Emerging Techniques for Venous Disease
by Jon Senkowsky, M.D.

Venous disease is a long recognized problem that affects almost everyone. Problems with veins often lead to swelling, heaviness in the legs, varicose veins, spider veins, and even ulcerations and blood clots, which are potentially life threatening. Despite the fact venous disease has been acknowledged since the time of Hippocrates hundreds of years B.C., innovative technology and significant diagnostic advances in treating venous disease are finally emerging in the field of vascular surgery.

Complications with veins occur for the simple reason they are always working against gravity. Veins in the legs carry blood from the leg to the heart. In order to cover this long distance efficiently, veins contain valves that allow blood to move up the leg, and not down. If these valves become destroyed, blood pools in the lower portion of the leg causing leg swelling, varicose veins and other venous problems. Typical symptoms include heaviness in the legs, swelling, development of varicose veins, and even skin damage, dry skin, and brownish pigmentation at the ankle level leading to ulcers. Another more serious symptom includes blood clots in the legs. Indeed, recent reports indicate people who frequently fly in airplanes are at risk of developing blood clots, which can break free and cause pulmonary emboli. However, the majority of people present with chronic problems in the legs. The most effective treatment can be found by making an accurate diagnosis; determining if blood clotting is present; and identifying whether any venous valve disorders are present. Valve disorders often indicate venous reflux, or pooling of the blood located in the deep veins of the muscle or on the surface veins underneath the skin. (The surface veins, when enlarged, are actually varicose veins.) By utilizing a machine called a Duplex Scan, a noninvasive and painless diagnostic test, all these questions can be answered. Once an accurate and thorough diagnosis is made, there are numerous techniques that can be used to treat venous disease. Perhaps the simplest and most well known treatment for venous disease is the compression garment. These are essentially tight hose or wraps that control the swelling in the leg by forcing the blood into the deeper veins. The compression garments force the same amount of blood into a smaller volume of veins, resulting in more efficient removal of the blood from the lower extremities. A variety of different hose products, both knee high, thigh high, and waist high, and a variety of different strengths and colors, are now available. Other techniques, such as lymphedema wraps and massaging can be administered in order to decrease the swelling associated with venous disease. Finally, an extremity pump, a device that resembles a pant leg is connected to an air pump. The pump blows up the pant legs like a balloon, in order to decrease edema, or swelling, at the lower extremities.

In cases where these noninvasive techniques do not work, or alternatively in patients who desire a better cosmetic result from their venous disease, there are a multitude of techniques to decrease the size of the surface veins. These include ligation, or tying off of the appropriate veins, which can be performed through small incisions under local anesthesia in an outpatient setting. Another technique for surface varicose veins includes a micro-stab avulsion, a treatment in which surgeons use a small needle to surgically remove the vein, again under local anesthesia. This minimally invasive approach replaces the traditional procedure of vein stripping, a technique that formerly left patients with large incisions and scars. Other techniques include sclerotherapy. These are injections of a solution primarily into spider veins and smaller veins that irritate the vein causing them to clot off. This approach, when utilized with compression, can result in essentially the disappearance of the veins and is most effective for spider veins. Perhaps, the most effective techniques to treat painful varicose veins involve vein stripping without removing the vein. These include the VNUS Closure Device and the Laser. In these techniques, a needle is inserted into the saphenous vein, which is the main surface vein in the leg. A catheter is then inserted into the saphenous vein and either ultrasound (utilizing the VNUS device) or laser light, (utilizing the laser device), is applied to the vein causing it to clot off. This decreases the backpressure on the lower leg, reducing the size of the varicose veins. Again, these techniques, which are performed under local anesthesia, can achieve tremendous results in the lower extremity varicose veins.

New techniques in the treatment of varicose veins are emerging. However, the techniques must be applied in the appropriate setting for them to be effective. Therefore, an accurate diagnosis with ultrasound and physical examination are essential to the quality of care for the treatment of varicose veins. Applied correctly, current and future technology offer great promise in the improvement, symptomatology and appearance of varicose veins and its associated complications.

Dr. Jon Senkowsky is a practicing vascular surgeon with COR Specialty Associates of North Texas, PA (CSANT) and The Varicose Vein Clinic of Texas in Fort Worth.