WHAT ARE VARICOSE VEINS?
Arteries bring blood from the heart to the extremities, veins, which have one-way valves, channel blood back to the heart. If the valves don’t function well, blood doesn’t flow efficiently. The veins become enlarged because they are congested with blood. These enlarged veins are commonly called spider veins or varicose veins. Spider veins are small red, blue or purple veins on the surface of the skin. Varicose veins are larger distended veins that are located somewhat deeper than spider veins.
Pain in the legs is frequently related to abnormal leg veins. Symptoms, often made worse by prolonged standing, include feelings of fatigue, heaviness, aching, burning, throbbing, itching, cramping, and restlessness of the legs. Leg swelling can occur. Severe varicose veins can compromise the nutrition of the skin and lead to eczema, inflammation or even ulceration of the lower leg.
Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause and severity of the problem. In addition to a physical examination, non-invasive ultrasound is often used.
WHAT CAUSES VARICOSE VEINS?
Heredity is the number one contributing factor causing varicose and spider veins. Women are more likely to suffer from abnormal leg veins. Up to 50% of women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, estrogen, and progesterone affect the disease. It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, standing occupations, obesity and leg injury.
WHEN AND HOW ARE VEINS TREATED?
The most commonly asked questions are: Do veins require treatment and What treatment is best? Veins that are cosmetically unappealing or cause pain or other symptoms are prime candidates for treatment. There are two general treatment options: conservative measures, such as compression stockings, and “corrective” methods such as sclerotherapy, surgery and light source/laser treatment. In some cases, a combination of treatment methods works best.
SCLEROTHERAPY
Sclerotherapy can be used to treat both varicose and spider veins. A tiny needle is used to inject the veins with a medication that irritates the lining of the vein. In response, the veins collapse and are reabsorbed. The surface veins are no longer visible. Sclerotherapy relieves symptoms due to varicose and spider veins in most patients. With this procedure, veins can be dealt with at an early stage, helping to prevent further complications.
You may need anywhere from one to several sclerotherapy sessions for any vein region. Depending on the type and number of veins being treated you may have one to many injections per session. Generally, normal activities can be resumed after sclerotherapy. Medically prescribed support hose and/or bandages may need to be worn for several days to several weeks to assist in resolution of the veins. The procedure, performed in the doctor’s office, usually causes no discomfort.
SURGERY
Surgical techniques to treat varicose veins include ligation (tying off of a vein), stripping (removal of a long segment of vein by pulling it out with a special instrument), and ambulatory phlebectomy (removal of veins through tiny incisions. Surgery may be performed using local or loco-regional anesthesia. Our patients return home the same day as the procedure. Surgery is generally used to treat large varicose veins.
When surgery is required, the most modern form of ligation and stripping procedure is performed at Flebocentrum. The procedure takes about one hour. Patients return home approximately two hours later, and may resume normal activities within three to five days.
We use an advanced surgical technique to remove the main vein. Usually, this procedure requires only two small hidden incisions – one in the groin area and the other in the inside of the leg by the knee. During surgery, damaged branches of the main vein can also be removed by a technique called ambulatory phlebectomy.
AMBULATORY PHLEBECTOMY
Ambulatory phlebectomy is a method of surgical removal of surface varicose veins. This is done under local anesthesia. Incisions are tiny (stitches are generally not necessary) and typically leave nearly imperceptible puncture mark scars. After the vein has been removed by phlebectomy, a bandage and/or compression stocking is worn for a short period.
ENDOVENOUS LASER TREATMENT ( EVLT )
Endovenous Laser Treatment is a treatment alternative to surgical stripping of the greater saphenous vein. Unlike surgical stripping, EVLT permanently closes off the vein while leaving it in place. A small laser fiber is inserted, usually through a needle stick in the skin, into the damaged vein, so there will be no post operative scarring. The fiber is guided into place using ultrasound and the procedure is performed under strictly local anesthetic of a similar type used by dentist to numb the treatment area.
Once the fiber is positioned correctly and the area around the area is anesthetized, the LASER treatment is started. In approximately three minutes, the LASER energy heats and seals the vein closed. Following the procedure a compression hose is placed on the treated leg.After the treatment, the patient is immediately ambulatory and ready to resume normal activities.
BENEFITS OF EVLT…
A simple procedure for the patient performed under local anesthetic Minimally invasive, so minimal risk of scarring and postoperative infection. Less than one hour treatment time. Rapid recovery with reduced postoperative pain. Normal activities can be resumed immediately. Excellent clinical and aesthetic results.
CURRICULUM VITAE of MD. Svatopluk Kašpar, Ph.D.