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Wash away varicose veins
Fifty percent of Americans over age 50 have varicose veins. For women – and men – they can be embarrassing, unattractive, even so painful that it is hard to walk. Now, there’s a new treatment option that uses foam to wash away problem veins.
Fixing painful varicose veins used to mean invasive surgery called vein stripping or laser treatments. A less invasive option uses foam to destroy the veins. Doctors inject the carbon dioxide foam deep into the diseased vein and track it through ultrasound. The foam pushes blood out of the way, eventually closing up the vein. Doctors say using foam means better lon-term results, especially for patients who have already had vein procedures.
To learn more about the vein removal procedure, please see the doctor’s interview below:
Rajagopalan Ravi, M.D., a vascular surgeon at the Arizona Heart Institute in Phoenix, explains how a new procedure for painful varicose veins can help patients who haven't seen relief from previous treatments.
How does the vein foam help patients?
Dr. Ravi: People with venous disease come for two reasons – either they don't look good because they are unsightly, or they come in because they have a lot of symptoms. In our practice, 10 to 15 percent is purely cosmetic. In other words, the veins have become unsightly and they want something done about it. About 80 percent of patients are suffering because of these large veins causing a lot of problems. When you are doing a surgery for a large vein where a patient is having a lot of symptoms, they don't mind going through an operation to remove it. However, when you're getting something done for cosmetic reasons, they want something very simple, and that's where the foam comes in.
Is the foam used mostly for cosmetic procedures rather than for pain?
Dr. Ravi: No, it can be for both. However, more and more foam gets used in this country for cosmetic reasons than therapeutic.
How does the foam work?
Dr. Ravi: We've got to go back a little bit history-wise. If you inject a solution into a vein to kill it, then there's blood flowing through the vein and the blood has a tendency to dilute it. On the other hand, if you inject a little bit of something like a solution, then that clears the blood and the solution is in contact with the vein wall. In 1997, a gentleman named Dr. Cabrera came out with a brilliant idea of agitating this air, like how you make soda or froth. When the froth went into the vein, because of the surface tension, it stayed in the vein a little bit longer, so you could use lower concentrations and smaller quantities to achieve the same results.
What are you putting in the vein, and how does it act when it gets in there?
Dr. Ravi: There are two types of solution that we use. One is a hypertonic solution, which is the old saline solution, or a high concentrated sugar solution. The second is a detergent solution, with a new group of drugs called sotradecol and polidocanol. Only soap makes froth, so you need a soap solution to really use it.
What does the foam allow you to do?
Dr. Ravi: It is a chemical agent toxic to the wall of the vein, so what you're doing is basically irritating the inner lining of the vein thereby causing the demise of the vein. The solution has to be in contact with the inner wall as long as it can; however, you can't use something too strong because then it can break the skin also, so you have to use the right concentration and the right amount to destroy the vein.
What is the goal of this procedure?
Dr. Ravi: Destruction of the vein, to remove it.
How long does the procedure take and how does it work?
Dr. Ravi: It all depends on how much area you're doing. Usually, it takes about 15 to 20 minutes. There are two major ways of how it's done, so that's where the time factor comes in. If you're doing it for a cosmetic reason and what's called a visual sclerotherapy -- it means that you're looking at the vein directly, because you're able to puncture it with direct sight -- and that takes much shorter time, because you're able to see the foam go through under the skin. However, when you have to do a vein which is a little bit deeper that you can't see from outside, we have to use the help of ultrasound guidance. What it means is basically you're putting the needle into the vein, which is a little bit deeper, under ultrasound guidance. Now, foam causes bubbles; therefore, you can see the foam travel and you can follow it with the ultrasound probe thereby accomplishing a remote location of treatment from an injection site which is much further away.
Can you actually watch in real time what's happening?
Dr. Ravi: That's correct, and it also adds an extra benefit of preventing any complication of this foam going into the deeper veins and causing phlebitis and blood clots.
What is the advantage of the foam over some other procedures?
Dr. Ravi: The same solution can be injected by itself. It causes the same result. However, you need a larger quantity of it. Secondly, you might need multiple treatments because you're not able to empty the vein. Now, if I have to use just the solution, then I have to get into the vein, raise the particular extremity so that the veins are empty, inject them, then immediately put a compression dressing on. On the other hand, I can do the foam very quickly with the patient -- actually with their the head down because the foam will travel more distally out towards the toe rather than proximally -- and I can wait a little bit before I put the dressings on because the foam will keep the vein from refilling as fast.
It's a quicker result, and is it a permanent fix?
Dr. Ravi: More than a quicker result, it is actually more effective because you might need less treatment and smaller quantity of the medicine, thereby fewer complications. The healing probably takes the same amount of time because it is the body that has to heal it, so the overall healing is the same amount.
Who is the ideal patient for this procedure?
Dr. Ravi: Patients who have veins which are unsightly and measure from one-eighth of an inch to larger, those are patients on whom we can do this procedure. For the more symptomatic veins -- these are people who had some of the old types of operations like stripping and ligation -- they've formed lots of new veins which are very, very tortuous, and it's ideal in those situations because the new veins respond well to treatment.
Is this a big deal in the treatment of these vein problems?
Dr. Ravi: Yes, because about 25 to 30 percent of the patients who come to us are people who've had some other treatment before. Before I go further, there are some complications related to the foam, so I don't want you to think it's the panacea. There is a limit to how much foam you can inject because after all, it's an agitation of a gas we use. They used to use air -- that's how it was originally proposed -- but now we use carbon dioxide. The reason for carbon dioxide is it gets absorbed faster in the blood, therefore, it doesn't travel. With patients who have asthma, this is a relative contraindication, mainly because the asthma can get worse. If they have asthma, you've got to be a little bit more cautious. The second group of patients are those who may have some kind of problem in the heart. What I'm saying is that there is a connection between the right and left side, what we call a PFO. Then the air can go from the right side to the left side and can even cause serious trauma, like a stroke. Therefore, with patients who have migraines, and most of those patients are women, this is a relative contraindication, because we want to make sure that it is not because of some problem in the heart that they have migraines. Otherwise, it's a very safe procedure.
For more information, please contact:
Arizona Heart Institute Vein Center
(602) 707-3511
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Ivanhoe Broadcast News
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Winter Park, FL 32789
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