May 12, 2007

All in vein

How does the minimally invasive treatment of varicose veins evolve? Is

sclerotherapy a promising therapeutic alternative? Will the trend to
treatment at ambulatory outpatient surgery centers continue? What are the
primary forms of therapies for venous varicosities?

Venous insufficiency is a very common condition resulting from valvular

dysfunction and consequently poor venous return to the heart with pooling
of blood in the leg veins (called reflux). The bad news: patients with
superficial venous reflux may develop varicose veins. The good news: the
number of minimally invasive varicose vein procedures performed in the USA
increases every year. Radiofrequency venous ablation allows early
intervention and replaces traditional vein stripping surgery with the help
of a catheter that is inserted into the vein, using a single needle stick.
Under ultrasound vision the catheter delivers radiofrequency energy to the
vein wall, causing it to collapse, and seal shut. The advantages: less
post-procedural complications with pain or leg numbness, less damage or
irritation of the nerves, and better cosmetic results (no scar surgery).
However the risk of recurrence is not eliminated. Endovenous laser
treatment is yet another treatment option for large, bulging varicose
veins. Again under local anaesthesia, and ultrasound vision, a small
catheter is inserted into the vein and laser energy is delivered through
the fiber into the vein, causing the vein to seal. A relatively new
treatment of proximal venous occlusion with endoluminal therapy, involves
the fine needle injection of a solution (sclerotherapy) into the lumen of
varicose veins and even small spider veins which causes the veins to
shrink. The treatment is performed as an outpatient hospital procedure
under local anesthesia with ultrasound guidance and takes about an hour.
The bad news: after shaking the sclerosant with air, the foam can
predispose to superficial thrombophlebitis. Patients with incomplete
saphenofemoral junction/great saphenous vein ligation or pelvic veins have
the need for a safe and permanent yet less invasive way to do the ligation
because the presence of proximal reflux may decrease the positive results
of foam treatment. A high tie could then be performed and the patients
would not have to be excluded from the benefits of injecting foam.

Nevertheless, in spite of all the less invasive treatment options, patients

that suffer from venous thrombosis have a disabling problem with a long-
term pathological condition.

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