October 9, 2007
Dr Sibasankar Dalai
Mob: +91 93485 11177
Newindpress.com
The aim of varicose vein treatment by any method (surgical or non-surgical) is to close or remove the diseased and incompetent superficial varicose vein.
Since most of the blood in the legs is returned to heart by the deep veins, and the superficial veins only return about 10 per cent, they can be sacrificed without serious harm.
Elevating the legs provides relief. Regular exercise has not shown to cure varicose vein. The wearing of graduated compression stockings with a pressure of 30-40 mmHg has been shown to provide temporary relief from the leg swelling. Anti-inflammatory medication such as ibuprofen or aspirin can be used as part of treatment for superficial thrombophlebitis along with graduated compression stockings.
Open Surgery
Traditionally, open surgery was the only choice for treatment of varicose vein till few years. It involved stripping the diseased varicose vein from the body. This operation is done under general anaesthesia as an inpatient procedure.
Multiple cuts are made on the legs at various places starting from the groin till the ankle. The vein is stripped through the open cuts.
This usually is a prolonged surgery with blood transfusion. Patient is admitted in the hospital for about five days. The post-operative period is often painful with risk of bleeding from the incision sites. Multiple surgical scars on the legs are produced due to surgery. The patient is advised rest for a period of six weeks following surgery.
The higher rate of deep vein thrombosis, pulmonary embolism, and wound complications including infection and bleeding are discouraging for a patient to undergo open surgery for varicose vein.
The open surgery has a high recurrence rate (five to 60 per cent), and a risk of nerve damage up to 15 per cent. Hence now open surgery for varicose vein is less commonly performed worldwide.
Endovenous Laser Ablation
Recent advances have improved lasers, making laser surgery a preferred method of treatment for varicose vein. By LASER, the whole lining of the diseased superficial varicose vein is destroyed, and hence a chance for new collateral veins to grow is almost zero.
The Laser energy seals the abnormal vein completely and permanently. The most modern 1470 nm diode laser system produces the highly wavelength, which safely passes through the skin and is selectively absorbed by the targeted blood vessel. The vein will gradually disappear, leaving the skin intact. Sclerotherapy may be then done on the remaining varicose veins. A crepe bandage is applied on the leg for 48 hours continuously.
The patient will be advised oral pain killer for five days following the procedure. Crepe bandage or stockings are worn for a couple of weeks on the calf from morning to evening. A monthly follow-up twice with Doppler scan following the LASER ablation of varicose vein is recommended. With open surgery- stripping plus sclerotherapy varicose veins reappear in about 30 per cent and for sclerotherapy alone the recurrence rate is more than 70 per cent.
Advantages
The advantages of endovenous LASER ablation are many. Due to the optimal absorption spectrum of 1470 nm, the veins get closed in without affecting the neighboring tissue. The closed vein remains in its natural position in the body, which reduces the invasiveness of surgery to a minimum.
The procedure is done under local anaesthesia, and there is no risk of blood transfusion. The patient does not require postoperative rest, and can resume routine activities on the next day of the procedure. The treatment duration is just about half an hour. Also, there is reduced risk of infection.
Side-Effects
The Laser Ablation for varicose vein is well tolerated and has few side-effects. Some patients may experience a slight ache along the shrunken veins, for which local cooling and anti-inflammatory drugs will provide quick relief. Some patients may experience bruising or paraesthesia, which are self-limiting in a few days time.
Radio Frequency Ablation
Radio frequency ablation of varicose vein is less invasive than open surgery, but more invasive than LASER ablation and recurrence rates are lower than open surgery but higher than LASER ablation. Not many centers across the world are now practicing RF ablation for varicose vein treatment after the advent of LASER as a modality to treat varicose vein.
Sclerotherapy
Sclerotherapy is a non-surgical approach in the treatment of varicose and spider veins of the legs.
A sclerosing solution is injected directly into the vein, causing it to quickly disappear. It has a recurrence rate as high as 70 per cent. It is never used as a sole method of treatment for varicose vein. It can be an added therapy with other mainstay treatment.
Prevention
Varicose vein is prevented by avoiding prolonged standing. Sitting for a few minutes during prolonged standing helps prevent the disease. A good compression stocking (pressure gradient of 30 to 40 mm Hg) should be worn by persons who stands for a prolonged period routinely. Consult a doctor if any of the symptoms of varicose vein is noted.
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Jaques says: | 2009-07-25 21:27:07 |
| Great Article | ||
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