New treatments for vein problems
Introduction
Recently
several new techniques have been reported in the
medical literature. The main aim of these is to
avoid surgical removal of varicose veins. The
idea is to avoid the need for general anaesthetic,
incisions in the legs and a hospital operating
theatre. Some of the methods summarised below
only partially succeed in this aim.
Treatments
for large varicose veins
VNUS
closure
VNUS
Closure (http://www.vnus.com)
uses a wire passed along the vein from the knee
or calf towards the groin to treat large varicose
veins in the thigh. The progress of the wire is
monitored using ultrasound imaging. When the wire
is in position the end of the catheter is heated
electrically and the vein is destroyed. Gradually
the wire is removed from the leg until all of
the diseased vein is destroyed.
Good
points
Stripping
of the vein is avoided and there is less discomfort
and bruising after the operation.
Bad
points
This
technique involves heating the vein which is
painful unless local anaesthetic is injected
around the vein or the operation is done under
general anaesthetic.
In
the UK this procedure is usually done under general
anaesthetic in an operating theatre.
The cost is considerably greater than for varicose
vein surgery due to the extra expense of the equipment.
This method can only be used to treat the major
superficial veins. Incisions must still be made
in the leg to remove prominent varicose veins.
VNUS Closure is generally unsuitable for the
treatment of recurrent varicose veins following
previous surgery.
Thermal damage to nerves in the skin may occur
due to the heating effects of the treatment.
Endo-venous
laser
treatment (EVLT) of varicose veins
This
method is similar to the VNUS Closure
technique, but this time a laser fibre is passed
along the vein from the knee or calf towards
the
groin to treat large varicose veins in the thigh.
The progress of the wire is monitored using
ultrasound
imaging. When the laser fibre is in position
the laser is fired to heat the vein. The vein
near
the end of the laser fibre is destroyed. Gradually
the wire is removed from the leg until all
of
the diseased vein is destroyed.
Good
points
Stripping
of the vein is avoided and there is less discomfort
after the operation. There is less bruising than
following surgery, but more than after the VNUS
Closure method.
Bad
points
This technique involves heating the vein which
is painful unless local anaesthetic is injected
around the vein or the operation is done under
general anaesthetic.
In the UK this procedure is usually done under
general anaesthetic in an operating theatre.
The cost is considerably greater than for varicose
vein surgery due to the extra expense of the
equipment and fibre.
This method can only be used to treat the major
superficial veins. Incisions must still be made
in the leg to remove prominent varicose veins.
EVLT is generally unsuitable for the treatment
of recurrent varicose veins following previous
surgery.
Thermal damage to nerves in the skin may occur due to the heating effects of
the treatment.
Ultrasound
guided foam sclerotherapy
This
method is used as an alternative to surgery for
large varicose veins. The main surface is vein
is injected with a special foam under ultrasound
guidance. The foam destroys the lining of the
vein and a firm bandage is applied to the leg.
This type of injection is suitable for treating
the main surface veins as well as varicose veins.
The procedure does not require an operating theatre
and is usually carried out in a consulting room
or treatment room. The injection causes only trivial
discomfort.
Good
points
Stripping
of the vein is avoided and there is little or
no discomfort after treatment.
There is less bruising than following surgery.
There is no need for general anaesthetic, incisions
in the leg or an operating theatre.
Re-treatment for further varices is simple.
The cost of treatment is much less than for surgical
treatment or for either VNUS Closure or Laser
treatment.
Bad
points
Stripping of the vein is avoided and there is
little or no discomfort after treatment.
There is less bruising than following surgery.
There is no need for general anaesthetic, incisions
in the leg or an operating theatre.
Re-treatment for further varices is simple.
Recurrent varicose veins following previous surgery
are readily treated.
Most varicose veins can be managed in this way.
The cost of foam treatment is much less than
for surgical treatment or for either VNUS Closure
or Laser treatment.
Thread
veins and small varicose veins
Creams
and pills
A
range of creams to rub on thread veins and pills
to treat vein problems is advertised from a number
of sources.
Good
points
Some
of the pills may reduce aching from varicose veins.
Bad
points
No
medication of any type removes varicose veins
- whatever the suppliers may say!
Laser treatment for thread veins
This works well on the face and upper body. In
the legs it is much less effective than injection
treatment. The world’s leading vein experts
do not use lasers in the management of thread
veins on the legs.
Conclusions
-
There is no magic treatment for varicose veins!
- Surgical
treatment is an established, effective treatment
for large varicose veins.
- Microsclerotherapy
is the best available treatment for thread veins
and small varices.
- VNUS
Closure and Laser Treatment are alternatives
for large varicose veins. These methods reduce
the extent of incisions made in the legs as
well as post-operative bruising. They are more
expensive than surgical treatment.
- Ultrasound
guided foam sclerotherapy is useful in patients
who wish to avoid surgery altogether. The final
outcome will take a little longer to achieve
but admission to hospital and general anaesthesia
are not needed. This is very inexpensive compared
to surgery.
Several of the new methods are available at
our centres. Please ask for details.
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