Latest advances for treatment of Varicose Veins

Treatment involves control of risk factors to prevent recurrence followed by use of limb elevation while sleeping, graduated compression stockings that are tighter near ankles and less tight as one moves up, exercises and use of venous tonics to increase venous tone

Varicose veins are the enlarged tortuous greenish veins seen in the legs and can vary in size from small to huge. Besides being “ugly looking” they can pose a risk to lifestyle (swollen, heavy or painful legs with pigmentation, bleeding or recurrent non-healing wounds) or life (causing blood clots that can break off and go to the lungs). Advances in techniques and equipment have made the treatment less invasive with reduced hospitalisation, convalescence, complications with more comfort and patient friendly outcomes. 

What is treatment of Varicose veins?
Treatment involves control of risk factors to prevent recurrence followed by use of limb elevation while sleeping, graduated compression stockings that are tighter near the ankle and less tight as one moves up, exercises and use of venous tonics to increase venous tone. While this form of treatment is very important and helps relieve symptoms and prevents deterioration, it does not help cure veins that have already gone bad. 

To get rid of varicose veins treatment options include Ultrasound-guided injection foam sclerotherapy offered in isolation for small veins or in combination with endovenous abalation (treatment from inside the vein) using heat generated with either laser (light) or RF (radiofrequency or current) or more recently glue. Open surgery (treatment from outside the vein) is rarely used nowadays. Stab avulsions (tiny nicks) with hook phlebectomies are used for removing varicosities.  

How does Laser differ from RF abalation?
The laser uses a temperature of 2000oC to destroy the vein whereas RF uses 120oC. The heat generated by laser not only destroys the vein but also the fat around the veins. At times the cutaenous nerve that is located close to the vein also gets damaged and can result in numbness and pain in the legs. Superficial veins can result in skin burns and deep wounds. Hence RF abalation is more gentle and causes less pain, discomfort and complications. 

 
What is new in RF abalation?
The RF closurefast “Venefit” is the 3rd generation device that uses a RF catheter with a sensor within it that allows the surgeon to know what amount of power is required to destroy the vein. This allows the surgeon to recognize if the vein is completely destroyed or not. He can repeat each 20-second cycle until the machine indicates the vein is destroyed. This reduces the risk of incomplete treatment and residual or recurrent varicose veins. The cost of the catheter is a little more than the Laser fiber but it is money well invested in terms of comfort post-procedure and lower risk of nerve and skin injury.

What is new in anesthesia?
Endovenous abalation can be performed under local anaesthesia using a technique called “Tumescent Anesthesia”. This involves injecting a mixture of cold saline mixed with local anaesthetic all around the vein after the catheter is in place that ensures that the procedure of destroying the vein is painless, causes the enlarged vein to go into spasm and maintain contact with the catheter ensuring complete damage of the wall and separates the skin and nerve from the adjacent vein thereby protecting it from damage. Using a Tumescent pump ensures a lesser number of needle pricks, better infiltration and reduces the time required for the surgery. Patients can choose to get the procedure done as a daycare or with admission depending on their preference.      

Please ensure your legs get the best treatment

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