Esp Cat
vascular Barcelona

What treatments are there?

Although THERE IS NO UNIVERSAL TREAMENT as such, it seems more and more obvious that sclerotherapy with certain products can treat ALL VARICOSE VEINS, OF ANY SIZE AND IN ANY AREA.

There are different techniques or procedures for treating varicose veins:

CONVENTIONAL surgery

It is called conventional because it is the most common treatment used among vascular surgeons and it has been carried out for more years. It is based on the extirpation of all visible varicose veins and the internal or external saphenous vein. The internal and external saphenous veins are located near the surface of the leg and they tend to be the origin of most varicose veins. This treatment is being used less and less due to its radical approach and because less aggressively invasive techniques are providing the same results. 

Type of anaesthetic:
Spinal or intradural: Through a small injection through the spine, the limb is anaesthetized. This helps the surgeon to work comfortably and avoids patient being bothered by multiple, continuous injections of local anaesthetic.

The recovery of activity:
Although recovery of deambulation (being able to walk) is very precocious (as soon as 2 to 3 hours after the operation), it is advisable to follow a postoperative period of several days (from 7 to 15 days) during which the series of medical instructions indicated below should be followed. Returning to work is expected between 10 and 20 days after the operation.

Disadvantages:
This is an aggressive surgery as it extirpates a large number of veins, some of which could play an important role in the future. Sometimes, although the short term result is excellent, if the patient shows a recurrence (growth of new varicose veins), their treatment is difficult and must once again be radical.

The Haemodynamic strategy or CHIVA treatment

This procedure is based on the knowledge provide by the ECHO-DOPPLER study (a painless diagnostic test which shows us how the circulatory system is functioning) .

By using a painless and quick examination which shows us the real time venous function, we are able to consider a less aggressive conservative therapeutic strategy which helps in the early return to a normal life.

Before the operation, the MARKING or CARTOGRAPHY of the venous system is carried out in which the points to be addressed on the leg are marked. The main objective is to keep the internal and/or external saphenous vein permeable to ensure correct venous drainage.

Type of anaesthetic:
A simple local anaesthetic with sedation is achieved through different punctures with a fine needle that introduce the local anaesthetic into the marked areas. Recently, the tumescent anaesthetic procedure has been incorporated, which avoids repeated punctures. It is best to complement this anaesthetic with the sedation of the patient, thereby drastically increasing his/her comfort.  

The recovery of activity:
This is immediate. Walking directly after the operation is considered that part of the treatment. The return to work varies from case to case and depends on the extension of the small wounds. There may be cases of returning in 1 day, while others may be up to 10-15 days.

Disadvantages:
It is sometimes considered convenient to carry out the treatment split into two separate operations. The particular nature of this strategy makes it necessary to carry out frequent checks (at least once a year).

Endoluminal treatments (ENDOLASER and RADIOFREQUENCY)

These treatments are based on applying an ENDOLUMINAL occlusion system (inside the vessel wall) in sclerosis or fibrosis of the interior of the internal or external saphenous vein.

Both the endolaser and RADIOFREQUENCY are an attempt to prevent the stripping of the internal saphenous vein and they act once the vein has been catheterized (the introduction of a catheter into the inside the vein lumen) and then the catheter releases energy in the form of heat, provoking the burning of its interior, thrombosis of the haematic content and then the withdrawal of its walls. Finally, the vein’s walls collapse and are fibrosed.

This procedure is equivalent to the conventional therapies, although the aggression in this case caused by the stripping of the saphenous vein is avoided along with certain wounds.

ENDOLASER and RADIOFREQUENCY

Type of anaesthetic: This can be done with a local tumescent anaesthetic and sedation or with a spinal anaesthetic.

The recovery of activity: This can be very soon. Return to work is different for each case and depends on the extension of the small wounds. There may be cases of returning within 1 day and up to 10-15 days

Disadvantages:
Not all patients are given this treatment. A series of requirements must be met for a patient to be operated on using ENDOLASER or RADIOFREQUENCY. A catheter has to be introduced into the vein, and not all patients have veins that will allow this.  

The removal of the accompanying venous packs must be added to the procedure of excising the saphenous vein, so these techniques  are partially low-invasive.  

SCLEROTHERAPY

This is a case of making the varicose veins disappear by repeated injections by which an irritating and sclerosing agent is introduced. The significant limitations of the commonly used foam include a set volume and concentration.

Although the use of sclerosis is a very well-known procedure with a long history, the use of products in the form of foam has brought about a significant breakthrough in its results. This foam multiplies the irritating effect of the injected product and, through spasms, helps the faster and more effective occlusion of the vein to be treated. This procedure is extremely useful in the treatment of recurrent varicose veins.

Type of anaesthetic:
No anaesthetic is required for the infiltrations are applied using a very fine needle.


The recovery of activity:
Not a single day of activity or regular day to day habits need be interrupted. The only recommendation made is not to swim at the beach or the swimming pool during the days following the treatment.

Disadvantages:
The foam made using the Tessari Method has some volume and concentration limitations. Although it is quite safe, complications related to gas embolism (the injected gas can pass through to the circulation of the artery and provoke embolisms) have been published. This is EXTREMELY RARE, but it does happen. This foam has specific indications and continuous treatment is required.

The most effective treatment of variculas, spider veins or telangiectasias, is achieved with the traditional SCLEROTHERAPY along with the percutaneous LASER.   

AESTHETIC SCLEROSIS

Aesthetic SCLEROSIS consists of concealing the small venules, vascular spiders or telangiectasias, or making them disappear, through a rather non-aggressive method. It is achieved through the injection of the sclerosing agent into the inside of the veins to produce an intraluminal (inside the vein) inflammatory reaction and to get the circulating blood to clot or thrombose. The result sought is the collapse of the capillary walls and, consequently, their gradually being concealed.   

The results vary depending on the type of vessels to be treated, the area, the patient’s skin type, its pigmentation and individual sensitivity. Therefore, as occurs with almost all medical procedures, it is impossible to guarantee a result and the total absence of side effects.


Recently, the PERCUTANEOUS LASER has been incorporated, which is ideally indicated for application to the finest variculas (those that cannot be receive injection due to their small diameter) and the residual veins which have been given the traditional sclerosis treatment and which have not completely disappeared.

The effect the laser produces is the heating and thrombosis of the inside of the vein, obtaining its interior thrombosis. This treatment allows very small vessels which cannot be subjected to injection to be treated. Repeated sessions must also be given to obtain the desired results.

Experience has shown us that the best results are obtained by combining these two procedures of SCLEROSIS + PERCUTANEOUS LASER.



SCLEROTHERAPY WITH IIDF - MICROESPUMA

Sclerotherapy using microfoam is the great revolution in varicose veins and venous malformations treatment. The phlebology of the future will probably include treatment with microfoam: with Varisolve® as the safest and least aggressive treatment. This is the only product that has passed the Phase I, II and III clinical trials in Europe and Phase I and II in the USA. Currently, it is in its last phase of development and validation by the US FOOD AND DRUG ADMINISTRATION (Phase III was begun in the last quarter of 2008). Until the product is on the market, the only centres authorized to use it are the International Institute of Phlebology in Granada and Barcelona and approved centres such as the University Clinic of Navarre in Pamplona and Madrid.