Vascular Procedures
Sclerotherapy
Sclerotherapy is a procedure used to treat blood vessels or blood vessel malformations (vascular malformations) and also those of the lymphatic system. A medicine is injected into the vessels, which makes them shrink. It is used for children and young adults with vascular or lymphatic malformations. In adults, sclerotherapy is often used to treat varicose veins and hemorrhoids.
Sclerotherapy is one method, along with surgery, radiofrequency and laser ablation, for treatment of varicose veins and venous malformations. In ultrasound-guided sclerotherapy, ultrasound is used to visualize the underlying vein so the physician can deliver and monitor the injection. Sclerotherapy should be done under ultrasound guidance after venous abnormalities have been diagnosed with duplex ultrasound. Sclerotherapy under ultrasound guidance and using microfoam sclerosants has been shown to be effective in controlling reflux from the sapheno-femoral and sapheno-popliteal junctions. However, some authors believe that sclerotherapy is not suitable for veins with reflux from the greater or lesser saphenous junction, or veins with axial reflux (above the knees).
Radiofrequency ablation is a minimally-invasive procedure used in the treatment of varicose veins. An alternative to the traditional stripping operation, it is usually used to treat the great or small saphenous veins. Branch varicose veins are then treated either with phlebectomy or sclerotherapy.
Under ultrasound guidance, a radiofrequency catheter is inserted into the abnormal vein and the vessel treated with radio-energy, resulting in closure of the involved vein. Early studies have shown a high success rate with low rates of complications.
Methods
Injecting the unwanted veins with a sclerosing solution causes the target vein to immediately shrink, and then dissolve over a period of weeks as the body naturally absorbs the treated vein.
Sclerotherapy is the "gold standard" and is preferred over laser for eliminating large spider veins (telangiectasiae) and smaller varicose leg veins.[13] Unlike a laser, the sclerosing solution additionally closes the "feeder veins" under the skin that are causing the spider veins to form, thereby making a recurrence of the spider veins in the treated area less likely. Multiple injections of dilute sclerosant are injected into the abnormal surface veins of the involved leg. The patient's leg is then compressed with either stockings or bandages that they wear usually for two weeks after treatment. Patients are also encouraged to walk regularly during that time. It is common practice for the patient to require at least two treatment sessions separated by several weeks to significantly improve the appearance of their leg veins.
Sclerotherapy can also be performed using microfoam sclerosants under ultrasound guidance to treat larger varicose veins, including the great and small saphenous veins.[14] After a map of the patient's varicose veins is created using ultrasound, these veins are injected whilst real-time monitoring of the injections is undertaken, also using ultrasound. The sclerosant can be observed entering the vein, and further injections performed so that all the abnormal veins are treated. Follow-up ultrasound scans are used to confirm closure of the treated veins, and any residual varicose veins can be identified and treated.
Venous Ablation
Venous ablation is an exciting new technique that is revolutionizing the treatment of venous reflux in legs. This site gives a brief discussion of venous reflux and the venous ablation procedure.
What is venous reflux?
Venous stasis is a common condition in which the flow of blood from the legs to the heart is abnormal. Most people assume that the heart pumps blood out to the legs and then pumps it back. That's only half right. Actually, the heart only pumps the blood out. Leg muscles pump it back. Every time a leg muscle tightens (called contraction), it squeezes the leg veins flat. Blood is pushed through the veins like toothpaste being squeezed from a tube. When everything is working normally, a series of one-way gates (called valves) makes sure that the blood can only move one direction: toward the heart. However, when the valves are damaged, the "muscle pump" doesn't work (imagine a busy intersection with no traffic signals). This condition is called reflux and most often involves a large leg vein called the saphenous vein. When saphenous reflux is present, blood simply pools in the legs, causing everything from unsightly varicose veins to severe pain and ulceration of the skin.
How is it treated?
The easiest treatment is to wear compression stockings. These special socks gently squeeze the leg, helping the muscle pump to work more effectively. If compression stockings do not help, the abnormal vein must be eliminated. Historically, this has been done with a surgical procedure called "vein stripping." It can now be done with a non-surgical technique known as venous ablation.
What is venous ablation?
Venous ablation eliminates the abnormal, refluxing vein by sealing it closed. The vein does not actually have to be removed from your body, as in vein stripping.
How is venous ablation done?
Through a tiny incision at the knee (the size of a pencil point), a small tube is placed into the saphenous vein. Then, a laser or radiofrequency fiber is passed through the tube into the vein. Once in place, the fiber is activated, delivering very localized heat to the vein wall. In response, the vein closes down and becomes permanently blocked.
Don't I need my veins?
Yes, veins are necessary for blood return from the legs to the heart. Venous ablation treats only the abnormal vein that is allowing blood to flow backwards. Since this vein has lost its ability to carry blood in the correct direction, it is no longer needed.
Is it painful?
The amount of energy delivered to the vein is actually very small and only affects the local vein wall. We use local anesthesia (like your dentist), but nothing stronger is generally needed. Afterwards, there may be some mild to moderate discomfort for a week to ten days, but this usually responds well to over-the-counter medications like aspirin or ibuprofen.
How quickly does it work?
The ablation procedure closes the vein immediately. The improvement in blood flow happens right away. However, it may take a few weeks for the original symptoms to go away, and large varicose veins may need some additional minor treatment.
