Like the public, physicians think of venous disease as only varicose veins. However, the most commom indications for endovenous ablation relate to the symptoms of nocturnal cramps; restless legs syndrome; early fatigue of lower extremities; difficulty in standing in one position ; chronic skin changes; edema, with the lower extremities feeling more comfortable when elevated. However, all patients will have some external stigmata of venous insufficiency, such as: spider veins, telangiectasia; or reticular veins. A small percentage only will exhibit frank varicose veins.
Venous insufficiency (venous reflux) is verified by supine or standing measurement of the superficial veins, and doppler assessment of the greater saphenous vein for reflux. A proximal saphenous vein diameter at the groin of greater than 6mm is abnormal and predicts reflux.
Cool Touch Laser EVLT is a preferred modality to close the greater saphenous vein and the anterior accessory vein. Venous blood is forced to flow proximally through the femoural/ iliac veins and IVC to the heart with no avenue of reflux present.
If one has restless leg syndrome and concomitant venous insufficiency a fifty percent cure rate is possible with EVLT, and another 25% of patients will have symptoms ameliorated. Similar results are possible in patients with nocturnal cramps. All patients with these two syndromes should have routine screening, even if diabetic or with a known history of neuropathy.
In patients that do have bulging varicosities, microphlebectomy is performed with a near perfect cosmetic result. In patients with other asthetic vein issues, all procedures are self pay, and include the following: sclerotherapy for spider and reticular veins; cutaneous laser treatment for very small spider veins; matting sometimes seen after sclerotherapy and for telangiectasia.
Some final points. Some patients have very advanced venous insuffiency in the thighs and the calves. Large perforator veins usually will be closed with ultrasound guided sclerotherapy. Patients with far advanced disease may present with lipodermatosclerosis. This condition presents usually as a very large area over the entire pretibular area that appears dark gray or black that is very tender and represents an emergency. This condition usually requires multiple procedures by an experienced phlebologist. All care of these patiens should be directed through an experienced vein center.
Please address questions or concerns to wooddeming@yahoo.com.
More will come on different relevant topics on veins and etc.
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