May 12, 2007

All in vein How does the minimally invasive treatment of varicose veins evolve? Is sclerotherapy a promising therapeutic alternative? Will the trend to treatment at ambulatory outpatient surgery centers continue? What are the primary forms of therapies for venous varicosities? Venous insufficiency is a very common condition resulting from valvular dysfunction and consequently poor venous return to the heart with pooling

of blood in the leg veins (called reflux). The bad news: patients with superficial venous reflux may develop varicose veins. The good news: the number of minimally invasive varicose vein procedures performed in the USA increases every year. Radiofrequency venous ablation allows early intervention and replaces traditional vein stripping surgery with the help of a catheter that is inserted into the vein, using a single needle stick. Under ultrasound vision the catheter delivers radiofrequency energy to the vein wall, causing it to collapse, and seal shut. The advantages: less post-procedural complications with pain or leg numbness, less damage or irritation of the nerves, and better cosmetic results (no scar surgery). However the risk of recurrence is not eliminated. Endovenous laser treatment is yet another treatment option for large, bulging varicose veins. Again under local anaesthesia, and ultrasound vision, a small catheter is inserted into the vein and laser energy is delivered through the fiber into the vein, causing the vein to seal. A relatively new treatment of proximal venous occlusion with endoluminal therapy, involves the fine needle injection of a solution (sclerotherapy) into the lumen of varicose veins and even small spider veins which causes the veins to shrink. The treatment is performed as an outpatient hospital procedure under local anesthesia with ultrasound guidance and takes about an hour. The bad news: after shaking the sclerosant with air, the foam can predispose to superficial thrombophlebitis. Patients with incomplete saphenofemoral junction/great saphenous vein ligation or pelvic veins have the need for a safe and permanent yet less invasive way to do the ligation because the presence of proximal reflux may decrease the positive results of foam treatment. A high tie could then be performed and the patients would not have to be excluded from the benefits of injecting foam. Nevertheless, in spite of all the less invasive treatment options, patients that suffer from venous thrombosis have a disabling problem with a longterm pathological condition. www.IdeasForSurgery.com - Further the future ain t what it used to be
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