January 24, 2012 > Varicose veins and the lunch-hour treatment
Varicose veins and the lunch-hour treatment
By Catherine Kirch
A new treatment for varicose veins is on the rise. So quick and relatively painless, some are calling it "the treatment you can get on your lunch break." An outpatient procedure, endovenous ablation treats uncomfortable and unsightly varicose veins in a matter of minutes.
"Venous insufficiency is a spectrum of disease," explains Dr. Ash Jain of California Cardiovascular Consultants. "Initial stages can be swelling, discomfort, pain, and cramping in the legs. As it progresses, you can see discoloration in the legs, varicose veins, and then ulcers in the severe stages." The treatment is for venous insufficiency, and most patients are referred when already in the later stages, when veins appear "ropy," but doctors like Jain can pick up on the disease earlier on. "If an ulcer causes an infection, that can been deadly, but overall the disease doesn't kill you; it just makes you miserable over time."
The venous system is quite complex, but fundamentally there are two systems: a deep system and a superficial system. The blood from the superficial system should flow into the deep system, and all of the blood should be flowing out of the leg and to the heart. Valves ensure that the blood is flowing in the right direction.
"What happens [in venous insufficiency]," says Dr. Jain, "is that these valves become incompetent. They don't close completely." When this occurs, blood can flow from the deep system into the superficial and away from the heart instead of towards it. "A lot of blood goes back to the leg, and only part goes to the heart. That is why people feel fatigued, swelling in the legs, and the other associated symptoms."
In the past, surgeons would remove the superficial veins in a painful process called stripping. With the new treatment, doctors insert a catheter into the superficial vein, heat it to 120 degrees, and cauterize the vein. "Once you cauterize it, it closes off after a few hours, so the blood can flow to the heart because there's no where else for it to go."
The technology is somewhat new - only about three years old - but the concept is not. Previously, doctors had used laser catheters to achieve the same end for the problematic superficial veins. Laser catheters, however, are "cumbersome, painful, and the results aren't as good." Dr. Jain explains that he did not use lasers, and waited a while before using the new catheter method. "I waited a good three years because I wanted the technology to evolve. I wanted to make sure, in my mind, that if you do the procedure, it helps the patient."
The catheter method of endovenous ablation takes about 15 to 20 minutes. Patients are given a pain pill and valium, as well as a cream anesthetic before the surgery, for which they are conscious. Following the procedure, patients are instructed to wear stockings and keep the leg elevated for a few weeks until the success of the treatment is verified. Those in advanced stages of the disease may have to wear stockings and elevate the leg for longer.
"I was afraid to do it," says Rosalind King, a patient of Dr. Jain's who had been suffering from venous insufficiency for over 40 years. She says of the procedure, "There was a little pain, but it wasn't that bad at all. It's amazing that it's that fast." Her leg felt better after the surgery, and she plans to go in again for treatment on her other leg. "As long as they don't hurt like they did, I'll be satisfied."
This treatment is not a cure, and it is not a permanent solution. "The blood needs to flow up," explains Dr. Jain. "If the deep system is not efficient enough and pressure rises in the deep system, it's going to flow back into the superficial system and more veins will be affected. If you catch disease early on, you can buy much more time." Dr. Jain advises both patients and primary care physicians to be attentive to this under-diagnosed and under-treated disease, as early diagnosis and treatment are both easier and longer lasting.
Venous insufficiency occurs when blood volume increases in the legs. For this reason, heart and liver failure patients, obese folk, women post-pregnancy, and people who stay standing for long periods of time are most susceptible to the disease. There is also a hereditary element.
Dr. Jain urges those most prone to be aware of their susceptibility. "Wear stockings, and if you have to stay on your feet, move around rather than standing in one place. If you move around, the calf muscles act as leg pumps so they keep the blood moving up in the right direction." The new procedure is both convenient and helpful, but prevention remains the best solution.