Op. Dr. Orhan Coşkun
When treating a patient with varicose veins, two aspects are crucial.
1- Is there venous insufficiency (leakage in the valve)?
If present, it must be treated. If there is no valve leakage and only visible varicose veins are present, treating them is sufficient.
2- The treatment should be performed by a specialist in this field (Phlebology), who is a Cardiovascular Surgeon.
Because often, what is more important than treating a patient is knowing which patient not to treat. This distinction can only be made through an examination by an experienced cardiovascular surgeon specialist and an advanced evaluation of the patient. Moreover, among numerous treatment options, determining which type of treatment is suitable for which patient is also assessed by the specialist.
For years, varicose vein disease was treated solely through surgical methods, attempting to remove varicose veins by a technique called stripping, which involves large incisions. This approach increased the patient’s hospital stay, delayed their return to work, and also marred aesthetics with unpleasant scars.
Varicose vein disease was perhaps underestimated, and the necessary attention was not given to its treatment. As the impact of varicose vein disease on a person’s lifestyle and the troubles it could cause when not treated properly became apparent, motivation to develop new treatment techniques increased.
Over time, new methods that do not require the patient to stay in the hospital, can be applied in outpatient conditions, and do not require anesthesia have been developed and implemented with very positive results.
The fundamental principle in the treatment of varicose vein disease is the elimination of veins that are varicose, diseased, and have lost their function, causing more harm than benefit to the body. This can be achieved either by surgically removing the vein or by non-surgical methods to close the vein. Popularly known as “drying the vein,” this is an accurate term. Because these veins, which have slowed down their flow and accumulated stagnant blood, have become like marshy pools when they were once healthy streams and need to be dried out. Otherwise, blood clots may form inside, leading to ulcers and causing discomfort such as pain and swelling.
To dry out the vein, medication can be used (Sclerotherapy-Foam, adhesive), or it can be dried out by using energy sources (Radiofrequency, Laser, Steam). Each method has its own advantages and disadvantages. The important thing is to be able to choose the most suitable treatment for our patient.
1- SCLEROTHERAPY; DRUG-FOAM
It is the process of delivering drugs specifically produced for this purpose into the varicose vein in liquid or foam form. It is crucial to ensure that it does not escape from the vein and does not go to unwanted veins, so experience is essential. It is a treatment applied in sessions. With 1-4 sessions and a 20-30 minute application, the patient can return to work and social life. There may be some discoloration and hardness around the application site for a while, but these disappear over time.
It is a very practical treatment method that does not require any anesthesia, is painless, and does not involve incisions. In this regard, experience has greatly increased, and very good results have been achieved, allowing even the most extensive varicose veins to be treated with this method.
2- LASER
The use of laser in varicose vein treatments occurs in two ways. Firstly, by sending a laser catheter (wire) into the large veins with venous insufficiency to burn them, or by burning spider veins on the skin. In the first method, to prevent the surrounding tissues from burning along with the vein, serum is given around the vein (tumescent anesthesia) to isolate it. The patient wears compression stockings after the procedure and is sent home. There is no loss of work or restriction in social life. The use of compression stockings is discontinued after 15 days.
Laser treatment for burning spider veins on the skin is also a less painful and easily applicable method.
3- RADIOFREQUENCY (RF)
This method is similar to laser treatment in terms of application. The only difference is that the energy given is not laser energy but energy produced through radio waves. Similarly, it can be applied both through the vein for large veins and on the skin for spider veins. Like in laser burning of large veins, serum is given around the vein to isolate it from the tissues. It does not require hospitalization or cause loss of work. The patient can return to work on the same day. Burning spider veins on the skin is not painful, and the application is quite easy.
In laser and radiofrequency treatments, there is no incision, so no stitches are required.
4- GLUE CLOSURE (VENOUS SEALING)
It is the method of canceling the vein by giving a tissue adhesive drug that ensures the closure of the vein. The adhesive substance is injected into the vein by entering the vein with a needle and a catheter. It only requires mild local anesthesia. Since there is no burning process, there is no need to give serum to separate the vein from surrounding tissues (tumescent). The usage period of compression stockings is shorter after the procedure. The patient can immediately return home and continue with daily life. There are no stitches, scars, etc. with this method as well.
5- MICROSURGERY
The role of surgery in varicose vein treatment has decreased to almost negligible levels. When needed, incisions are no longer large and coarse as before; instead, they are made in harmony with body lines and, to a micro-scale, often without requiring stitches. There is no longer a need for long hospital stays as before, and the patient can be discharged on the same day, returning to work the next day.
6- COMPRESSION THERAPY
It is supportive in varicose vein treatment. We use it to increase the treatment effectiveness of patients we treat with foam, laser, RF, and sealing. When used correctly, there are opinions that it both increases the success of treatment and eliminates the possibility of recurrence of the disease later.
It may not be necessary for the treatment of very large or spider veins.
We use elastic bandages and varicose stockings for compression purposes.
While elastic bandages are often applied by nurses or doctors after treatment, varicose stockings can be worn by patients. Varicose stockings are not just tight socks; they are stockings with pressure adjusted according to the condition of the disease. The pressure is higher at the ankle and decreases as it goes upward. Due to its structure, it supports the upward movement of venous blood. However, it has a protective and supportive function and does not provide a permanent cure. Wearing and removing varicose stockings can be challenging. To overcome this difficulty, there may be devices available where you purchase the stockings.
Correct usage is crucial. Before putting them on, the feet are elevated above chest level with pillows placed underneath, allowing the blood in the veins to be emptied, and then they are worn.
7- DRUG THERAPY
A permanent cure for the disease is not possible with medication. Medications can alleviate some symptoms such as pain, itching, and signs like swelling, but they do not fix them permanently. Therefore, patients may be forced to use the medication continuously. A clear explanation to patients is necessary in this regard. Otherwise, patients may find themselves moving from one doctor to another, experiencing the disease without receiving permanent treatment, having varicose stockings sitting in their closet untouched, and resorting to one or several varicose medications from their drawer when they experience pain. After a while, they may find themselves dealing with an advanced and challenging venous disease.
Taking these medications on a full stomach and regular usage are crucial to avoid causing stomach discomfort.
