Comparison Of Laser Procedure With Surgery

Conservative Treatment

Special support stockings are prescribed to slow down the progression of varicose veins. This is done for symptomatic relief, but they must be worn pretty much every day for the rest of your life to be effective. Stockings may help vein symptoms so long as they are worn, but they do not cure the problem.

Sclerotherapy

Sclerotherapy is performed by injecting a solution into the diseased veins. A mild chemical solution is injected into the dysfunctional vein, which causes it to shrink and gradually disappear. A single treatment session may involve as few as 1 to as many as 50 injections. After treatment, the leg is wrapped in elastic bandages to ensure that the treated veins remain closed. Sclerotherapy does not require anesthesia, and can be done in the doctor's office. Side effects which may only occur at the site of the injection, such as stinging or painful cramps; red raised patches of skin, small skin ulcers, and bruises. Spots, brown lines, or groups of fine red blood vessels could appear around the vein being treated. These usually disappear. The treated vein could become inflamed. Applying heat and taking aspirin or antibiotics can relieve this. Lumps of coagulated or congested blood may develop which are not dangerous and can be drained.

Foam sclerotherapy

Instead of using a sclerosing agent in its liquid form, this technique involves a foam sclerosing solution. The principle behind foam sclerotherapy is the same one that makes shaving cream so effective: foam has a greater surface area than liquid, which increases the likelihood that it will cling to its target surface. Foam sclerotherapy irritates the vein and causes it to shrink more quickly than liquid sclerotherapy.

"No-Stitch" Micro-Surgical Procedures

These procedures are used for surface varicose veins that are too large to be easily treated by sclerotherapy. The incisions are only 2-3mm (about an eighth of an inch) and are so small that they do not require stitches. Advanced micro-surgical procedures such as ambulatory phlebectomy are performed in the office with mild sedation and leave no large scars.

Image Guided Ligation

Ligation may be needed to treat deeper vein disease in some patients who cannot be treated by other methods. Unlike older "blind" surgery requiring larger exploratory incisions, the surgical site is localized using ultrasound imaging and a small incision is made, usually 1 to 2 inches long. Ligation is usually performed in combination with injection sclerotherapy and/or micro-incisional removal of surface varicose veins.

Surgical Ligation and Stripping

Surgical stripping is reserved for only the most severe 10% of varicose vein cases. It is usually used to remove the main superficial vein (the long saphenous vein), which runs from the groin to the ankle. This collects blood only from the skin. Removing the veins will not affect the circulation of blood in the leg because veins deeper in the leg take care of the larger volumes of blood. Vein stripping" is the oldest method for treatment of varicose veins. The first surgery was first performed 100 years ago. Incisions are made to dissect down into the leg and locate underlying diseased veins. Long "strippers" of various designs are passed through these deeper veins and then the stripper and vein are pulled out of the leg together. This is almost always performed using general anesthesia (with the patient completely unconscious and connected to a ventilator) due to the tissue trauma involved. The need for general anesthesia requires that the surgery be performed in a hospital or equivalent surgical facility. Surface vessels are commonly removed at the same time through several incisions measuring 1 to 4 inches each. Recovery times vary widely, but are typically about two to four weeks. Some surgeons perform stripping as an outpatient surgery, with the patient going home at the end of the day, but others will keep patients hospitalized overnight or for a day or two.

The 2 main types of surgery for varicose veins are:

1. Mini-phlebectomy
2. Ambulatory surgery.

Mini-phlebectomy is an in-office surgical procedure performed under local anesthesia to remove the faulty area of a vein through minute incisions. Ambulatory surgery is performed in the hospital to remove the long saphenous vein through two small incisions at the groin and at the ankle or knee

SIDE EFFECTS

• Surgery can leave permanent scars.
• Serious side effects are uncommon
• However, with general anesthesia, there always is a risk of cardiac and respiratory complications.
• Bleeding and congestion of blood can be a problem, but the collected blood usually settles on its own and does not require any further treating.
• Wound infection, inflammation, swelling and redness can occur.
• A very common complication is the damage of nerve fibres around the veins which can lead to pain.