Doctors In-Depth: New Help for Varicose Veins

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The following is a Q&A with G Kendrix Adcock, M.D. about a new vascular surgery to remove varicose veins.


Why do people get varicose veins?...

Dr. Adcock: Varicose veins are caused by a number of reasons, a lot of which are not totally understood. We just know varicosities tend to run in families and unfortunately strike women more than men. They are also more frequent with multiple pregnancies, obesity, and a number of other conditions.

Describe the vascular surgery procedure you perform to remove varicose veins.

Dr. Adcock: First we numb the patient. Then we access the vein and put a little sheath up to work everything through. We then use a radiofrequency probe, positioning it where the deep and superficial systems come together in the groin. We put tumescent around the catheter to serve three purposes. The most important one is to anesthetize the area. It also collapses the vein down and protects the surrounding tissues from the radiofrequency energy. 

If you look at out monitor, you can see the tumescent tracks along the catheter. The bright dot in the center and the fluid around it are the tumescent. It tracks up the sheath around the greater saphenous vein.

Using the ultrasound, we then look up and down the track and around the catheter to make sure we have the tumescent all along it. We want the tumescent thoroughly in the area where the vein will be treated. We then institute a couple of cycles of radiofrequency.

The catheter is heated to 120 degrees centigrade. We treat the initial part of the vein in two cycles. The nice thing about this is the closure fast catheter treats the veins in seven centimeter segments at a time.

Next, we interrogate the vein to make sure there is no flow to the greater saphenous vein. We put a little color flow in there to detect even the most minute amount of flow. Then we will go up to where the saphenous vein empties into the deep system of veins and confirm that the deep system is intact without any problems -- without any thrombus or clot.

What are the benefits of this procedure?

Dr. Adcock: The majority of these people are very young, active, working individuals so the major benefit of this is that the recuperative phase is so short. The procedure is a lot less traumatic to the surrounding tissues and a lot better as far as patient comfort. A lot of these people engage in running, power walking, yoga and they are able to return to those activities very, very quickly. They can go back to work within 48 hours. That is a huge plus to this procedure.

How long does the procedure take?

Dr. Adcock: Typically, just a few minutes. So obviously it's a huge savings in time and effort for patients.

What happens to the vein during the procedure?

Dr. Adcock: The radiofrequency denatures the proteins inside it, sealing the vein down. It kind of cooks the tissue and seals it, kind of cauterizes it. This will eventually shut the blood flow from this vein into the veins in the deeper part of the patient's leg where they are more efficiently able to be taken care of. The venous return flow in his leg is more efficient.

How does this varicose vein procedure compare to previous types of vascular surgery?

Dr. Adcock: I have been performing vascular surgery for almost 25 years and this is a quantum leap forward. It almost makes the procedure that we did when I started seem archaic or like something out of the middle century. This is such a major advance.

How does this procedure compare to laser treatment, which was at one time considered a breakthrough in varicose vein treatment?

Dr. Adcock: It certainly was considered a breakthrough. I think this represents an advance because in this modality the amount of traumatic injury to the surrounding tissue is significantly reduced. The laser seems to cause more injury to the surrounding tissue and people have a longer recuperative phase.

Who would benefit from this procedure?

Dr. Adcock: Typically, patients have been preoperatively evaluated and the majority have symptoms of heaviness, swelling, and fatigue in their legs. We have done non-invasive workup and found the greater saphenous vein is not working correctly. The little valves do not work so instead of the blood stair-stepping back up the leg and going into the deep system and eventually back to the heart, the blood and pressure tends to stay in the lower part of the legs. Typically, once this procedure is done, the blood flow is shunted into the deep system of the veins where it is much more efficiently able to return to the heart.

What are the potential complications from this procedure?

Dr. Adcock: The potential complications are bleeding because we are working on a vein, but this is not usually a major issue. There is always a small chance of infection. Also, thermal injury to the surrounding tissues or reaction to the anesthesia or the prep we give can occur. About 90 percent of veins are closed at two years. However, there is a small percentage that veins will open back up over a period of time and require being retreated.

Is this procedure performed for cosmetic reasons?

Dr. Adcock: Obviously, cosmetic issues have a part in this, but most people are much more concerned about the fatigability of their leg, the swelling, and the discomfort than the way the vein looks. But obviously, in warm climate areas where people wear shorts, this helps alleviate the unsightliness of varicosities.

 

G. Kendrix Adcock, MD

Florida Vascular Consultants

Maitland, FL

407-539-2100

http://www.flvascular.com