In the utmost 10 years there has been a change in the way that varicose veins and venous reflux is treated. The old ‘occult tie and strip’ operation involving a not special anaesthetic, 6 weeks of post op discomfort, groin wound infections and a return rate of 30% is now all but a thing of the past (or should have existence).
Minimally invasive treatments with Endovenous Laser and VnUS closure take largely replaced high tie and plunder. Both of these operations involve inserting a catheter into the saphenous streak under ultrasound control. These operations are referred to viewed like ‘thermal ablation’ because heat is used to extirpate the vein wall from the interior which causes the leaking saphenous turn of mind to block and eventually disintegrate and disappear. These procedures can be done almost exclusively under local anaesthetic as a walk in walk in walk out manner of proceeding with minimal recovery time and extremely good clinical and cosmetic results with degraded recurrence rates.
The only weakness of the thermal ablation techniques is that, because they use heat as the active agent of streak closure, they require injection of topical anaesthetic and saline around the current as it courses down the thigh. For greatest in number patients this is well tolerated, if it were not that it is still a little miserable and makes the experience similar to going to the dentist. There are some patients who effect find the prospect of multiple injections in the leg really terrifying and those individuals require weighty sedation or even general anaesthetic to take patiently treatment.
The next step in strain treatment is therefore to devise a technique that does not urgency injections. There are already some established techniques suitable such as the Clarivein operation what one. can do this and has serious efficacy data at 2 years column -op. The latest procedure to exist trialled is the Sapheon tissue cement system which uses a cyanoacrylate glue injected into the vein in one attempt to seal the vein through . sticking the vein walls together. The glue is inserted into the vein by way of a thin catheter in the same way as EVLT and VNUS closure, if it were not that the key pint is that as there is no heat involved in the technique interior the vein, there is no require to inject local anaesthetic and liquid and gaseous into the thigh – making the technique essentially painless the pair during and after the surgery.
Although in that place has been a fair amount of publicness in the popular press about this process already, the data is actually very thin so far. The initial clinical wretchedness was performed in the Dominican Republic attached 8 patients in 2010. All patients be in actual possession of been reported to have had successful vein closure at 1 year. A unhappiness of a further 30 patients in Germany has been running conducive to about a year with 2 management failures to date.
For most faculty treatments successful closure of the saphenous streak can be achieved quite easily in the deficient term – what makes the difference betwixt success and failure is the closure find fault with over the longer 2 to 5 year proposition. At this time it is certainly possible to say that the tissue gelatine procedure is an exciting development and has the potential to become a useful option in the manipulation of venous reflux, but at the flash thermal ablation techniques remain the ‘gold ensign’. Further trials of the glue technique are underway and we expect developments with considerable interest!
Eddie Chaloner is a consultant vascular surgeon at Radiance Health, a clinic in London, that specialises in the treatment of Varicose Veins, Thread Veins, and DVT. Eddie is united of the leading authorities on lode treatment, having been the first surgeon in London to use the EVLT method, and the capital surgeon in the UK to appliance the new Clarivein technique.
Category: Pain management