Understanding Varicose veins and Treatment by LASER Dr. Rajesh Mundhada (MD. DNB) Dr. Atul Rewatkar (MD) Orange city Hospital & Research Institute 19, Pandey Lay out, Veer Sawarkar Square, Nagpur 440015 Telephone: 9373103196, 9822571411, 0712 6635912 Email: dearrajesh1@yahoo.com, atulre@yahoo.com Fax: 0712 221152 Patient Education Booklet
Introduction Varicose veins are twisted, enlarged 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. For many people, varicose veins can cause aching pain and discomfort. For very few are simply a cosmetic concern. Sometimes the condition leads to more serious problems like cellulites, phlebitis and deep venous thrombosis (DVT). Varicose veins may also signal a higher risk of other disorders of the circulatory system. Varicose veins are dark purple or blue in color and may appear twisted and bulging like cords. They commonly appear on the backs of the calves or on the inside of the leg. However, they can form anywhere on your legs, from your groin to your ankle. Spider veins are similar to varicose veins, but they're smaller. Spider veins are found closer to the skin's surface and are often red or blue. They occur on the legs, but can also be found on the face. Spider veins vary in size and often look like a spider's web or a tree branch. Varicose veins is a very common condition in the India, affecting up to 25 percent of women and up to 15 percent of men. Causes and Risk factors for varicose veins Blood act as a media to circulate the nutrients to all the body tissues. Heart is the pump of the body which circulates 5 6 liters of blood in the body. The Arteries carry pure blood from your heart to the rest of your tissues. Veins return impure blood from the rest of your body to your heart, so the blood can be recirculated. To return blood to your heart, the veins in your legs must work against gravity. Muscle contractions in your lower legs act as pumps, while toned, elastic vein walls help blood return to your heart. Tiny one way valves in your veins open as blood flows toward your heart then close to stop blood from flowing backward down. The common causes for development of varicose veins are Sitting or standing for long periods (inactivity) People who have to work in sitting or standing posture for long periods like teachers,policemen, doctors, engineers, computer workers, housewives etc. can develop varicose veins as compared to others.
Obesity, Weight more than 15 % of your expected BMI, put more pressure on your legs and can aggravate development of varicose veins Aging, With ageing veins can lose elasticity, causing them to stretch. Aging cause s wear and tear on the valves in your veins eventually that wear causes the valves to malfunction allowing blood that should be moving toward your heart to flow backward. Thus dilatation and valve incompetence leads to faster development and worsening of the varicosities. Sex Women are more likely than men are to develop the condition because of the heredity, hormonal, pregnancy and obesity. Leg injury Leg injury directly or indirectly to the veins of the leg can traumatize valves and lead to early development of varicose veins Pregnancy Some pregnant women develop varicose veins. Pregnancy increases the volume of blood in your body, but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing fetus, but it can produce an unfortunate side effect enlarged veins in your legs. Varicose veins may surface for the first time or may worsen during late pregnancy, when your uterus exerts greater pressure on the veins in your legs. Smoking Smoking causes laxity of walls of the vein leading early development varicose veins as compared to non smokers as per the literature. Hormones (progesterone) Hormonal misbalances especially in the females tend to relax vein walls, obesity and incompetent valves which further are responsible for the development of varicose veins. Taking hormone replacement therapy or birth control pills may increase your risk of varicose veins. Heredity (being born with weak vein valves) Varicose veins can run in your family. If your parents are suffering from varicose veins then the chances having the disease is 60 90 % in females and 40 60 % in males.
DVT Thrombosed (blood clotting) deep veins of the legs cause extra burden on the superficial veins leading to their dilatation and varicose vein formation. Signs and symptoms In initial phase No discomfort / pain. In later state Prominent dilated and tortuous veins. They can become painful and following signs and symptoms do occur, they may include: An achy or heavy feeling in your legs, with burning, throbbing, muscle cramping Swelling in your lower legs. Prolonged sitting or standing tends to make your legs feel heavy and worse. Itching around one or more of your veins. Hyperpigmentation (blackening) of skin in lower legs. Skin ulcers near your ankle, which represent a severe form of vascular disease and require immediate attention. Complications Extremely painful ulcers may form on the skin near varicose veins, particularly near the ankles. Ulcers are the result of long term "water logging" of these tissues, caused by increased pressure of blood within affected veins. Brownish pigmentation usually precedes the development of an ulcer. See your doctor immediately if you suspect you've developed an ulcer. Occasionally, veins deep within the legs become enlarged. In such cases, the affected leg may swell considerably. Any sudden leg swelling warrants urgent medical attention because it may indicate a blood clot a condition known medically as thrombophlebitis. When to seek medical advice Self help measures can help you ease the pain of varicose veins and may prevent them from getting worse. But if you're concerned about how your veins look and feel and selfcare measures haven't stopped your condition from getting worse, see your doctor. Screening and diagnosis In making a diagnosis, your doctor will examine your legs while you're standing and will look for swelling. He or she may also ask you to describe the pain and aching in your
legs. Finally, your doctor may perform an ultrasound Doppler test to see if the valves in your veins are functioning normally or if there's any evidence of a blood clot. Treatment Fortunately, treatment usually doesn't mean a hospital stay or a long, uncomfortable recovery. Less invasive techniques generally allow varicose veins to be dealt with on an outpatient basis. Self help measures such as exercising, losing weight, not wearing tight clothes, elevating your legs and avoiding long periods of standing or sitting can ease pain and prevent varicose veins from getting worse. Varicose veins that develop during pregnancy generally improve without medical treatment within three months after delivery. If you don't respond to self help or if your condition is more severe, your doctor may advise one of these varicose vein treatments: Vein stripping. This procedure involves removing a long superficial vein through surgical incisions followed by large and many scars. Removing the vein won't affect circulation in your leg because veins deeper in the leg take care of the larger volumes of blood. The success rate of the surgery with time has proved to be very less with very early recurrence. Ambulatory phlebectomy Your doctor removes smaller varicose veins through a series of tiny skin punctures. Local anesthesia is used in this outpatient procedure. Scarring is generally minimal. Endoscopic vein surgery. You might need this operation only in an advanced case involving leg ulcers. Your surgeon uses a thin video camera inserted in your leg to visualize and close varicose veins, and then removes the veins through small incisions. Sclerotherapy. In this procedure, your doctor injects small and medium sized varicose veins with a solution that scars and closes those veins. In a few weeks, treated varicose veins should fade. Although the same vein may need to be injected more than once, sclerotherapy is painful, only effective in smaller veins and recurrence is very common. Radiofrequency Occlusion. The RF Closure procedure is a treatment alternative to surgical stripping of the greater saphenous vein. A small catheter is inserted, usually through a needle stick in the skin, into the damaged vein. The catheter delivers radiofrequency energy to the vein wall, causing it to heat. As the vein warms, it collapses and seals shut. The procedure is generally done in an outpatient or in office setting. It may be done under local anesthesia. Following the procedure, the catheter is removed and a bandage or compression stocking is placed on the treated leg.
Endovenous Laser Therapy (EVLT) is a safe and simple varicose vein treatment that closes varicose veins without surgery. Doctors are using new technology in laser treatments to close varicose veins of all sizes and all nature and spider veins. With EVLT, a laser is threaded through a tiny incision and through the full length of the varicose vein. As the laser is slowly withdrawn, heat is applied to the vein walls, causing the vein to permanently close and disappear. The body then reroutes the blood to healthier veins. No other tissue in the legs is affected. This procedure is FDA approved for the treatment of varicose veins. ENDOVENOUS LASER THERAPY (EVLT) FOR VARICOSE VEINS Preparation for the procedure: Procedure : Post Procedure Care: Complications : Advantages : Laser treatment works by sending laser energy into the dilated vein, which heats up and burns the veins from inside and dries and destroys it in its complete course. Under sonography guidance access into the dilated abnormal large veins as well as branch and tributary veins and incompetent perforators (bridging veins between deep and superficial veins) are taken as per seen on USG/ Doppler. The laser fiber is passed through out the course of the accessed vein and tip of the laser fiber is parked away from the deep veins. Further the procedure is carried out under perivenous local anaesthesia (tumescent anesthesia) with the help of small needle pricks. With the delivery of Laser energy at the tip, heat is generated which destroys the vein by causing it to collapse and seal shut. Thus all the abnormal dilated tortuous veins are burnt off. These burnt veins heal with fibrosis (permanent sticking) and thus abnormal superficial veins are taken out of circulation.
Advantages of LASER Treatment : Minimally invasive Outpatient procedure. immediate back to work Very high success rate Very low recurrence and complication rate The procedure is outpatient and patient starts work immediately. Catheter assisted procedures. In one of these treatments, your doctor inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter. As the catheter is pulled out, the heat. This procedure is usually done for larger varicose veins. Be a cautious consumer When it comes to treatment options for varicose veins, it pays to be a cautious health consumer. Advertisements claiming "unique," "permanent" or "painless" methods to remove varicose veins may be appealing, but they may not actually measure up to those claims. Before undergoing any procedure, ask your doctor about any health risks and possible side effects. You may want to inquire about treatment costs, as well. Most insurance policies don't cover the expense of elective cosmetic surgery for varicose veins. However, in many cases, if you have signs or symptoms such as swelling and bleeding, insurance may cover the treatment. Current treatments for varicose veins and spider veins are highly successful. However, it's possible that varicose veins can recur. Prevention There's no way to completely prevent varicose veins. But improving your circulation and muscle tone can reduce your risk of developing varicose veins or getting additional ones. Traditional, common sense approaches include: Exercise. Get your legs moving. Walking is a great way to encourage blood circulation in your legs. Your doctor can recommend an appropriate activity level for you. Watch your weight, and your diet. Shedding excess pounds takes unnecessary pressure off your veins. What you eat makes a difference, too. Follow a low salt,
high fiber diet to prevent the swelling that may result from water retention and constipation. Watch what you wear. Avoid high heels. Low heeled shoes work calf muscles more, which is better for your veins. Don't wear tight clothes around your waist, legs or groin. Tight panty leg girdles, for instance, can restrict circulation. Elevate your legs. To improve venous circulation, take several short breaks daily to elevate your legs above the level of your heart. For example, lie down with your legs resting on three or four pillows. Avoid long periods of sitting or standing. Make a point of changing your position frequently to encourage blood flow. Try to move around at least every 30 minutes. Don't sit with your legs crossed. This position can aggravate circulation problems Self care Wearing compression stockings is often the first approach to try before moving on to other treatments. Compression stockings are worn all day. They steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by type and brand. Stockings today come in a variety of strengths, styles and colors. With the variety offered, you're likely to find a stocking that you're comfortable wearing. You can buy compression stockings at most pharmacies and medical supply stores. Prices vary. Prescription strength stockings also are available. When purchasing compression stockings, make sure that they fit properly. Using a tape measure, you or your pharmacist can measure your legs to ensure you get the right size and fit according to the size chart found on the stocking package. Compression stockings should be strong but not necessarily tight. If you have weak hands or arthritis, getting these stockings on may be difficult. There are devices to make putting them on easier.