​

TREATMENT PRINCIPLES OF VARICOSE VEINS

​

In order to understand their treatment, varicose veins must be understood correctly: Varicose veins in the legs are formed as a result of a disease called venous insufficiency. Venous insufficiency is the disruption of the valves in the veins, which work unidirectionally and allow the deoxygenated blood to go to the lung. When these valves are broken the venous blood retains in the legs and causes complaints such as pain, burning, swelling and cramps. It also forms swollen veins called varicose veins over the years. Thus, in most of the patients, the underlying disease is venous insufficiency, and varicose veins are one of the signs of this disease, probably the most unpleasant one.

 

Incompetent vein is like an open tap

In varicose veins, venous insufficiency can be compared to an open tap that spills blood. For a successful and lasting treatment, these taps must be either removed, as in classical surgery, or closed in the body as in new treatments such as endovenous laser. If the varices are attempted to be treated directly before this is done, the treatment will either fail or the varices will reappear in a short time. Therefore, the basic concept in the treatment of varicose veins is to detect and destroy the veins that cause the varicose veins and then eliminate the varicose veins.

 

 

 

 

 

 

 

 

 

 

 

​

​

​

​

 

​

​

In varicose veins, not the treatment concept but the means of treatment has changed

In fact, the treatment concept has not changed over the course of a hundred years of varicose vein surgery. However, new methods are used to achieve these objectives:

 

1. In the past, it was not possible to understand which vein was incompetent and causing the varicose veins. For this purpose, these vessels was "predicted" either by looking at the location of varicose veins or by using some primitive devices called hand Doppler. Nowadays, with a "good" color Doppler examination, we can clearly understand which vessels cause the varicose veins.

 

2. In the past, the vessel, which was thought to cause varicose veins, was excised by surgery. Nowadays, these vessels are destroyed with methods such as laser, radiofrequency, MOCA and glue and closed in the body. The destroyed vessel is shrunk and disappeared by the body's own natural mechanism, just as it heals a wound.

 

3. For the treatment of varicose veins, in the past, either varicose veins were removed from the skin with a large incision (varicectomy) or a simple sclerotherapy was done with a syringe. However, because ultrasound was not used, only varicose veins visible to the naked eye could be treated. Nowadays, sclerotherapy is performed with "foam" which is 3-4 times stronger than the liquid and  treatment can be applied under ultrasound guidance to the varices deep under the skin which can not be seen to the naked eye. If the varices need to be removed, this can be done through the pinholes under local anesthesia (miniphlebectomy) without any incision in the skin.

 

 

 

 

 

 

 

​

​

 

​

​

​

 

 

 

​

​

​

 

In conclusion, the right concept in the treatment of varicose veins is to treat the cause first, namely venous insufficiency and then the result, namely the varicose veins. Procedures to be performed only on the visible varicose veins will not be a real treatment unless the cause of the varicose veins is identified and eliminated.

​

​