Cardiovascular Surgery Specialist Prof Dr Semih Barlas said that classical surgeries, which aim to remove the vein that missed the valves (with venous insufficiency) under general anesthesia or to be tied in place, are left behind.

Stating that varicose veins treatments should not be postponed due to Covid-19, Prof Dr Semih Barlas underlined that patients can quickly return to their daily lives with new treatment methods.

Women have twice the problem of varicose veins than men

Numerous clinical studies show that women are 2 times more likely to have varicose veins in the legs than men. Its incidence also increases with age. Regardless of men and women, when the individuals are examined, it is revealed that the rate of varicose veins is 22% in 40-year-olds, 35% in 50-year-olds, and 41% in 60-year-olds. Regardless of age and gender, it is known that the frequency of venous insufficiency in general is between 20% and 60% all over the world.

The cause of varicose veins is venous insufficiency

There are veins (veins) that carry the dirty blood in our body to the heart and lungs to be cleaned. Since the leg veins perform these functions from bottom to top, that is, against gravity, there are valves inside them that work in one direction. The deterioration and retraction of these valves is called venous insufficiency. Symptoms of venous insufficiency are also called varicose veins.

Still life leads to venous insufficiency

During the pandemic, people had to restrict their movements preferentially or necessarily. When the remote working system, curfews and the natural lifestyle of the winter months came together, people spent most of their time in closed areas. This can lead to venous insufficiency. When immobile, the function of the valves in the veins in the legs may deteriorate, the massage effect of the calf muscle on the veins may decrease, and weight gain in addition to this can lead to venous insufficiency and varicose veins.

The most serious risk is pulmonary embolism

When venous insufficiency is not treated, it may predispose to clot formation in the leg veins. If such a clot breaks out of its location, whether in the main veins (deep venous thrombus-DVT) located in the innermost part of our leg, or in more superficial veins, the first target it will reach is the lungs. This is called ‘pulmonary embolism’ (clot in the lung). Pulmonary embolism is a very serious picture and creates a vital risk.

Treatment of varicose is not as difficult as it used to be

Great advances have been made in the treatment of varicose veins after 2007. Classical surgeries aimed at removing the vein that missed the valves (with venous insufficiency) under general anesthesia or tying it in place were abandoned due to the recurrence of the disease in 5 years. The current treatment methods currently used do not adversely affect the daily life and business life of the patient. The patient can continue his daily life from where he left off.

There is no need for general anesthesia anymore in the treatment of varicose veins.

It is very important for individuals to be conscious in the diagnosis of venous insufficiency. Swelling in the ankles or sock rubber marks, noticing the veins that may have different diameters from capillary to thick in the legs, and feeling of restlessness are the first symptoms. In such cases, it is recommended to share the complaints with a cardiovascular surgeon, to examine the leg and to perform a very detailed leg ultrasound examination called venous doppler. Treatment method is determined according to the result of ultrasound.

Today, treatment methods can be performed under local anesthesia and in a short time. For this reason, patients should not hesitate and disrupt their treatment due to the pandemic. The main treatment methods according to the condition of varicose veins are as follows;

A) Superficial Foam Sclerotherapy (VFS): It is a method applied in the treatment of capillaries with a diameter of 1-3 mm in the legs. With very fine needles, a foamy drug is injected into the veins and the veins are eliminated. It is applied in cases of mild venous insufficiency. It is a cosmetic procedure and does not require anesthesia.

B) Superficial Laser Treatments: It is generally applied in addition to Superficial Foam Sclerotherapy when necessary. It is successful in very fine capillaries with a diameter of 0.5-1mm. In cases where it is applied to thicker veins, it may cause permanent burn marks or fail. It is applied in cases of mild venous insufficiency. It is a cosmetic procedure and does not require anesthesia when new generation laser devices are used and it is painful.

C) Ambulatory Phlebectomy (AP): It is applied to veins thicker than 3mm, like spaghetti pasta. Under local anesthesia, the veins are removed through 1mm incisions that do not require stitches. It is a medical procedure.

D) Endovenous Truncal Ablation (EVTA): It is applied in cases of moderate to severe venous insufficiency. Under local anesthesia, with the help of a catheter (thin tube) inserted into the vein

1) radiofrequency energy or
2) laser energy or
3) By giving a kind of glue, it is aimed to destroy the patient’s vein, shrink and cancel it.

EVTA is a medical method, no matter what type of catheter is used.

E) Chemical Ablation under Doppler (DGS): An astringent drug is injected into the vein under ultrasound imaging. It is generally used as a complement to the EVTA procedure, in cases of moderate to severe venous insufficiency. It is applied in about 5-15 minutes and does not require any anesthesia. It is a medical method.

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