Aim of treatment of varicose veins (vv)

The aim of treatment of varicose veins is not just for cosmetic reasons alone,as is generally believed ,but to prevent the development of CVD as described above and to reverse the process of CVD inestablished cases.

Treatment of Primary varicose veins

Though there are some drugs available for treatment of varicose veins ,they would help only to provide relief of symptoms to some extent.The definitive treatment is surgery.There are two types of surgical management 

A: Open Surgical procedures

These procedure is basically meant to close the saphenous veins at their exit points into the deep veins, to block the flow of blood from deep vein into superficial venous system.It is known as ‘Trendelenburg’s Operation’.This procedure is usually combined with either of the following procedures
1. Stripping of the external(saphenous) vein 2. Multiple excisions of the vein to produce blocking of the vein or interruption at different levels of its course

B: Minimally invasive procedures

A small incision is made in the leg under anesthesia ,to introduce a thin intravenous laser probe.After the introduction of the probe ,the inner wall of the vein is burned off with the laser beam, as it is gradually pulled out of the vein. The burn subsequently helps to occlude the lumen of the vein.

 

1.Endo-venous laser ablation (EVLT)

In this technique also a thin probe is used as in Laser treatment. Instead of the Laser beam, the tip of the probe is heated with radiofrequency and the inner wall of the vein is burned to produce occlusion of the vein by scarring.

 

2.Radio frequency Ablation (RFA)

Sclerotherapy is the oldest technique and it is centuries old (17th century).The principle remains to be the same as in EVLT and RFA .Instead of using thermal burn, a chemical solution is used to produce chemical burn on the inner lining of the vein wall. The solution is mixed with air and is agitated to make microfoam, whereby , with a very small quantity of chemical the volume can be increased enormously. This helps to cover a large area of veins and adds to the safety of the drug

 

3.Microfoam sclerotherapy (MFST)

Side effects ,if at all, are very mild.
1.Some patients may complain of some heaviness of head or dryness of mouth.
2.Some may complain of itching over the injection site.
3.After a few weeks there may be some swelling of the lower limb, pain, bleb formation, redness , indurations, and/or discolouration of the injection site.
4.In case of extravasation of the sclerosant ,it can cause excruciating pain locally.
5.Local hirsutism/hypertrichiasis has been observed in a few patients.

Disadvantages
Allergic/hypersensitivity reactions (extremely rare)
Recurrence of new varices or recanalization
Local reactions ,tissue necrosis , itching
Extremely rare chance of Deep vein thrombosis(DVT)

Any side effects ..?

1.No anesthesia required ,hence no risk of anesthesia
2.Very safe when compared to any other techniques
3.It is usually done as a ‘day care procedure’.
4.The procedure may take hardly an hour
5. This is the least expensive of all procedures.
6.It is more effective than all other techniques.
7.Patient can resume his/her normal activities earlier than all other techniques.
8.Safe for even very aged patients and those having comorbid conditions like diabetes,hypertension

What are the advantages of sclerotherapy ?

It is a modified version of sclerotherapy. The vein is cannulated with the help of ultrasound to locate the perforators and major junctions (Saphenofemoral & saphenopopliteal junction) and the sclerosant which is mixed with air and strongly agitated by a special technique is injected. Trunkal veins are also injected in the same way.

 

What is the effect of sclerotherapy ?

The word ‘sclero’ means ‘hardening’. A chemical solution is infused into the vein, which selectively burns the inner most lining of the vein. The chemical burn thus produced , makes the wall inflamed and hence the veins become swollen. Over a period of weeks ,the inflamed vein will stick together and heals by scarring (fibrosis) and the vein lumen is completely occluded. The vein ,though it will shrink immediately after the procedure, it will become harder and harder for about a few months. A crepe bandage is applied immediately after the procedure to keep the vein wall stick together during the process of healing. The bandage is not to be used after 3-4 weeks of the procedure.

Ultrasound guided MFST

It is a modified version of sclerotherapy. The vein is cannulated with the help of ultrasound to locate the perforators and major junctions (Saphenofemoral & saphenopopliteal junction) and the sclerosant which is mixed with air and strongly agitated by a special technique is injected. Trunkal veins are also injected in the same way.

Where not to be done ?

1.In established Deep Vein Thrombisis (DVT)
2.If the patient is allergic/Hypersensitive to the drug.
3.In pregnancy
4.In lactating mothers ?

Can both the legs be treated in one sitting ?

Usually not. It is preferable to do the next leg after three months after the first leg is set alright.This is mainly due to the following reasons:
1.To give better care for the leg, especially in advanced stages of the disease.
2.Any recanalization , revascularization, or skipped veins can be detected and corrected during the procedure of the second leg.
3.There is also dosage limit.

How many sittings are required ?

Almost 90% of the cases can be treated in one sitting. But in very extensive and very large veins , it may require multiple sittings due to dosage limitations. Recanalization or revascularization may also require multiple sittings.

Conclusion

The sclerotherapy technique which we follow at Vein Miracles is the most effective technique available. It is a very safe promising technique. It can be used in all stages of the chronic venous disease, in all patients irrespective of age and with any co-existing diseases