemoral junction to ensure maintenance of the integrity of the common femoral vein against the first wave of laser energy.
Application of tumescence anaesthesia around the major saphenous vein throughout its length, which acts protectively for the tissue surrounding the vein as well as the skin.
The laser fibre-optic-bearing catheter is withdrawn while releasing energy to the vein endothelium causing condensing, shrinking and finally fully blocking of the vein walls, thereby rendering it inactive.
As soon as the procedure is completed, US validates the response and the full sealing of the vein lumen.
What are the important advantages of endovenous laser ablation, if any?
It is carried out under local anaesthesia and mild sedation without skin incisions. Recently the National Institute for Health and Care Excellence in the UK, in its guidelines for the management of varicose veins, has stated that the classical surgical management (saphenectomy) should be offered only when the latest minimally-invasive endovenous methods cannot be applied.
Patient mobilisation is immediate, with exceptionally rare cases needing post-operative painkillers, and the patient is discharged in the same afternoon. Endovenous laser ablation can thus offer, apart from an aesthetically superior outcome, less inconvenience to the patient. It also ensures a speedy return to daily activities, a factor that also reduces the method’s actual cost.
The total treatment length is on average about 45 min. The individual varicose venules can be managed by local stripping.
Endovenous laser application for the management of the insufficient superficial greater vein branches in the lower limbs has been proven to be a practical, fully safe, fast and fully effective method that brings and excellent and aesthetically pleasing result, minimal inconvenience to the patient, applicable even on an outpatient basis, ensuring fast return to daily activities, a factor that reduces the method’s actual cost.