Modern methods of treating venous insufficiency

Venous insufficiency is a complex disease process that does not only affect the veins of the lower limbs. However, the severity of the symptoms is most pronounced in the lower legs. The direct cause of backflow in the veins (so-called reflux) and the formation of varicose veins are malfunctioning valves.

A rarer cause of venous insufficiency in the legs is a history of thrombosis and the subsequent post-thrombotic syndrome. 

In women, an additional cause of venous insufficiency of the legs is pelvic venous insufficiency. This process is most often related to the number of pregnancies. Sometimes the cause of pelvic venous insufficiency is venous compression syndromes, such as 'nutcracker' syndrome or May-Thurner syndrome.

In recent years, there have been tremendous advances in venous treatment. Minimally invasive procedures have irreversibly revolutionised the approach to treating venous insufficiency. They are characterised by high efficiency, precision and negligible risk, making the treatment of varicose veins an enjoyable experience, not only for the patient but also for the doctor.

Instead of classic stripping (i.e. a brutal operation to pull out inefficient veins), minimally invasive endovascular methods are used, which require no skin incisions at all. The inside of the vein can be accessed with a needle, almost like drawing blood. Compared to classical surgery, the risk of complications is minimal after endovascular surgery. This makes it possible to treat patients with other chronic diseases in this way. Very important in minimally invasive procedures is that the patient quickly returns to normal function and activity, often possible immediately after the procedure. 

At the Phlebology Clinic, all the most effective and state-of-the-art methods of treating venous insufficiency are used, from sclerotherapy, echosclerotherapy to the state-of-the-art 1470nm ELVES laser and the even newer bonding technique. 

The team of doctors at the Phlebology Clinic were the first in Poland to perform varicose vein adhesive procedures with all currently available systems: VenaSeal, VariClose and VenaBlock.

The bonding of insufficient venous trunks involves the insertion of special catheters into the centre of the vessel, through which a very small amount of glue is administered, binding the vessel walls and initiating the process of vein fibrosis. Immediately after the procedure, the patient can function normally and does not require the use of compression devices (compression stockings). There is no possibility of the glue, which is injected into the lumen of the vessel, moving to another place or breaking off. The adhesives used in medicine, such as the popularly used SuperGlue, glue the vessel walls together under pressure almost in the blink of an eye (5 to 30 seconds). The amount of product that remains in the vessel is very small (2 ml of glue is sufficient to close a 50 cm long vein). Thanks to such properties, the adhesive method is very widely used among patients with various internal and cardiac burdens, but also among obese people who find it difficult to select suitable compression devices.

The method of laser treatment of venous insufficiency, works sensationally for patients with recurrent and atypical varicose veins. The Phlebology Clinic in Warsaw very often treats patients after multiple classical surgeries with recurrent varicose veins of the lower limbs. The modern 1470 nm laser is not contraindicated in oncology patients or those with an implanted pacemaker. The procedure is performed under local tumescent anaesthesia, so veins located just under the skin can be treated without the risk of burns or nerve damage.

The team at the Phlebology Clinic makes every effort to ensure that the patient is first of all well diagnosed by Doppler ultrasound, venography or phlebography. The next step is effective and comprehensive treatment. In addition to venous insufficiency of the lower limbs, our team also treats pelvic venous insufficiency, venous thromboses or venous vascular malformations.

Authors: Dr Cezary Szary, Tomasz Grzela, MD, PhD, Dr Justyna Wilczko

The article appeared in the capital edition of Gazeta Wyborcza on 29.09.17.