THINGS TO KNOW  ABOUT VARICOSE VEINS


WHAT ARE VARICOSE VEINS?

Varicose veins are pathological enlargement of the veins in our body. This enlargement can occur in any part of our body (eg brain, testicle, abdomen) but it is most common in the legs. For varicose to occur, venous blood pressure must increase. In some cases, this may be due to occlusion in the main vein or abnormal connections between the artery and vein, such as fistula, malformation (AVM, AVF). However, the most important cause of varicose veins in the leg is valve insufficiency in the veins, namely venous insufficiency. Varicose veins are mostly seen on our legs due to the effect of gravity, and they can be of various types and sizes. In general, varicose veins begin to appear years after venous insufficiency begins. Over time, both the severity of venous insufficiency and the size of varicose veins increase. Our legs are a little disadvantageous when it comes to sending venous blood to the lungs, because the deoxygenated blood must be sent upwards in the opposite direction to gravity. In this respect, for example, our arms and head and neck areas are more fortunate, because gravity makes it easier for blood to go to the lungs. Considering that we spend approximately 75% of our life in a standing or sitting position, the difficulty experienced by the leg veins can be better understood. Due to this disadvantage, venous insufficiency and varicose veins are more common in our legs than other parts of the body.

HOW DO OUR LEGS SEND DEOXYGENATED BLOOD TO THE LUNGS?

Our body has developed two mechanisms so that the deoxygenated blood in the legs can be sent to the lung without any problem. The first is that during movements such as walking and running, our leg muscles compress the veins like a pump to send the deoxygenated blood up, and the second is that the valves in the veins allow the blood to flow upwards in one direction. When our leg muscles contract, the valves in the veins open and blood is sent upwards. When the muscles relax, the blood tends to flow back, however, when it happens the valves close and prevent the blood from flowing back. Thanks to the harmonious operation of these two mechanisms, the deoxygenated blood in our legs flow intermittently but in one direction to the lungs.

Device

If one of these two mechanisms that allow the vein blood to go to the lungs is broken, deoxygenated blood begins to accumulate in the leg. This situation causes symptoms such as pain, cramping, burning, swelling and itching in the leg. After a while, with the increased pressure of the deoxygenated blood, the veins close to the skin begin to swell and varicose veins occur. In later stages, skin wounds (venous ulcers) occur related to the accumulation of deoxygenated blood. The accumulation of deoxygenated blood in the leg can occur as a result of insufficient contraction of the muscles or insufficiency of the venous valves. For example, in people with paralysis and some nerve-muscle diseases, the legs may swell and varicose veins may occur because the leg muscles cannot pump enough blood. People who have chronic pain in their legs due to bone problems such as rheumatism, meniscus and arthrosis walk less and slower than normal individuals, so the pump in the leg works less. In such people, swelling and varicose veins can be seen in the feet over time. However, in practice, the main mechanism that causes the accumulation of deoxygenated blood in the leg is the valve insufficiency in the veins. This valve insufficiency is usually in superficial veins close to the skin and is called "superficial vein insufficiency". Rarely, valvular insufficiency occurs in the deep veins, which are the main veins of our leg, and it is called "deep vein insufficiency". As a result, all conditions which cause a pressure increase in the leg veins can cause varicose veins over time. However, the most common reason for this is the malfunction of the venous valves, namely venous insufficiency. In order to obtain a good and permanent result, not only varicose veins themselves but also conditions such as venous insufficiency that cause varicose veins should be treated.

WHAT ARE THE RISK FACTORS IN VARICOSE VEINS?

The most important risk factor is genetic predisposition. Your mother or father doesn't need to have varicose veins for a genetic or constitutional predisposition. However, genes inherited from your parents' relatives may have combined to create a genetic predisposition for you. We can say that a person who does not have a genetic predisposition will not have a serious problem of varicose veins. When we look around, we see many people such as cooks, waiters, dentists who spend most of their life standing or who have given birth to 5-6 children but have no genetic predisposition, therefore, they do not have varicose veins. This proves to us that environmental factors are not as effective as thought to occur in people with no genetic predisposition. However, in a person with a genetic or constitutional predisposition, some environmental factors can increase, accelerate or trigger the formation of varicose veins. The best known of such factors are gender (more common in women), pregnancy, hot climate, age, weight, and a lifestyle that requires prolonged standing or sitting. As you can see, the majority of risk factors are not the type we can change.

What are the complaints of varicose veins?

The most common complaint of varicose patients is the visual disturbance caused by the varicose veins themselves. In addition to this visual disturbance, some of the patients with varicose veins may have all or some of the symptoms such as pain, burning, swelling, cramping and itching. In fact, it is not the varicose veins itself that creates these complaints, but the venous insufficiency that causes the accumulation of deoxygenated blood in the leg. More precisely, venous insufficiency causes the accumulation of deoxygenated blood in the legs, creating both varicose veins and causing the complaints mentioned above. Therefore, discontinuing venous insufficiency and treating varicose veins alone will not eliminate complaints such as pain, burning, cramping, swelling and itching. Venous insufficiency should be treated first in order to eliminate these complaints and to eliminate varicose veins permanently. In patients with spider veins, the symptoms of venous insufficiency listed above usually do not occur. Besides, some patients with severe venous insufficiency and very large varicose veins may not have any complaints too. Such patients may think that treatment is not necessary because they do not have any complaints. However, in people with such varicose veins, problems such as clot formation, bleeding, wound formation (venous ulcer) and failure of other healthy veins over time may occur. Therefore, professionals strongly recommend that patients with large varicose veins and venous insufficiency should be treated.

Modern treatments for varicose veins

The most recent innovation in the treatment of varicose veins is the use of medical glue known (cyanoacrylate) to seal the main defective vein. Once the vein has been sealed, it will undergo a process of hardening (sclerosis) and will be gradually absorbed by the body. The procedure is minimally invasive.

What is glue ablation method

The most recent innovation in the treatment of varicose veins is the use of medical glue known (cyanoacrylate) to seal the main defective vein. Once the vein has been sealed, it will undergo a process of hardening (sclerosis) and will be gradually absorbed by the body. The procedure is minimally invasive.

Well-known glue ablation method: venablock

VenaBlock offers a unique treatment for venous insufficiency. The magic part of VenaBlock is its glue, VenaBlock Embolic agent has low viscosity and this low viscosity allows a progressive and homogenous injection, without leaving large empty spaces. The polymerization time is very short (4-5 seconds) and that makes treatment shorter than before. The treatment is simply delivering specific formulated medical adhesive inside of dysfunctioning vein segment. And the procedure prevents complications such as burn marks, bruising, hematoma, numbness and pigmentation. In this way, patients can return their daily routines in the shortest time. Up to 5 years of the scientific clinical study shows that VenaBlock has %98,8 success rate.

The venablock glue ablation procedure

The VenaBlock procedure involves the placement of a very small amount of VenaBlock glue into the vein through a small catheter. Once the affected vein is closed, blood is immediately re-routed through other healthy veins in the leg. Unlike other treatments, VenaBlock does not require any anaesthesia. Furthermore, there are no pre-procedures drugs involved and patients can return to their normal activities right after the treatment. Unlike heat-based procedures such as endovenous laser or radiofrequency ablation, with VenaBlock there is no risk of skin burns or nerve damage. VenaBlock does not require any immediate post-treatment pain medication or uncomfortable compression stockings.

Advantages of venablock glue ablation

  • Luminous Source: The Venablock Catheter has a laser light tip that allows it to be visualized transdermally. The position of the tip is therefore always visible, allowing the doctor to apply an effective compression where the injection of glue has just taken place, while the polymerization reaction is still in progress. In addition, the light tip is useful for checking the initial position of the catheter (3 cm distal from the femoral) before starting the injection of the glue, to avoid injection into the deep vein. In addition, 620 nanometers light accelerates polymerization also has a pain relief feature.
  • Polymerization Time: The quick VenaBlock polymerization time allows high safety of procedure due to the very rapid activation of the glue with immediate occlusion of the vessel (less than 5 seconds), a condition which prevents the migration of the glue in the deep veins. In this short period of time, a strong external compression must be applied to the vein, repeatedly from top to bottom, taking care to maintain the occlusive compression on the proximal saphenous with the ultrasound probe. Compression is crucial for adhering venous walls while avoiding blood residue in free spaces and thrombus formation. The correct application of compression collapses the walls of the vein avoiding hardening of the vein caused by excess glue and residual blood thrombosis. It also reduces recanalization caused by insufficient adhesion.
  • Continues Injection: Continuous injection makes the operation faster and much more efficient. In this way, there won’t be any gaps and the closure of the dilated vein is fully ensured.
  • Low Viscosity: The low viscosity (Similar to water) allows a progressive and homogenous injection, without leaving large empty spaces thus eliminating thrombosis with fibrotic residues and subcutaneous nodes/cords.
  • Excellent Pushability
  • Braided and Marked PTFA Catheter
  • High Echogenity and better visibility under USG
  • Non-tumescent Procedure / No need to use compression stocking after the procedure
  • No burn marks, skin pigmentation or lesions, numbness

Thermoblock radiofrequency treatment

"Rapid and effective closure of the vein."
Radiofrequency (RF) ablation has also been used as an alternative to surgical operation in the treatment of great saphenous vein insufficiency in the early 2000s, like the endovenous laser. Both laser and RF have been used in the non-surgical treatment of venous insufficiency in millions of patients all over the world since those years. And both methods have been scientifically proven in many studies that they are safe and successful and that they first close venous insufficient vessels and then completely absorbed

by the body over time. The way RF ablation is performed is like a laser. First, the venous insufficient vein is entered under ultrasound guidance and the RF catheter is placed at the beginning of the vein with the help of a guidewire. Then, by operating the RF device, the vein with venous insufficiency is destroyed by heat.

Just like a laser, RF ablation should be done under tumescent anaesthesia. Tumescent anaesthesia will ensure that the procedure is performed painlessly, will protect the surrounding tissues from RF, and will ensure that RF is more effective and safe in a bloodless environment by draining the blood inside the vessel to other vessels. After each application, the catheter is pulled up to the next section marked on it. Thus, continuous ablation therapy is applied throughout the varicose vein.

Termoblock Thermal Coagulation Ablation Catheter; is a vascular fibrillation auxiliary catheter providing heat transmission from the generator for the ablation of arrhythmia focus.
Thermal Coagulation Ablation Catheter is a system that uses thermal energy to destroy endothelium and collagen in vessel walls. Thermal Coagulation The Ablation Catheter heats the vessel wall to 120°C. This temperature has been shown to be sufficient for denaturing proteins in the vessel wall. It causes changes in the collagen of the vessel wall by thermal injury and causes the vessel to contract. Over time, the vessel is gradually absorbed by the body's natural mechanisms, so there is little if any risk of reactivation.

Advantages

  • Laser-guide guidance
  • Temperature 80-130 degrees
  • Easy set-up, battery-powered RF generator
  • Consistent & effective temperature-controlled energy delivery
  • No capital equipment or additional installation required
  • Adjustable temperature and time interval selections available
  • Intravascular heat parameters are monitored in real-time
  • High catheter echogenicity and better visibility under USG
  • Easy repositioning between segments
  • OTW


1. LARGE VARICOSE VEINS

When viewed from above while standing, varicose veins protruding clearly from the skin. In such varicose veins, there is almost always an underlying venous insufficiency (valve insufficiency). In fact, venous insufficiency starts first, and after years passed the first varicose veins begin to appear. The diameter of varicose veins is proportional to the severity and duration of venous insufficiency. In other words, the more protruding varicose veins, the longer we can say that venous insufficiency has been present. In these patients, venous insufficiency and varicose veins increase with each passing year, it is progressive. In the vein with venous insufficiency and in varicose veins, blood flow is much slower than normal, so clots can easily form. The clot formed makes non-surgical treatments difficult. In addition, it may go into the lungs (pulmonary embolism) and create a life-threatening risk. In this type of varicose veins, problems such as bleeding, wound formation, and affecting healthy vessels over time may also occur. For these reasons, professionals recommend that patients with protruding varicose veins should be treated.

2. MEDIUM SIZE (RETICULAR) VARICOSE VEINS

They are blue-greenish varicose veins with an average diameter of 3-4 mm, slightly protruding from the skin. Typically, they are behind the knee and on the outer lateral surface of the leg. Usually, there are spider varicose veins with different diameters. In fact, medium-size and spider veins are visible parts of a single vessel network in many patients. This vascular network, whose medical name is Lateral Subdermic Venous Plexus (LSVP), is actually thought to be the remnants of the normal veins we use in the womb. Since our circulatory system changes completely at the time of birth, this vein network becomes disabled and we start using new veins. In fact, this vascular network, which exists in the form of a remnant in every person, can be reactivated in some people, especially in women, and forms such varicose veins that are common in women on the outside of the leg and behind the knee. In this type of varicose veins, failure of the main veins is usually not seen and health problems do not occur. The main complaint in these patients is visual disturbance and treatment should be done to eliminate this complaint.

3. SPIDER VEINS

Spider varicose veins are often seen with medium (reticular) varicose veins and should be treated with them. In some cases, spider varicose veins are isolated, there is no medium size varicoses. Such spider veins should be treated with laser applied from the skin if they are very thin, and sclerotherapy if they are slightly thicker. In general, in Doppler ultrasound in spider veins, failure of the main vessels is rare and health problems do not occur. The main complaint in these patients is visual disturbance and treatment should be done accordingly. A special type of spider veins is "Corona Phlebektika". This is a type of varicose veins, mostly seen on the ankles and feet, consisting of pink purple small bubbles and the appearance is extremely disturbing for patients. Unlike other spider veins, Corona Phlebectica is often associated with leakage and larger types of varicose veins in the main vessels. In the treatment, leaky veins must be detected with color Doppler ultrasound and closed with laser or other treatment options, and then large varicose veins must be treated, and then corona phlebectica must be removed with a good sclerotherapy (foam treatment) or telangiectasia devices with very fine needles.


Interventions for venous insufficiency

These are ligation & stripping surgery performed in great saphenous vein insufficiency and perforating ligation surgery performed in perforating vein insufficiency. In ligation-stripping surgery, incisions are made in the groin and various parts of the leg and the great saphenous vein is removed in pieces. Against the risk of injury to the saphenous nerve, the part of the great saphenous vein above the knee is usually removed, and the lower part of the knee is left. In ligation of perforating veins, the perforating veins under the skin are closed by laparoscopic method using endoscopy. Both ligation-stripping and SEPS surgeries are operations that have been applied in medicine for decades and have proven success. However, both of them have disadvantages such as general anesthesia, hospitalization, late return to normal life, and the risk of wounds, stitches and infections that can be seen in every surgical operation. In addition, there is a risk of deep vein thrombosis (clot in the vein) up to 5%, especially after ligation-stripping operations, and venous insufficiency recurs in about half of the patients even after the most successful operations. The reason for the recurrence of venous insufficiency and varicose veins so often is that the body creates new curved veins in the place of the removed vein due to the trauma caused by the surgery. These vessels, which are easily seen on color Doppler ultrasound in operated patients, are called "neovascularization". Since neovascularization consists of tiny veins that do not contain valves, dirty blood flows backward from these vessels and venous insufficiency recurs in the patient, varicose veins reappear. In such patients, if neovascularization areas are detected correctly, ultrasound-guided foam sclerotherapy or glue ablation treatment can be successfully applied.

Treatment of varicose veins with phlebectomy

These are varisectomy or phlebectomy operations where varicose veins are cut and removed. In these surgeries, incisions are made from the skin, varicose veins are removed and the incision sites are stitched and closed. In this method, the patient immediately gets rid of large varicose veins, but permanent stitch marks occur in various parts of the leg.