Nonsurgical methods are the standart of care in varicose veins
In varicose veins, the basic treatment concept has not changed for over 100 years; According to this concept, venous insufficiency causing varicose veins should be treated first and then varicose veins should be eliminated. While in the past surgeries such as ligation & stripping and SEPS have been used to treat venous insufficiency, new treatments such as laser, radiofrequency, steam, MOCA and glue are currently preferred. The aim of the surgical operation was to remove the vessels whose valves did not work and leak the dirty blood back out of the body. In new treatments, the aim is to close these vessels by destroying them within the body and to ensure that they disappear by time through the natural healing mechanism of the body. In other words, if we compare the blood-leaking vessels with venous insufficiency to an open tap, the aim of surgery is to remove the tap, and the aim of modern treatments is to close the tap in the body and make it harmless.
Modern treatments destroy the incompetent vein, which causes varicose veins, inside the body. To do this, it is necessary to insert a catheter into this vein under ultrasound guidance. Then, the vein is closed by heating (laser, radiofrequency), sealing it with glue or mechanicochemically destroying it. Laser is the first method used for this purpose and is still the most preferred one in the world. Laser and subsequent radiofrequency and steam therapies heat the internal surface of the vessel, which is then eliminated by the body's own natural mechanism. The methods of destruction in MOCA and glue treatments are slightly different. In MOCA, the vessel wall is destroyed by a rotating wire and chemical substance. In the glue method, the vessel is closed by injecting a special adhesive.
During these ablation therapies, a fluid containing local anesthetic is given around the vessel. This procedure, called tumescent anesthesia, provides local anesthesia during the procedure, protects the surrounding tissues by separating the vein and empties the blood inside the vessel making the process more effective and safe. Tumescent anesthesia is a simple procedure of 10-15 minutes for a physician with sufficient ultrasound experience, while it may be a very difficult procedure for physicians who cannot use ultrasound. Since most of the physicians dealing with varicose veins have no ultrasound experience, new treatment methods that doesnt require tumescent anesthesia have been introduced such as MOCA and glue. However, in our experience, even in these therapies, the use of a tumescent anesthesia helps to make the procedure safer and more effective. Therefore, in all venous insufficiency treatments, we recommend the of tumescent anesthesia.
In addition to the treatment of venous insufficiency, new methods have been developed for the treatment of varicose veins. In the past, large varicose veins were removed via large incisions that create unpleasant scars. Classical sclerotherapy, which has been used for decades for the treatment of medium to small varices, has also been modified. Nowadays, sclerotherapy is generally used as foam sclerotherapy by mixing the sclerosant agent with air or CO2. Foam sclerotherapy has some advantages over liquid sclerotherapy.
1. Foam is diluted less with blood and is thus effective over a larger area.
2. It has a destructive effect on the vessel wall 3-4 times stronger than liquid sclerotherapy.
3.Foam is readily visible on ultrasound, allowing us to see which vessels we are injecting the sclerosant. This increases the efficacy and safety of sclerotherapy.
In conclusion, modern methods have dramatically changed the treatment of both venous insufficiency and varicose veins.
Laser, radiofrequency and steam destroy the incompetent vein by heating it from inside.
Tumescent anesthesia empties the vein which decreases the risk of thrombosis, provides local anesthesia during ablation and help us protect the surrounding tissues.