INTERVENTION IN VARICOSE VEIN

Abstract

Chronic venous insufficiency (CVI) is extraordinarily common, with estimates of up to 25% of women and 10% of men suffering from some form of CVI.1 Most patients with CVI have symptoms that interfere with daily living (e.g., leg aches, fatigue, throbbing, heaviness, night cramps). Severe cases can lead to skin damage resulting from chronic venous hypertension (e.g., eczema, edema, hyperpigmentation, lipodermatosclerosis). The majority of patients with leg ulceration have superficial venous insufficiency (SVI) as the primary underlying cause, with SVI being the sole factor in 20%. Initial treatment includes graduated compression and wound care, but long-term control is dependent on the ability to successfully treat the underlying venous disease. Many patients with SVI also seek to rid their legs of spider veins, varicose veins, or other sequelae of SVI, and though not life threatening, the unsightly appearance of CVI can and often does adversely affect quality of life. Patients with symptoms typical of CVI and clinical signs of CVI require further evaluation with duplex ultrasound (DUS). The goal of DUS evaluation is to map out all the incompetent venous pathways responsible for the patient's condition, including the primary or highest points of reflux and the presence of obstruction.3 Such a map is necessary to determine the best treatment plan.

Types of Vein Treatment

Radiofrequency and LASER ablation VenaSealTM vein closure Sclerotherapy Phlebectomy

Technical success of EVLT is defined as a procedure in which successful access is achieved, the segment to be treated is crossed, the vein is emptied adequately, tumescent anesthesia is administered properly, and sufficient laser energy is delivered to the entire incompetent segment. Clinical success is defined as occlusion of the treated vein segments, with successful elimination of related varicose veins and improvement in the clinical classification of patients. Adequate understanding of an appropriate history and physical, ultrasound evaluation, anatomy, pathophysiology, knowledge of sclerosing solutions, patient selection, and post-treatment care, as well as the ability to prevent, recognize, and treat complications are required before embarking on treatment.