An incorrect ultrasound exam may lead to unnecessary or wrong treatments
VARİSTE SIK SORULAN SORULAR
WHICH VEIN WILL TAKE OVER THE FUNCTION OF THE ABLATED VEIN?
In patients with varicose veins, backflow (reflux) begins as a result of valve failure in some vessels and the first varices occur after many years. In other words, when varices are seen, the patient has had venous insufficiency for a long time. When venous insufficiency begins, our body senses the blood flowing in the opposite direction in the vein and begins to seek remedies to send back the blood back up to the lung. To do this, it first dilates the interconnecting vessels and directs the backflow of blood to the superficial and deep veins that work in good health. Thus, it assigns the function of the diseased vessel to other healthy vessels.
So, the task of the vein that causes varicose veins, our body in the early days of other healthy vessels to load. Therefore, when varicose veins appear years later, the function of the leaking vessel is already loaded on other vessels. Therefore, when the leakage vessel is closed by means of laser, radiofrequency, there will be no deterioration in the function of the leg, on the contrary, the load of healthy vessels trying to send back the blood flowing back to the lung will be relieved.
MAY I NEED THE ABLATED VEIN IN CASE OF BYPASS SURGERY?
In varicose veins, the most common vein that produces leakage is the large saphenous vein (vena safena magna). This vein has been the most commonly used vessel for bypass surgery, especially in the past. The more commonly preferred vessels are the arteries of the breast (internal mammarian artery) and the arteries of the wrist (radial artery).
In addition, saphenous vein should be close to the coronary heart vessels (3-4 mm) in order to be used in bypass surgery. However, in venous insufficiency, the diameter of the large saphenous vein, whose valves are defective, is usually close to 1 cm, ie too large for the bypass vessel.
In conclusion, in patients with varicose veins with venous insufficiency, diseased saphenous vein cannot be used as a bypass vessel, even if untreated. Therefore, in such patients, when the leakage vessel is closed by laser, radiofrequency methods, there is no loss of the patient. In addition, as mentioned above, saphenous vein is now less used for bypass. However, if the saphenous vein has to be used, the vein in the other leg of the patient (if appropriate) can be used.
I HAVE LARGE VARICOSE VEINS BUT NO PAIN. DO I NEED THERAPY?
People with great heirs sometimes have no complaints at all, or have been accustomed to some of their complaints for decades because they have heirs. Such people may feel that treatment is not necessary if they are not too disturbed by the image. However, treatment of these patients is necessary for the following 4 reasons:
1. Risk of bleeding: People with large varices, standing or sitting while a needle is inserted into the varicose veins bleeding will occur. The reason for this is that the veins causing the varicose veins cannot retain blood because the valves of the veins are defective and that all the venous blood of the body presses the varices under the effect of gravity. Therefore, varices have a small risk of trauma and sometimes spontaneous bleeding.
2. Coagulation: The most common cause of clot formation in the veins is the slow flow of blood. Blood flow is normal because normal veins are flat and narrow, so coagulation is rare. However, varicose veins are enlarged and curved veins, so the blood flow within them is very slow. This slow flow may cause a sudden coagulation. Coagulation is more common in pregnant women, those who survive for a long time, those who have undergone surgery, and usually occurs after long aircraft or bus trips, or when they stay for a long time in hot environments such as baths, hot springs, saunas. However, without any of these, the varicose veins may suddenly clot.
Coagulation, although rare, can cause the clot to go to the lung (embolism). Furthermore, it is not possible to treat the coagulated vessel by laser, foam or other methods. Because these are methods that destroy the vessel from the inside and cannot be effective when there is a clot in the vein. As a result, clotting of varicose veins poses a risk to the patient and prevents non-operative treatment.
3. Wound formation: In large varices, there is almost always an underlying venous insufficiency. Venous insufficiency is a kind of circulatory disorder. In a healthy circulation, it sends clean blood to the arterial tissue, but this is not enough. The veins should also remove the contaminated blood and send it to the lung. Here in venous insufficiency, the artery brings clean blood, but the veins cannot remove the contaminated blood. In this case, skin malnutrition occurs and toxins in the veins accumulate in the skin and cause itchy wounds over time. These wounds, which are called venous ulcers, can hardly heal, even if they heal. Because the cause of the wound is the underlying circulatory disorder.
4. Disturbance of healthy vessels: In venous insufficiency in large varices, the body must send the dirty blood back to the lung in some way, otherwise the leg will swell in a short time and a serious circulation problem will occur. Therefore, as soon as venous insufficiency begins, the body opens the interconnecting vessels and transmits back-flowing blood to healthy vessels. However, some of the blood that these veins send up constantly flows back from the diseased vein to the foot. That is, for years, healthy vessels carry the burden of a vein with venous insufficiency, which requires 20-30% more work for healthy vessels. This extra burden also exhausts healthy vessels over the years, leading to valve failure in them. However, if the diseased vessel is closed, this load is taken from the back of healthy vessels.
As a result, those with large varicose veins have a circulatory problem that can lead to serious health problems, even if there are no complaints, and this problem should be solved by appropriate methods.
CAN PILLS, SOCKS, LEECHES AND HERBS TREAT VARICOSE VEINS?
Varicose vein disease is a "mechanical" problem caused by venous insufficiency in venous veins. This problem does not go away spontaneously, it progresses continuously. Over time, both the vein with venous insufficiency and the varicose varices become larger and curved. As the process lengthens, non-healing wounds on the feet and valve failure may occur in other healthy vessels.
Some drugs used in varicose veins (such as Daflon, Venoruton) generally increase the tone of the veins and help to send the contaminated blood to the lung. Varicose stockings also compress the diseased superficial veins and varicose veins, reducing the pooling of blood in these vessels and directing the blood to healthy veins deep. If both medication and varicose veins are used regularly, they can reduce the rate of progression of venous insufficiency and varices and the complaints. However, it cannot treat existing varices and venous insufficiency. This treatment can only be done by laser, radiofrequency, foam, or surgery.
Leech, on the other hand, has been used for centuries in varicose veins. The effect of leech is not actually absorbing dirty blood, because the absorbed blood is immediately replaced by dirty blood. However, the leech feeds with blood and secretes certain substances on the skin. These substances may reduce the varicose-related symptoms in the patient. However, just like medicine and varicose veins stockings, it cannot treat existing varices and venous insufficiency. It can also sometimes cause bleeding and wound formation, and if used in more than one person, it can transmit some blood-borne diseases.
IS THERE A CASE SUITABLE FOR SURGERY BUT NOT FOR ABLATION?
Technically, there is no varicose vein that is suitable for surgery and is not suitable for laser, radiofrequency. Therefore, any patient that can be treated surgically can be treated with these methods.
In some patients, saphenous vein with venous insufficiency may be very large. The risk of re-opening such vessels after laser or radiofrequency treatment is slightly higher. Therefore, there may be those who prefer surgery in such large vessels. However, even in such large vessels, the risk of reopening is only 10-20%, and we can easily cover the opened vessel with a second laser treatment or foam treatment. Therefore, considering the risks and side effects of varicose veins, we recommend non-surgical treatments in such patients and have been performing them for years. During my professional life, among thousands of patients I have examined, laser, radiofrequency and foam treatment methods, such as I do not find any patient I should mention that there is no patient.
I HAVE VARICOSE VEINS DUE TO DVT. IS THERE A HOPE FOR TREATMENT?
In deep vein thrombosis, if the clot in the deep veins stops, the superficial vessels are usually not touched. Although superficial veins appear to be curved and broad like classic varicose veins, these are actually useful "bypass" vessels that our body enlarges to overcome congestion in the deep veins. Therefore, in exceptional cases, superficial veins are not touched in patients with DVT.
The ideal treatment for DVT is to give the clot dissolving drug by entering ultrasound guidance into the occluded vein within the first 2 weeks after clotting occurs. With this method called thrombolytic therapy, the clot is completely cleared in approximately two thirds of patients and the patient does not have any serious problems in the future. However, the majority of patients present after the clot has become chronic. Thrombolytic therapy is not successful in the chronic period, but in some cases the occluded vessel can be opened with balloon and stent.
However, stenting cannot be performed on all patients. Stenting is useless if the DVT has involved the vessels in the lower part of the groin, because even if the vessel is opened, it will soon become blocked. However, if the patient has open veins in the lower part of the groin, if there is blockage in the il iliac top veins in the upper part of the groin, it may be opened with a stent and may remain open for a long time, or even not at all. Stenting in such patients may reduce patient complaints and improve quality of life.
In patients with DVT, evaluation with color Doppler is often difficult and not sufficient alone. In such patients, venography should be performed on the back of the foot or groin and evaluated by an experienced radiologist.
I HAVE DEEP VEIN INCOMPETENCE. IS THERE A CHANCE OF CURE?
We should first examine such a person in detail with color Doppler ultrasound. Because, in our country, a significant number of patients who are said to have deep vein insufficiency do not actually have deep vein insufficiency, but it is reported that there is deep vein insufficiency because ultrasound is performed incorrectly. The most common reason for this is that variceal ultrasound is performed inpatient, not standing. Insufficiency (reflux) is the flow of blood back by gravity, so the patient needs to be examined in an outpatient and not inpatient manner. Inpatients may have insufficiency even if the deep veins are normal. Therefore, even if you have been told that you have deep vein insufficiency, you can say that you are completely normal after color Doppler ultrasound or you have superficial vein insufficiency, not deep.
If there is really deep vein insufficiency, this usually depends on two reasons. Either you have a superficial vein insufficiency that lasts for many years, and this has affected your deep veins over time. Or, you've had a deep vein thrombosis before, and it's melted by the body. However, as the substances released from the clot destroy the lids, valve failure developed in the deep vein after the clot melted.
In the first case, that is, deep vein failure due to superficial vein insufficiency, ultrasound shows both superficial and deep veins insufficiency, but deep vein insufficiency is less severe. In such patients, deep vein insufficiency does not preclude the treatment of superficial vein insufficiency and varicose veins. In fact, deep vein insufficiency regresses in about one third of patients after superficial veins are treated.
In the second case, the superficial veins are normal and deep veins have severe insufficiency due to previous DVT. In these individuals, the body directs the blood that cannot be transferred to the lung through the deep veins and into the superficial superficial veins. In time, it extends the superficial veins, allowing them to carry more blood. The superficial veins, which become increasingly enlarged and curved, are similar to normal varices when viewed, but are in fact useful bypass vessels that the body produces because the deep veins do not work. Thus, if these vessels are considered normal varices and treated with foam or phlebectomy, the leg will be in a worse condition than before. In such patients, superficial veins should not be touched except in some exceptional cases.
I HAVE VARICOSE VEINS IN LEG AND TESTICLE, WHAT MUST I DO?
Varicose formation around the testis is called "varicocele". Like varicose veins in the leg, varicose veins around the testis are caused by reflux in some vessels that we cannot see. Varicose veins and varicocele are "related" diseases and may be both varicose and varicocele in the same person. Sometimes the veins in the abdomen that form the varicocele can also be the cause of varicose veins in the leg.
The principles of treatment of varicose veins and varicocele are similar: first detect and close the veins causing the event, then treat varices that occur. While the veins forming the varices in the leg are closed by laser, radiofrequency methods, the vessel forming the varices in the varicocele around the testis is closed using an angio device without surgery.
In both persons with varicocele and varicocele, treatment of both diseases is preferred if possible. Because the treatment of varicose veins, if the varicocele is released, the possibility of recurrence of leg varices may increase.
I HAVE VARICES IN VAGINA AND VULVA. CAN THEY BE TREATED?
Varicose veins formation in the vagina-vulva region and groin is one of the common varicose vein problems in our country. It is common in women with multiple births, but it is also thought that there is a genetic predisposition in Turkish women. Vagina-vulva varices are formed by some veins that leak in the lower abdomen. The most common of these are the left ovarian vein and the right inner iliac vein, but in many patients, a large number of small vessels may leak from the abdomen.
In those with vagina-vulva varices, color Doppler ultrasound from the groin or vagina is first attempted to determine which vessels or vessels leak. In some cases, CT or Emar can also help. If there is a significant leak and the findings indicate a single, large vessel, such as the left ovarian vein, it is first entered through the groin or arm vein in the angio device and reached by the vein and closed with a method called em embolization kaçak. Thus, the "open tap" causing the vaginal vessels is closed.
Then, under the guidance of ultrasound, varicose veins in the vagina and deeper are entered with needles and foam is given at the appropriate density. Ultrasound guided foam sclerotherapy called this method with the vulva and around the vagina can be successfully treated vessels.
WILL I HAVE PAIN DURING AND AFTER THE VARICOSE VEIN TREATMENT?
During the treatment of varicose veins, the patient should ideally be awake, but should not feel any pain other than tiny stinging. General anesthesia or spinal anesthesia, which makes the patient completely sleepless and immobile for a long time, increases both the cost and prolonged immobility and numbness may increase some complications such as deep vein thrombosis.
During the treatment of varicose veins, our anesthesia method is local anesthesia and sedation. In other words, we make the patient semi-sleepy by giving some intravenous medications, and then we perform the procedure with very fine needles under local anesthesia. If the treatment is going to take a long time and if the large veins need to be taken out of the needle holes, then with a method called sinir nerve blockage uştur, we can numb the leg with a single needle, such as dentists numbing the jaw, so that the patient does not feel any further procedures. In nerve blockage, the patient does not feel pain, but can move his foot to accelerate blood circulation and thus prevent clot formation.
In addition to local anesthesia, laser, radiofrequency, such as leakage in all treatments covering the vein, necessarily integrated anesthesia anesthesia by anesthesia around the vessel. With some long-acting analgesic drugs we put in tumulusant fluid, we make the patient feel very little pain after the procedure. Tumorant anesthesia has additional advantages such as pain relief, protecting the surrounding tissue and increasing the process efficiency by discharging the blood in the vein. Emptying the blood in the vein greatly reduces the amount of clot remaining in the vein after procedures such as laser and foam, thus preventing painful thrombophlebitis.
As a result, there are many subtleties of anesthesia in the treatment of varicose veins. The aim is to keep the patient safety at maximum and to ensure that the patient does not feel any pain at all.
IS THERE A RISK OF THROMBOSIS DURING ENDOVENOUS ABLATION?
In classical varicose veins, deep vein thrombosis (venous coagulation) develops in approximately 5% of patients. Deep vein thrombosis (DVT) is a serious condition that can cause clot to go into the lung (embolism) in some cases and affect a person's quality of life for a lifetime. DVT can be used for the treatment of varicose veins.
Although not mentioned by physicians, DVT may occur in new varicose veins treatments such as laser, RF and foam. Laser, radiofrequency, MOCA, steam and gum treatments such as ultrasound not performed, can cause damage to the deep veins and DVT formation. Again, in methods such as sclerotherapy or foam treatment, such as over or high doses of the drug, which vessels do not follow the ultrasound to follow the foam, the drug can escape large amounts of deep veins and DVT may occur.
During treatment of varicose veins, prolonged immobilization increases the risk of DVT. In particular, methods such as general anesthesia and spinal anesthesia not only expose patients to some unnecessary anesthesia risks but also facilitate the formation of DVT by preventing long-term movement.
As a result, coagulation (DVT) may also occur in modern varicose veins treatments if the ideal treatment is not performed. All stages of varicose veins should be visualized and local anesthesia should be preferred and the risk of DVT will be close to zero.
WHICH METHOD IS BEST: LASER, RF, STEAM OR GLUE?
Among these treatments, laser and radiofrequency (RF) are the most proven methods. However, these methods are the treatments that should be performed with integrated anesthesia and integrated anesthesia cannot be performed by physicians who do not have ultrasound experience. Therefore, treatments such as Zamk and MOCA, which can be performed without integrated anesthesia, have been developed. These treatments are also successful, but it is not known whether they are as effective as laser and radiofrequency.
In the treatment of varicose veins, it is not correct and reasonable for the patients to make a choice about which of these methods should be used. What is decisive in the treatment of varicose veins is not the method used, but the physician who performs the procedure is able to make the diagnosis by Doppler ultrasound itself and can make these treatments correctly under ultrasound guidance.
WILL THE VARICOSE VEINS RECUR AFTER TREATMENT?
Varicose veins are a genetic predisposition disease and can be repeated after successful treatment. However, this widespread belief among the public that varicose veins recur is due to incomplete or inappropriate treatments for decades. If the cause of the varicose vein is not investigated by a detailed color Doppler ultrasound and all the vessels with leakage insufficiency are not closed, even if the surface varices are removed, the varices will recur because the underlying cause is not treated. The most important reason for the recurrence of varicose veins is the failure to comply with these rules.
However, even after an excellent treatment, it is possible for varicose veins to recur in persons with strong predisposition. After surgical operations, in about half of the patients, the body forms tiny twisted veins (neovascularization) in the bed of the vein that is surgically removed, and varicose veins repeat accordingly. After laser, radiofrequency treatments, the closed vein can be reopened in about 5% of patients, sometimes the vein is closed, but the body can create new vessels that leak. Capillary varices and genital varices tend to recur more than other varices.
As a result, the heir is likely to recur. However, the better and more accurate the diagnosis and treatment, the less likely it is to recur in the varicose veins.
IS IT DIFFICULT TO TREAT SPIDER VEINS?
Contrary to popular belief, capillary varices are highly resistant to treatment. This type of varicose veins usually originates from the remains of normal veins that we use in the womb and are of genetic-hormonal origin. Acquired factors such as standing, pregnancy, warm climate and wearing high heels are not effective in capillary varices. Capillary varices start more during puberty and gradually multiply over the years.
Microsclerotherapy is the ideal treatment for capillary varices. In this method, very fine needles are introduced into the capillary varices and a small amount of drug or foam is injected. It is important to administer very low and low-intensity medication at each injection, but to make numerous entries into capillary varices. When treated in this way, approximately 80-90% reduction in capillary varices can be achieved in 2-3 sessions.
Transdermal treatments such as lasers may be appropriate for the small amount of fine capillary varices remaining after microsclerotherapy. Transdermal lasers can be applied without microscopic therapy in patients with very small, thin and diffuse capillary varices. However, the realistic goal of capillary varicose veins is not to eradicate varicose veins, but to achieve a significant reduction and visual improvement. Even if a perfect treatment is applied, a small amount of capillary varices will remain and new capillary varices will be added every year.
In our personal experience, most patients with capillary varicose veins can achieve a reduction of around 80-90% with a 2-session intensive microsclerotherapy, which can satisfy our patients for many years. However, after the first intensive treatment, there are patients in whom we have had an additional session within a few years.
MY VEINS BECAME DARKER AND HARDER AFTER SCLEROTHERAPY, WHY?
The most known effect of foam treatment or sclerotherapy is the hardening of the vessel being treated and some thickening. If foam is applied to a large vein, it will be treated as a chickpea or lentil grain for months, but then it will disappear by itself over time. Erectile dysfunction is an indication that varicose veins have been successfully treated. After the foam treatment, if the varicose vein is as soft as a normal vessel, it may not have been adequately treated.
After foam treatment, some thickening is also normal and indicates that the vessel is being treated. However, darkening should be mild and disappear within months. If the foam is applied at a very high density, the darkness may be too high and may take a long time to completely pass through.
MY VARICOSE VEINS CAME BACK AFTER TREATMENT, WHY?
In people with capillary varicose veins, varicose veins can sometimes reappear within a few years. This condition can easily be treated with good microsclerotherapy. In the case of large varicose veins, if new varicose veins have developed in a short time instead of the varicose veins disappeared with foam treatment, there is a high probability of a deficiency or error in the diagnosis and treatment of Doppler ultrasound.
The most common cause of this phenomenon is the lack of investigation of the cause of varicose veins on color Doppler ultrasound or insufficient or incorrect color Doppler ultrasound. In both cases, the varicose veins will be treated with foam before they are treated adequately. In this case, there is a temporary improvement in varicose veins, but because the underlying cause has not been treated, the varicose veins recur in a short time.
What we need to do in such patients is a good and detailed color Doppler ultrasonography. In the ultrasonography, the vessels causing the varices should be identified, these vessels should be closed first and then the varices should be treated.
WHAT MUST I DO TO STOP VARICOSE VEINS TO COME BACK AGAIN?
If you have been treated for your capillary varicose veins, it is possible that these varicose veins may increase again over the years. What you need to do is to get microsclerotherapy again when the new varices have reached an uncomfortable level. In such varicose veins, there is not much to do to prevent varicose veins from recurring. Varicose stockings, heelless shoes, measures such as not standing are not very effective.
If you have been treated for large varices, a new vascular insufficiency (leakage) may develop in your body over time and your varices may recur. However, some changes in your lifestyle may reduce this possibility and prolong the development of varicose veins. These are to avoid long-term immobility, to prefer cool environments, to stay away from hot places such as baths, saunas, hot springs, not to lose weight, to prefer sports like walking-swimming, wear special daily socks that apply light pressure to the knees, not to wear very high-heeled shoes and avoid pregnancy if not necessary.