Non Surgical Treatment for Varicose Veins

The word "varicose" comes from the Latin root "varix," which means "twisted." Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins in your lower body.

The veins of the legs are divided into two systems - the deep veins (which run deep to the leathery layer of fascia surrounding the muscles) and the superficial veins (which run in the layer of fat just beneath the skin). The superficial veins are the ones that you can see (for example, on your foot or around the ankle) and they are the ones that can become varicose. It is essential to keep in mind these two different systems - deep and superficial - in order to understand varicose veins and their treatment. In a number of places in the leg, the superficial and deep veins are linked by perforating veins (or 'perforators'). They are called perforators because they perforate the leathery fascial layer surrounding the muscles of the legs. Normally their valves should allow blood to flow only inwards - from the superficial veins to the deep veins. If the valves stop working properly, then blood is pushed out into the superficial veins when the muscles contract: this is one reason for high pressure in the superficial veins, and can be a cause of varicose veins.

The blood in your leg veins must work against gravity to return to your heart. To help move blood back to your heart, your leg muscles squeeze the deep veins of your legs and feet. One-way flaps called valves in your veins keep blood flowing in the right direction. When your leg muscles contract, the valves inside your veins open. When your legs relax, the valves close. This prevents blood from flowing backward. However, when these valves do not function properly, the blood pools, pressure builds up, and the veins become weakened, enlarged, and twisted. This causes varicose veins to develop. Varicose veins develop when one has faulty valves in the veins and weakened vein walls. These veins are twisted, enlarged veins close to the surface of the skin. They usually develop in the legs and ankles.

Comfortable and sedentary life-style, modern fashion, special postures adopted while performing professional duties have contributed to increased incidence of a set of diseases unheard of in the past. Varicose vein disease is one of them and is a direct result of sedentary life-style. The problem has become very common during these days. According to one estimate, 15 to 20 per cent of the population in India is suffering from varicose vein disease these days. Women suffer from this disease four times more than men. There is an increased risk of the development of varicose vein among young females who wear tight jeans and high-heeled sandals.

The most common presenting with symptoms:

• Pain (some time on & off).

• Swelling more prominent in end of day.

• Heaviness in leg.

• Fatigue.

• Prominent & dilated veins in leg veins.

• Pigmentation.

• Venous ulcer.

How is it diagnosed?

Varicose veins are arguably the most frequently referred general surgical malady presenting to hospitals. Varicose veins are often caused by an underlying problem in leg vein.

General examination

First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. Your physician will examine the texture and color of any prominent veins. He or she may apply a tourniquet or direct hand pressure to observe how your veins fill with blood. So the diagnosis is based primarily on the characteristic appearance of the legs when the patient is standing or is seated with the legs dangling.

Uplex ultrasound exam

At times a physician may order a duplex ultrasound exam of extremity to see blood flow and characterize the vessels, and to rule out other disorders of the legs. Duplex ultrasound uses high-frequency waves higher than human hearing can detect. Your physician uses duplex ultrasound to measure the speed of blood flow and to see the structure of your leg veins. The test can take approximately 20 minutes for each leg.

Angiography

Rarely, an angiography of the legs may be performed to rule out other disorders.

Endovenous Laser Ablation (EVLT) / Radio Frequency Ablation (RFA)

Radiofrequency ablation (RFA) is the latest and most effective, patient friendly and non-surgical treatment for varicose vein using Multipolar RFA machine. Under color-doppler ultrasound vision, a radiofrequency catheter is inserted into the abnormal vein and the vessel treated with radio-energy, resulting is closure of the involved vein.

The interventional radiologist (are uniquely skilled in using the vascular system to deliver targeted treatments throughout the body without surgery) accesses the abnormal saphenous vein just above ankle or below the knee percutaneously through a small cannula in abnormal vein. Ablation uses a thin, flexible tube called a catheter with tiny electrodes at the tip of the catheter, which heat the walls of the varicose vein, and collapses the thick veins

Advantages of Non Surgical EVLT/ RFA Varicose Veins Treatment

1. It is less risky as compared to surgery.

2. Needs no general anesthesia.

3. No Surgical scar on skin.

4. Done as a Day Care procedure with no overnight hospital stay necessary.

5. No blood loss or risk of blood transfusion.

6. The recovery is very fast as compared to traditional surgery.

7. The recurrence rate is very low as compared to conventional surgery.

8. Normal activities like long distance walking, running, standing can be resumed within 1-2 days.

Sclerotherapy

This form of treatment is a non-surgical procedure in which a solution is injected into the problem varicose veins or spider veins in order to cause its disappearance.A chemical irritant can be injected into veins, although large veins are difficult to treat using this method, as the chemical has to physically come in contact with the lining of the target vein for long enough to destroy it. Sclerotherapy works by burning the lining of the vein, which causes the vessel to spasm and block off with clot. The idea is to make the vein shrivel away by scarring. Unfortunately, the clot often clears away, allowing the scarred vessel to open up again.

Subfacial Endoscopic Perforator Surgery (SEPS) is a minimally invasive surgical procedure which the doctors use to treat the underlying condition that causes venous ulcers. During the procedure they disconnect the abnormal perforator veins, which cause ulceration because of improperly functioning valves. By disconnecting these veins, they redirect the blood flow to healthy veins. Circulation in the leg is improved, and the ulcer is healed.

SEPS is usually performed with two ports of entry into the leg. A special instrument is inserted deep to the fascia of the leg and a large balloon is inflated with water to create a working space. The balloon is then emptied and the space is insufflated with air. The camera is inserted and the perforator veins can be seen in the space passing from superficial to deep layers. Another small incision is made in the calf for passage of another instrument. The perforator veins are carefully dissected, clips are applied and the veins are divided if necessary. Perforating veins are then divided with endoscopic scissors. Metal clips are placed on the cut ends of the vein to avoid bleeding. Another option to interrupt the vein is to use a harmonic scalpel, an instrument that uses ultrasonic waves to seal the cut end of the veins to avoid bleeding. All trocars are then removed and the wounds are closed. The leg is dressed with an ACE wrap.