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Ecto Derma Polyclinic - Dental - Medical - Laser  Educational and Research Center

1085. Budapest, József krt.37.  Hungary  Tel.: +36 1 3178175 ; +36 1 2350024
Fax.: +36 1 2350025  Email:  titkarsag@ectoderma.hu recepcios@ectoderma.hu

postheadericon Treatment of veins

By the introduction of a new procedure at our Clinic such method is available for patients suffering from vein disease whereby re-narrowing of certain expanded veins through a little pin-prick is possible. With the use of this minimum invasive procedure, solving the problems of the patients in need can be helped in many cases.

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Laser surgery treatment of veins through a pin-prick performed with use of minimum invasive method. The 200 micron thin laser beam causes the expanded veins to shrink and re-narrow.

Interested in getting rid of your spider veins? Searching for the most modern medicine to help you become more confidant and alleviate symptoms related to spider veins? With modern medicine, there are always advancements and with venous health, it is no different. Modern laser technology is offering a number of health care alternatives that are minimally invasive, simple to use, and even more effective than former treatments.

For laser treatment spider veins, one need only seek out a professional vein specialist or vein doctor that is experienced in the field of vein removal. Since this field of medical care is quickly growing, finding a doctor that suits your needs, that you can trust, is rather simple. Laser treatment means no injections! The former sclerotherapy still offers a high success rate that has proven itself over time, yet laser treatments are fast becoming the solution of choice. Why is this?

For laser treatment spider veins, patients seek out a minimally invasive treatment which does not require down time and is an entirely out patient procedure. Furthermore, there are only minor side effects, such as bruising, swelling, a pain that feels like a rubber band snapping, and perhaps some burning after the laser is used. The procedure can be done in very little time and in only a few treatments, you are on your way to more beautiful skin. It is important to remember that spider veins are not permanently prevented from recurring with laser treatment. There are certain factors that contribute to the formation of spider veins and to keep the skin clear of them in the future, it is important to be aware of things that can be done to prevent them.

Since laser treatment of spider veins is considered an elective and cosmetic procedure, most health care insurance providers will not cover treatments. With this in mind, it is a great idea to become familiar with the financial commitment associated with laser treatment. You may ask about financing packages that are available if necessary. Each vein clinic offers different rates and each clinic is different. By understanding more about the treatment process, you can help to familiarize yourself with basic rates and get an idea of what to expect.

To help maintain skin that is free from spider veins, it is important to maintain a healthy diet and a routine that consists of regular exercise. Furthermore, weight gain and pressure on the legs can contribute to spider veins. Laser treatment spider veins can help eliminate already existing veins but it does not prevent them from occurring. Regular exercise and getting blood flowing through the veins in the legs and elsewhere is a great way to stay vein free. There are some genetic factors related to getting veins over time but that does not mean that you shouldn't start a vein healthy routine which helps to keep your heart and overall health in order. Overall, laser removal spider veins is a great way to eliminate any unwanted spider veins, but to keep them away, one must focus on adjusting to a more completely healthy lifestyle that involves the veins throughout the body.

Varicose veins are veins that have become enlarged and twisted. Carl Arnold Ruge is credited with having first defined varicose veins as "any dilated, elongated and tortuous vein irrespective of size". The term commonly refers to the veins on the leg, although varicose veins occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards (retrograde). Leg muscles pump the veins to return blood to the heart. When veins become enlarged, the leaflets of the valves no longer meet properly, and the valves don't work. One cause of valve failure is deep vein thrombosis (DVT), which can cause permanent damage to the valves. The blood collects in the veins and they enlarge even more. Varicose veins are common in the superficial veins of the legs, which are subject to high pressure when standing. Besides cosmetic problems, varicose veins are often painful, especially when standing or walking. They often itch, and scratching them can cause ulcers. Serious complications are rare. Non-surgical treatments include sclerotherapy, elastic stockings, elevating the legs, and exercise. The traditional surgical treatment has been vein stripping to remove the affected veins. Newer, less invasive treatments, such as radiofrequency ablation and endovenous laser treatment, are slowly replacing traditional surgical treatments. Because most of the blood in the legs is returned by the deep veins, the superficial veins, which return only about 10 per cent of the total blood of the legs, can usually be removed or ablated without serious harm. Varicose veins are distinguished from reticular veins (blue veins) and telangiectasias (spider veins), which also involve valvular insufficiency, by the size and location of the veins.

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Symptoms

  • Aching, heavy legs (often worse at night and after exercise).
  • Appearance of spider veins (telangiectasia) in the affected leg.
  • Ankle swelling.
  • A brownish-blue shiny skin discoloration near the affected veins.
  • Redness, dryness, and itchiness of areas of skin - termed stasis dermatitis or venous eczema, because of waste products building up in the leg.
  • Minor injuries to the area may bleed more than normal and/or take a long time to heal.
  • In some people the skin above the ankle may shrink (lipodermatosclerosis) because the fat underneath the skin becomes hard.
  • Restless legs syndrome appears to be a common overlapping clinical syndrome in patients with varicose veins and other chronic venous insufficiency.
  • Whitened irregular "scar-like" patches can appear, especially at the ankles, "atrophie blanche".

Complications

Most varicose veins are relatively benign, but severe varicosities can lead to major complications, due to the poor circulation through the affected limb.

  • Pain, heaviness, inability to walk or stand for long hours thus hindering work
  • Skin conditions / Dermatitis which could predispose skin loss
  • Skin ulcers especially near the ankle, usually referred to as venous ulcers.
  • Development of carcinoma or sarcoma in longstanding venous ulcers. There have been over 100 reported cases of malignant transformation and the rate is reported as 0.4% to 1%.[5]
  • Severe bleeding from minor trauma, of particular concern in the elderly.
  • Blood clotting within affected veins. Termed superficial thrombophlebitis. These are frequently isolated to the superficial veins, but can extend into deep veins becoming a more serious problem.
  • Acute fat necrosis can occur, especially at the ankle of overweight patients with varicose veins. Females are more frequently affected than males.

Etiology/Epidemiology

Varicose veins are more common in women than in men, and are linked with heredity. Other related factors are pregnancy, obesity, menopause, aging, prolonged standing, leg injury and abdominal straining. Varicose veins are bulging veins that are larger than spider veins, typically 3 mm or more in diameter.
Less commonly, but not exceptionally, varicose veins can be due to other causes, as post phlebitic obstruction and/or incompetence, venous and arteriovenous malformations.

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Conservative treatment

The symptoms of varicose veins can be controlled to an extent with the following:

  • Elevating the legs often provides temporary symptomatic relief.
  • "Advice about regular exercise sounds sensible but is not supported by any evidence."
  • The wearing of graduated compression stockings with a pressure of 30-40 mmHg has been shown to correct the swelling, nutritional exchange, and improve the microcirculation in legs affected by varicose veins. They also often provide relief from the discomfort associated with this disease. Caution should be exercised in their use in patients with concurrent arterial disease.
  • Anti-inflammatory medication such as ibuprofen or aspirin can be used as part of treatment for superficial thrombophlebitis along with graduated compression hosiery - but there is a risk of intestinal bleeding. In extensive superficial thrombophlebitis, consideration should be given to anti-coagulation, thrombectomy or sclerotherapy of the involved vein.
  • Diosmin 95 is a dietary supplement distributed in the U.S. by Nutratech, Inc. The U.S. Food and Drug Administration do not approve dietary supplements, and concluded that there was an "inadequate basis for reasonable expectation of safety." 

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  • Interventional treatment
  • Active medical intervention in varicose veins can be divided into surgical and non-surgical treatments. Some doctors favor traditional open surgery, while others prefer the newer methods. Newer methods for treating varicose veins, such as endovenous laser treatment (EVLT), radiofrequency ablation, and foam sclerotherapy are not as well studied, especially in the longer term.

Surgical treatment

Several techniques have been performed for over a century, from the more invasive named "saphenous stripping" up to mini invasives like superficial phlectomies and CHIVA cure.

Stripping

Stripping consists in a removal of all the saphena vein main trunk from the groin down to the ankle. The complications include deep vein thrombosis (5.3%), pulmonary embolism (0.06%), and wound complications including infection (2.2%). For traditional surgery, reported recurrence rates, which have been tracked for 10 years, range from 5-60%. In addition, since stripping removes the saphenous main trunks, they are no longer available for venous by-pass in the future (coronary and/or leg artery vital disease.

CHIVA

CHIVA is the acronym for Conservative and Haemodynamic cure of Incompetent Varicose veins in Ambulatory patients translated from the French cure "Conservatrice et Hémodynamique de l'Insuffisance Veineuse en Ambulatoire" published in France in 1988. Lurie in his analysis of Chiva states that "CHIVA definitely falls into a research category and should be continued as such until sufficient evidence of its validity is generated". 

Pathophysiological principles

To be achieved properly, the CHIVA method needs a comprehensive knowledge of both hemodynamics and Ultrasound venous investigation. CHIVA relies on a hemodynamic impairment assessed by data and evidences depicted through Ultrasound dynamic venous investigations. According to this new concept, the clinical symptoms of venous insufficiency are not the cause but the consequence of various abnormalities of the venous system. For example,a varicose vein being overloaded, may be dilated not only because of valvular incompetence (the most frequent) but because of a venous block (thombosis) or arterio-venous fistulae... and so the treatment has to be tailored according the hemodynamic feature. 

Procedure and outcomes

It generally consists in 1 to 4 small incisions under local anesthesia in order to disconnect the varicose veins from the abnormal flow due to valvular incompetence which dilates them.[18] The patient is dismissed the same day. This method leads to an improvement of the venous function in order to:

  • Cure the symptoms of venous insufficiency as varicose veins, legs swelling, ulcers.
  • Prevent varicose recurrence due to progressive enlargement of collateral veins which replace and overtake the destroyed veins: CHIVA vs Stripping: varicose recurrence divided by 2 to 5 at 10 years.
  • Preserve the superficial venous capital for unpredictable but possible need for coronary or leg artery vital by-pass which increases with ageing.

Unfortunately at this stage, the best available publication of CHIVA outcomes that meets current methological standards is a study by Carandina et al. The authors estimate that only 30-35% of patients with varicose veins can be treated with CHIVA. This study showed that there were recurrent varices in 18% of cases treated by CHIVA despite there being some bias in the selection of patients favoring CHIVA.

Non-surgical treatment

Sclerotherapy

A commonly performed non-surgical treatment for varicose and "spider" leg veins is sclerotherapy in which medicine is injected into the veins to make them shrink. It has been used in the treatment of varicose veins for over 150 years. Sclerotherapy is often used for telangiectasias (spider veins) and varicose veins that persist or recur after vein stripping. Sclerotherapy can also be performed using microfoam sclerosants under ultrasound guidance to treat larger varicose veins, including the great and short saphenous veins. A study by Kanter and Thibault in 1996 reported a 76% success rate at 24 months in treating saphenofemoral junction and great saphenous vein incompetence with STS 3% solution. A Cochrane Collaboration review concluded sclerotherapy was better than surgery in the short term (1 year) for its treatment success, complication rate and cost, but surgery was better after 5 years, although the research is weak. A Health Technology Assessment found that sclerotherapy provided less benefit than surgery, but is likely to provide a small benefit in varicose veins without reflux. Complications of sclerotherapy are rare but can include blood clots and ulceration. Anaphylactic reactions are "extraordinarily rare but can be life-threatening," and doctors should have resuscitation equipment ready. There has been one reported case of stroke after ultrasound guided sclerotherapy when an unusually large dose of sclerosant foam was injected.

Endovenous laser and radiofrequency ablation

The Australian Medical Services Advisory Committee (MSAC) in 2008 has determined that endovenous laser treatment for varicose veins "appears to be more effective in the short term, and at least as effective overall, as the comparative procedure of junction ligation and vein stripping for the treatment of varicose veins." It also found in its assessment of available literature, that "occurrence rates of more severe complications such as DVT, nerve injury and paraesthesia, post-operative infections and haematomas, appears to be greater after ligation and stripping than after EVLT". Complications for endovenous laser treatment include minor skin burns (0.4%) and temporary paraesthesia (2.1%). The longest study of endovenous laser ablation is 39 months.

Two prospective randomized trials found speedier recovery and fewer complications after radiofrequency obliteration (AKA radiofrequency ablation) compared to open surgery. Myers wrote that open surgery for small saphenous vein reflux is obsolete. Myers said these veins should be treated with endovenous techniques, citing high recurrence rates after surgical management, and risk of nerve damage up to 15%. In comparison, radiofrequency ablation has been shown to control 80% of cases of small saphenous vein reflux at 4 years, said Myers. Complications for radiofrequency ablation include burns, paraesthesia, clinical phlebitis, and slightly higher rates of deep vein thrombosis (0.57%) and pulmonary embolism (0.17%).One 3-year study compared radiofrequency, with a recurrence rate of 33%, to open surgery, which had a recurrence rate of 23%.

Endovenous laser and radiofrequency ablation require specialized training for doctors and expensive equipment. Endovenous laser treatment is performed as an outpatient procedure and does not require the use of an operating theatre, nor does the patient need a general anesthetic. Doctors must use ultrasound during the procedure to see what they are doing. Some practitioners also perform phlebectomy or ultrasound guided sclerotherapy at the time of endovenous treatment. Follow-up treatment to smaller branch varicose veins is often needed in the weeks after the initial procedure.

From wikipedia

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