Endovenous Laser Therapy––

A Successful New Treatment

Option For Varicose Veins

By Dottie Evans

At the end of a long day, most of us just want to put our feet up.

But for some, a natural tiredness may be accompanied by additional leg discomfort, such as aching, itching, burning, restlessness, or even swelling.

Any or all of these complaints may be the first signs of vascular disease.

“Varicose veins are not only a cosmetic issue, but they may also be debilitating,” said Dr George M. Stohr of Newtown Diagnostic Imaging, a new radiology service located at 153 South Main Street.

Dr Stohr, who is a former Fellow at Yale University in vascular and interventional radiology, spoke Tuesday, September 20, at Lockwood Lodge at Ashlar of Newtown.

“Whether patients suffer from superficial spider veins on the skin of the legs, or the more painful and serious bulging veins that are palpable, it is the same disease process at work here –– faulty or insufficient return of the blood to the heart,” Dr Stohr said.

He explained that veins are responsible for returning blood to the heart, while arteries carry newly oxygenated blood away from the heart.

“The venous system is responsible for five percent of the total blood volume in the body. With vascular disease, there may be abnormal valve function causing the venous blood to pool. This causes turbulent flow at the valve site and bulging of the vein walls.”

When the vein wall becomes weakened, it stretches and dilates. This pulls the valves farther apart so they cannot close properly. The result is that blood flows backward.

“Usually, the disease begins higher up, say, in the groin area,” Dr Stohr said, “where the deep vein and the surface vein systems meet, and it works its way on down the leg.”

In more advanced cases, there may be discoloration and even ulceration of the skin, eczema, inflamed tissue, and bleeding. In very rare cases, a pulmonary embolism may occur, though this is more often a result of a clot in the deep vein system, not the surface vascular system.

Causes of varicose veins include family history, obesity, age, trauma, work-related stress where an individual must stand for a long period of time, and pregnancy, where the presence of hormones causes muscles and venous walls to relax.

Indeed, hormones related to reproduction figure prominently in the likelihood of a woman’s contracting varicose vein disease, since 72 percent of women over the age of 60 suffer from it. Only 40 percent of men in the same age group are symptomatic.

 Lasers To Cook Damaged Veins

A person who suffers from varicose veins may benefit from a number of treatments. The use of compression stockings and elevation are recommended to relieve symptoms, but do not address the underlying problem.

Sclerotherapy, which is removal of the superficial spider vein clusters, is a well-known technique that provides cosmetic benefit.

Surgical vein stripping, or phlebectomy, is the procedure during which diseased, bulging veins are literally pulled out of the leg. It is both expensive and painful and involves hospitalization, a lengthy, painful recovery. There is also a possibility of recurrence.

“Phlebectomy has pretty much fallen by the wayside,” Dr Stohr said of the stripping method.

Today’s primary treatment option for removal of bulging varicose veins involves a new laser technique called endovenous laser therapy, in which the vein is disabled in situ by a heat-producing laser beam.

“It has without question supplanted all other treatments. It’s the mainstay these days,” Dr Stohr said.

When considering endovenous therapy, the patient would first schedule an office visit with the doctor for consultation. An ultrasound evaluation is done in conjunction a physical exam, and the doctor pinpoints the exact spot from which the disease has progressed down the leg. This area is often high up on the thigh in the greater saphenous vein.

If the decision is made to go ahead, an out-patient surgical procedure is scheduled. The patient is given a mild relaxing sedative, and a small needle is inserted at the site. A local anesthetic is injected at the target point but no general anesthetic is needed.

An intravenous catheter is then introduced that carries a small guide wire containing the laser. As the wire is slowly pulled back out, the laser is activated and the vein walls are heat-zapped or damaged to the point that they collapse in place rather than having to be physically removed.

“We use local anesthesia, and it is minimally invasive. The procedure takes 45 minutes to an hour at most, and there is 95 percent efficacy. Also, it is much less expensive.”

Afterward, the patient is fitted with a bandage and a compressor stocking and is free to get up and go home. Two days later, there is a follow-up ultrasound exam.

“It’s truly an ambulatory procedure, since we recommend you walk 20 to 30 minutes three times a day,” Dr Stohr said.

“There is always the option of schlerotherapy for touch-up at the site at a later time.”

As far as prevention of varicose vein disease is concerned, Dr Stohr called exercise “the best course” and recommended compressive stockings. But he cautioned that “these methods may only alleviate symptoms.”

Once varicose vein disease begins, reversing the process nearly impossible.

“You are dealing with an unsupported system here,” Dr Stohr said, because when vein walls become stretched, there is no way to restore elasticity so that the valves can function as they should.

At that point, the best option may be surgery.

“For the past three years, the insurance companies have been accepting endovenous laser treatment. Medicare, too, has accepted it.”

The only patients who would not be good candidates for this treatment, he said, would be those having clots in the deep vein system.

“That’s because the deep vein system is where the blood must be shunted when the surface system is shut down.”