Treatment
Treatment Expectations
Treatment of varicose and spider vein disease is an ongoing process. This is particularly true of patients who are taking estrogen supplements such as birth control pills or hormone replacement therapy. It is important that the expectations of treatment are understood. Clearly, if a vein is removed surgically, or by ambulatory phlebectomy, that particular vein will not recur. However, others may form. I liken the expectations of injection sclerotherapy to going to the dentist. When first seen, the dentist may have to repair your teeth. This is the equivalent of having large symptomatic veins injected. Your teeth are then cleaned and flossed, which compares to the treatment of smaller reticular and spider veins. Afterwards, periodic checkups are needed. Then a new filling may be needed or existing fillings replaced. Some cleaning and flossing is done. Sclerotherapy follows the same pattern. Just as in dentistry, periodic checkups keep the disease under control and seldom involve the amount of treatment needed at the beginning. In dentistry you know ongoing flossing and cleaning plays a very important role. Similarly, preventative care plays a role in varicose veins.
Assessment - Diagnostic Ultrasound
Ultrasound is being used more and more to accurately diagnose of the cause of varicose veins. A hand held Doppler is used during initial assessment of your veins at the clinic. The hand held Doppler is really just a screening tool. In more complex cases Duplex Ultrasound testing in the Diagnostic Imaging Department at St. Joseph’s Hospital will be used. This gives a much better ultrasound assessment and allows Dr. Trusdale to see the flow of the blood in the individual veins. The new ultrasound machine at St Joseph’ s Hospital is the latest in technology. It enables one to see the direction of blood flow in colour, as well as hearing it. Duplex Ultrasonography is used particularly to assess patients with recurrent varicose veins after injections or surgery. It is also used to establish whether surgery is necessary and to assist the surgeons in mapping veins. This technique has been developed from the more traditional use of the Doppler - testing for blood clots in the deep veins. It can be used to show valve function and blood flow in the deep and superficial veins of the legs. It has been fascinating to see the causes of varicose veins reveal themselves on the Duplex. It is playing an increasingly important role in the modern treatment of varicose veins.
Ambulatory Phlebectomy
• History
This technique was first performed by Robert Muller in Switzerland in 1956. It was pioneered in North America by physicians, including a Montreal group, in the late 1980’s. Ambulatory Phlebectomy has been refined and is increasingly being used in addition to traditional surgery and sclerotherapy. It is another option in a balanced approach to the treatment of varicose veins.
• What is Ambulatory Phlebectomy?
The technique involves removing selected veins through tiny punctures in the skin. The vein is extracted using a hook, designed by Dr. Muller. The procedure is done as an outpatient under local anesthetic . On average it takes less than half an hour. The patient is able to walk in and out of the treatment. After treatment they must wear a compression stocking or special bandages . No sedation is necessary.
• Is it painful?
The anaesthetic is similar to that used for stitches in emergency or "freezing" at the dentist. It may cause transient discomfort similar to that of injection sclerotherapy. The procedure itself should be relatively painless, although sensations of tugging may be felt. After the procedure there may be some mild discomfort for a few days. This should not interfer with regular activities.
• Complications
Bruising is to be expected. Bleeding and local haematoma can occur. They are unusual if adequate compression is used. Occasionally numbness around the removal site can occur if a superficial nerve is damaged. Such numbness often goes away. Rarely it can be permanent. Deep Venous Thrombosis [DVT] is a rare complication. This blood clot in the deep veins of the leg may move to the lungs casuing a pulmonary embolus, which can be life threatening. As in any surgical procedure infection, allergies and skin reactions can occur.
• Advantages
Aesthetically the small punctures mean little, or no, scarring.
This leads to less infection than traditional surgery. The vein is permanently removed and therefore cannot recur. The patient is able to return to normal life very quickly, simply wearing the compression stocking. It decreases the risks of inflamation of the veins and skin colour changes, seen occasinally with injections.
• Which veins can be treated?
The largest veins in the legs [long and short saphenous] still often need some kind of conventional surgery if they are diseased. Sclerotherapy remains the treatment of choice in most other veins. Ambulatory phlebectomy is most useful on relatively large "non saphenous" veins. In selected cases this technique is very useful and may be offered as part of an overall treatment plan.
• Cost
Ontario's Provincial Health Plan [OHIP] covers the cost if the vein is diseased and causing symptoms. The cost of the stocking, used after the procedure, is the patient's responsibility. Most private insurance [drug] plans will pay for the stocking.
Please feel free to ask any other questions you may have on this technique.
Sclerotherapy
Sclerotherapy involves injecting with a needle, a medication that irritates the walls of the vein. This irritation causes an inflammation, which results in the veins collapsing. The vein then remains closed and is absorbed by the body over a period of time.
Compression
Compression continues to be a most important word in treatment, management, and ongoing care of varicose veins. Wearing the proper graduated compression stockings makes your legs feel better, helps treatment succeed, and decreases the rate of recurrence of large and small veins. It is important that you realize compression stockings are not the same as support stockings. It is graduated compression which help your veins. Other forms of compression such as tensor bandages, special pressure dressings, and boots may be recommended to patients with complications from their veins or during treatment. Please feel free to ask me or my staff, at any time, about the correct type of compression for your legs. I have devised a special form to prescribe compression stockings. It explains where you can get them and outlines the reasons why you need them. This is often needed for insurance purposes.
|
