New varicose vein treatment techniques have emerged and are increasingly used. Sclerotherapy, laser, Chiva … What are the results of these interventions lighter than surgery? A report Anaes an update on the issue.
Varicose veins and tired legs are very common ailments. It is estimated that three out of four have varicose veins in their lives and that for one in four symptoms will be troublesome enough to warrant medical treatment or intervention. In recent years, techniques have been improved and new methods have emerged, promising treatments lighter and a priori less traumatic. But what are their real benefits? The answer with the experts of the Agency National Accreditation and Evaluation in Health (ANAES).
Understanding the formation of varicose veins
To understand the techniques used in the treatment of varicose veins, some anatomical clarifications. Blood flows through the legs in a deep venous network, located in the heart muscle, and in a superficial network, located under the skin. It is this superficial network that is affected by varicose veins. It includes two main veins, the large and the small saphenous vein, which bring a small amount of blood into the deep network, and veins secondary, smaller. To prevent the blood stagnates in the superficial veins of antireflux valves are spread all along their journey. In case of failure of these valves, reflux occurs and the vein expands, forming a varix visible under the skin.
The veinotonic relieve symptoms and may, for some, help the healing of an ulcer, but they have no effect on the development of varicose veins. By elastic compression stockings or bands is effective when it is carried. But this is a palliative, symptomatic treatment, which has no action on the anomalies already installed.
Different interventions can, however, remove varicose veins. They can be considered:
- To relieve symptoms become too painful;
- To prevent complications of venous stasis (venous ulcers, skin lesions or, rarely, phlebitis and embolism);
- Or simply for aesthetic reasons.
A precise assessment will be carried out before any intervention, including a Doppler. This painless examination clarifies the status of the valves and the mechanism responsible reflux.
Surgery to the largest varicose veins
Varicose veins treatment Surgery is the treatment of choice for the largest varicose veins. Several techniques exist. One of the most classic is the stripping of removing the main vein of the lower limbs (saphenous vein) by making two small incisions at the ankle and the groin. The procedure is completed by the removal of all small varicose veins could develop from the saphenous vein.
After removal of the superficial veins, blood return is through the deep veins. The only absolute cons-indication to surgical stripping is obstruction of the deep venous system by phlebitis.
The procedure is performed in an operating room under epidural or general anesthesia. Hospitalizations are increasingly short, often a few hours, and generally does not exceed two days. In the aftermath of the intervention hematomas and bruising sensitive, which will fade in two to three weeks. The march was resumed immediately after the intervention, but a work stoppage of three weeks is generally prescribed.
Surgery can be performed at any age, except during pregnancy, and in any season. However be aware that wearing compression stockings is necessary for two to four weeks after the operation and that it is necessarily more painful during intense heat periods.
Sclerotherapy in other cases
To treat smaller cases using natural treatment for Varicose Veins, the choice discussed between sclerotherapy and stripping. Sclerotherapy has the advantage of being a much lighter approach, carried out in practice and does not require anesthesia. It is injected into the varicose vein with a fine needle, a substance that will induce a retraction and hardening of the diseased vein, which will clog (to “ossify”). The activities can be resumed immediately, a work stoppage is not necessary. Therefore, the procedure seems simple, but it does require a good experience for the injection to be accurate. There is a small risk but serious accidental injection into an artery. Using ultrasound guidance makes sure that the product is correctly injected into the vein.
The treatment of small varicose veins
Regarding the varicose veins that affect secondary veins, they can be deleted either by sclerotherapy or surgically by phlebectomy. This is a minor surgery, performed under local anesthesia. Some practice in the firm, although experts believe best to intervene in the operating room, for aseptic reasons. Small portions of veins are removed with a hook through tiny incisions.
Sclerotherapy has the advantage of being lighter and better tolerated than surgery. It does not lead to scarring. Its main disadvantage is the risk of recanalization of the vein. The choice depends primarily on the characteristics of varicose veins to be treated and the physician’s experience.
More recently appeared endovenous new techniques designed to treat saphenous trunks less traumatic way than surgery. Radio Frequency (or closure) comprises introducing into the greater saphenous a probe having an electrode which is capable of raising the temperature to 85 ° C. This heating causes the closure of the treated vein segment. Endovenous laser is based on the same principle. These interventions are done under local anesthesia. The suites are simpler and less painful after surgery, the recovery of walking is immediate and return to normal activity may be fast, with a few days off work. The first results of these recent techniques appear satisfactory, but the number of people treated remains low and it will take a few years to check for recurrence.
Clip and Chiva
Other techniques are at a less advanced stage of assessment. The installation of a metal clip on the saphenous vein (V-clip), has been proposed to improve the results of sclerotherapy. But this clip does not suffice to remove the ebb and must always be complemented with sclerotherapy and phlebectomy. The data are still insufficient to validate this technique.
Finally conservative treatment to remove the reflux without removing varicose veins is used for several years. These hemodynamic treatment of venous insufficiency also called Chiva.
This technique keeps the vein drifting sick superficial veins to deeper veins. But few teams are performing the procedure and the studies do not allow to date to evaluate the efficacy and safety of this technique.
Pending further studies
Unsurprisingly, this is surgery and sclerotherapy therefore remain the reference methods today, sclerotherapy is by far the most common: 95% of varicose veins are thus treated in France, only 4% with surgery and less than 1 % by other methods.
New technologies should not be buried so far. The laser, radiofrequency and sclerotherapy have fewer immediate side effects than surgery, with medium-term results that seem too good. See you in a few years to know the relative performance of these new methods.