2016 01 19

Modern treatment for varicose veins: get up and go

Vascular Diseases, Varicose Veins

Modernus venu varikozes gydymas kelkis ir eik

My legs feel tired” we say lying down on the couch after a working day. Symptoms like tired, achy, swollen legs and nocturnal leg cramps may be indicative of bigger problems. Even if the skin on the legs is smooth, the above could be the first signs of varicose veins. “People get worried and go to see the doctor having noticed changes on the skin and varices underneath. However, a considerably more dangerous form of the condition with no accompanying external symptoms initially – venous insufficiency, may go unnoticed. Therefore, the diagnosis of varicose veins is not entirely accurate,” says Nerijus Bičkauskas, a neovascular surgeon at the Medical Diagnostic and Treatment Centre. „This type of vascular condition should be called venous insufficiency.“

Veins are blood vessels that carry blood upward toward the heart. This function is disrupted when the valves within the veins become impaired and the pressure in the veins increases. When the blood flow slows down, sooner or later the veins undergo changes. They become longer and lumps form underneath the skin. If left untreated varicose veins can cause additional health problems, while the complications can be life-threatening.

“To avoid consequences, first of all we need to treat visible varices, and then continue with stems and truncal veins,” says experienced vascular surgeon Nerijus Bičkauskas. “We would all agree that swollen varices are not a pretty sight but they do have a useful function in that they act like shock absorbers and minimize the blow to the legs when we change the position of our body. If we only remove the varices and leave the insufficient trunk, we could make the situation worse instead of making it better.”

When the condition is still in the initial stages, the doctor and the patient look at it from different perspectives. “Nobody can see my legs anyway,” many men tend to dismiss the problem and choose to hide the bulging blood vessels under their trousers until the discomfort can no longer be ignored. Women are more careful and get worried about little changes in the skin.

“The doctor always wants to establish the cause because the condition always deteriorates eventually. In order to restore health to the legs we have to stop the blood flowing in the wrong direction and turn it around,” says the doctor who was the first in Lithuania to use the very advanced adhesive ablation method for treatment of incompetent truncal veins.

Patients often ask the doctor to apply the advanced method for cosmetic removal of enlarged veins. However, the glue treatment, as well as other modern endovascular treatment methods – laser, radiofrequency, and steam ablation are only intended for the stems and trunks of deep veins. Glue is not used to treat varices. “Varices that are visible under the surface of the skin are treated with sclerotherapy, i.e. we “lock them in” with medicine,” explains Dr. Bičkauskas.

Vein glue is a particularly innovative and advanced varicose vein treatment method. Due to its many advantages, it is becoming very popular all over the world. “The glue system was introduced over eight years ago. This year the US Food and Drug Administration (FDA) announced that the method is safe and as effective as other endovascular surgeries (laser, radiofrequency), and therefore is suitable for wide application. In medicine, the glue was first used in the middle of the last century to treat vascular tumors,” says vascular surgeon Dr. N. Bičkauskas. “Varicose vein glue was created in the US and the first surgeries were performed there eight years ago. It is only one prick – minimal anesthesia, no compression stockings, or post-operative discomfort.”

What is the course of the procedure? In the theatre, the doctor freezes the patient’s skin with a local anesthetic where the catheter will be inserted. A small amount of glue is injected through it into the vein, and pressure is applied from the outside using the ultrasound probe. This seals the vein and reroutes blood flow toward the heart through other healthy veins. Patients can return to work right after the surgery.

“In the US these procedures are called “consulting room surgeries” because they are performed in specially equipped doctors’ rooms, where the surroundings are less stressful than in operating theatres,” says Dr. N. Bičkauskas. “No such permits have been issued in Europe, therefore we continue working in theatres.”

The times when patients had their legs in bandages for the entire month following leg vein surgery are gone. People go back to work the next day after modern endovascular procedures, and on the same day following the varicose vein glue surgery. “In recent years the main focus in medicine has been on minimally traumatizing medical procedures. Patients are eager to return to their normal life as soon as possible. The stress that the patient experiences, and not the post-operative physical restrictions are the main concern at the moment. The new glue method is not cheap but some people lose more money by spending a day in bed and not at work.”

Can be swollen and enlarged veins on the legs treated with creams as advertised in commercials? Dr. Bičkauskas replies with skepticism “I tell my patients if you have a favorite cream do apply it on your legs. Legs love being loved and the massage helps to improve circulation. But let’s say you tried fixing a hole in your garden hose by applying the cream. Would that help? Venous insufficiency is a dangerous condition that needs to be treated sooner or later. The more you delay, the longer the treatment will be.”

Thinking about the advancement of technology, treatment methods, and devices the doctor wonders about the future of varicose vein treatment. Vascular surgeon Dr. N. Bičkauskas is confident that it is the genetics specialists who will have the next say.

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