Cardiovascular Surgery
Veins are blood vessels that vary in size and have valves to ensure the blood flow only towards the heart in order to carry the venous or dark blood in our body. Those blood vessels are addressed in three groups: deep veins located beneath our muscles; superficial veins lying beneath the skin; and the perforating veins that allow communication between the former ones. Any dysfunction in valves of veins leads to increased pressure, a clinical picture called venous insufficiency, as the blood cannot be properly carried out the heart and it accumulates inside the blood vessels.
Any insufficiency in superficial veins of our legs is called varicose vein. This condition leads to cosmetic problems, such as dilatation of capillaries, blood vessels that can be seen on the skin and dark discoloration of skin and spots, while it may also cause fatal problems such as deep vein thrombosis and pulmonary embolism (migration of a clot in lungs).
Therefore, venous insufficiencies should not be ignored and they should be treated by experienced physicians in well-equipped facilities, if the condition is clearly documented.
Causes of Varicose Veins and Resultant Complaints?
Venous insufficiency is detected in adults by 50 percent and the condition has many underlying factors. Some of them are long-term standing, smoking, pregnancy, obesity, sedentary life, hypertension, blood clots in veins and genetic factors. Aging increases incidence of varicose veins in both genders, but it is more common in women than men.
Most common complaints caused by venous insufficiency are leg pain, tiredness, feeling of burn, swelling, itching and tingling that impair the quality of life substantially. Venous insufficiency may clinically emerge as a cosmetic problem, but it may also result in serious skin problems, such as ulcers.
How is it diagnosed?
The major examination for diagnosis of venous diseases is color Doppler ultrasound that measures diameter of the blood vessel and the duration of reflux – backward flow of the blood inside the blood vessel. The principal treatment modality is surgery for blood vessels that have reached a certain diameter and progressed to certain duration of reflux, while medical treatment, compression socks and regular follow-up are reserved for milder cases.
How many types of varicose veins are there?
Spider Web (Telangiectasia): The varicose veins measure 1 mm or thinner, they are usually red and located around the ankle and they look like a spider web.
Reticular veins: They are blue, green and purple dilated veins that measure 3 to 4 mm in diameter and they appear slightly erupted on the skin.
Varicose Formations in Major Veins: these varicose veins measure >4 mm in diameter and they occur at medial side of legs, below the knee or at posterior side of legs. The congestion (accumulation of blood inside the vessel) is provoked by long-term standing. It disappears when the leg is elevated.
How are varicose veins treated?
Principal precautions that can be taken by us are weight loss, cessation of smoking and avoiding from sedentary life by doing sports. If our profession requires long-term standing (teacher, salesclerk, hairdresser), use of compression socks will both alleviate out complaints and slow down progression of the disease in the long term.
For cases of venous insufficiencies that do not meet criteria of surgical management, venostatic drugs – medications that reduce pressure of the blood accumulated inside veins – are prescribed by authorized physicians and they can be combined with compression socks.
What are the surgical treatment options for varicose veins?
The cosmetic problems caused by dilated capillaries can be eliminated by superficial or radiofrequency technique practices, while the larger skin lesions, called venulectasia, can be treated with sclerotherapy or foam therapy.
Sclerotherapy (Foam therapy): it implies an intravascular injection that occludes the vein by inducing a damage on the lining of the blood vessel with a thin needle. After the blood vessel is filled in with the drug, a special bandage or compression socks are used for 3 days.
On the other hand, for venous insufficiencies that require surgical treatment, conventional surgery involves two incisions made at level of groin and ankle; next, a wire is inserted to and advanced inside the blood vessel in order to strip the diseased blood vessel, but this modality is gradually replaced by modern closed techniques.
Stripping: It is performed for large-bore varicose veins. Vascular ultrasound is scanned in patients with insufficiency of superficial veins. An incision (approximately 3 cm in diameter) is made in the groin, while another incision (approximately 1 to 1.5 cm in diameter) is made in the knee region in order to strip the insufficiency superficial veins. The surgery lasts for approximately half an hour. It is performed under general or spinal anesthesia. A special bandage is applied to the leg and the incisions are closed. Patients stay at the hospital for one night. Sutures will be removed 8 days after the surgery. Bed rest is not required.
How is closed treatment of varicose veins performed? Are the outcomes good?
Advanced technology allows elimination of varicose veins without general anesthesia and hospital stay. A catheter is inserted into the vein by a needle punctured below or above the knee level with the guidance of ultrasonography and the diseased blood vessel is occluded without any incision (blood- and incision-free) and the patient can be discharged within several hours.
Spinal anesthesia, superficial sedation or local anesthesia can be used instead of general anesthesia in those endovenous ablation techniques and therefore, it allows an option of surgical treatment for patients for whom general anesthesia is contraindicated. Varicose veins are sealed with radiofrequency energy, laser energy, foam or N-butyl cyanoacrylate and those novel techniques have far better early and late outcomes relative to the conventional surgery.
Sealing or ablation method implies occluding the blood vessel with a special non-hazardous substance with stripping or coagulation. It is a comfortable treatment modality with high success rate. Absence of surgical incision eliminates certain burdens for the patient, such as risk of infection, wound dressing need and hospital stay.
What are possible outcomes if varicose veins are left untreated?
Untreated patients may face and suffer from pain, restless leg, itching, impaired quality of life due to cramps at night, bleeding potentially caused by severely dilated varicose veins, inflammation diseases of blood vessels caused by blood clots in dilated blood vessels, occlusions and wounds that develop in late stages at medial side of the ankle and are hardly treated. In conclusion, it is not possible to prevent varicose veins by using a drug. The medications prescribed by your physician help alleviation of varicose vein-related complaints to a certain extent. Effects of commercially available herbal medicines, creams and similar products have not been scientifically proven. The best treatment modality to prevent and stop progression of varicose veins is the use of compression socks along with surgeries, invasive procedures or medical treatments recommended by your physician. Certain precautions, including but not limited to avoiding from long-term standing, use of special compression socks during pregnancy, regular walk, maintenance of optimal body weight and avoiding from hot temperature, may help prevention of varicose veins.
May varicose veins recur after surgery?
Although the rate of recurrence is …… for varicose veins treated with conventional surgery, novel endovenous ablation (closed system) techniques reduced this rate down to 5 percent.