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Advances in Venous Disease Treatment
Minimally invasive surgery is revolutionizing the treatment of venous disease and its associated symptoms, allowing extensive surgeries with long recovery times to become a thing of the past.
In previous years, vein stripping was regarded as the only viable option for the treatment of venous disease. This procedure was extremely invasive and generally required patients to abstain from activities for five to 10 days following surgery. Often, it took up to six weeks for patients to return to optimal functioning, and the chance of patients developing recurrent disease was as high as 40%.
Through the use of new, minimally invasive techniques such as endovenous laser ablation, which requires little to no down time, more patients have been able to benefit from treatment for venous disease.
Endovenous laser ablation is utilized for the treatment of lower-extremity venous disease and can be performed in an outpatient setting without the use of general anesthesia. This has enabled its use to treat various patient populations — such as the elderly — who were previously not considered appropriate candidates for treatment.
“Patients who were often excluded from treatment of venous disease due to age or the presence of comorbid medical conditions now have an option,” says William Schuh, M.D., general and vascular surgeon at the Vein Care Institute in Denver, CO. “Because endovenous laser ablation does not require the use of general anesthesia, these patients can now benefit, even in the presence of other medical concerns.”
Prior to an endovenous laser ablation procedure, a duplex ultrasound is used to confirm the diagnosis. The physicians then review the ultrasound images and perform a comprehensive evaluation of each patient. If patients are determined to be appropriate candidates, an endovenous laser ablation procedure will be performed.
“At the Vein Care Institute, we feel very strongly that the physician who is performing the procedure should also perform the intraoperative ultrasound imaging,” says Carl Dando, M.D., clinical phlebologist on staff at the Vein Care Institute. “During procedures, all of the physicians perform their own imaging, which helps improve patient outcomes.”
During endovenous laser ablation, an IV is placed in the diseased vein. Using ultrasound guidance, placement of the IV is confirmed, and a laser fiber is safely positioned within the IV. This laser fiber is used to seal the vein that is causing a patient’s symptoms. When this occurs, blood flowing through the abnormal vein is rerouted back through the patient’s normal venous pathways. Results are often seen within the first week following surgery, and research has shown that fewer than 5% of patients have recurrent venous disease following an endovenous laser ablation procedure.
After the diseased vein has been treated with endovenous laser ablation, varicose veins, reticular veins and spider veins branching from the diseased vein can be treated with sclerotherapy injections.
Due to the safety and efficacy of the procedure, patients with all stages of venous disease can benefit from endovenous laser ablation. Because it is well-tolerated, even patients with mild disease are able to receive treatment.
“Any patient with venous disease — whether he or she is at the end of the disease process and suffering from skin ulceration or only exhibiting mild symptoms — is considered a candidate for the minimally invasive approach,” says Dr. Dando. “Conventional, open surgery is no longer recommended.”
Symptoms necessitating evaluation for the treatment of venous disease include achiness, tiredness or heaviness in the leg, swelling, throbbing pain, burning pain, leg cramping, restless legs, stasis dermatitis and venous stasis ulcers.
Venous stasis ulcers can profoundly affect a patient’s quality of life, causing pain and requiring multiple physician appointments, dressings and wound-healing modalities. The presence of venous stasis ulcers can interfere with daily activities, including work, exercise and sleeping. Many patients live with venous stasis ulcers, thinking the condition is incurable, without realizing they could be the result of an underlying disease. Many patients with venous stasis ulcers experience significant improvements after endovenous laser ablation that were not achieved using conventional surgery. As a result, physicians are gaining a better understanding of venous disease as a whole and its associated symptoms.
“Physicians are beginning to realize that venous disease is much more profound than we once believed,” says Dr. Schuh. “Many associated symptoms, including venous stasis ulcers, can now be resolved through the use of this technique.”
“In the past, venous stasis ulcers were regarded as an incurable medical condition,” adds Darrick Payne, M.D., clinical phlebologist on staff at the Vein Care Institute. “Essentially, we were trying to correct a symptom rather than addressing the underlying disease process that causes the symptom, which prevented patients from experiencing an optimal outcome.”
A Safe Return to Activity
Patients undergoing endovenous laser ablation often return to normal daily activities the day of their procedure. In fact, exercise is encouraged immediately after surgery, which makes this treatment a desirable alternative for athletes.
“Since we have begun utilizing the minimally invasive technique, we have been able to measure differences in patients’ athletic performance after treating their diseased veins,” says
Dr. Schuh. “I recently treated a competitive cyclist who shaved 90 seconds off of a 23-minute ride three days after his endovenous ablation procedure. Because the body is able to rid itself of lactic acid and toxins more efficiently, patients are able to train harder and benefit from increased performance.”
Regardless of age or activity level, almost all patients are able to achieve optimal functioning after treatment for venous disease. Dr. Schuh also treated a patient who worked two jobs and had suffered from venous stasis ulcers for the past 13 years with little relief. Within several weeks of treatment, he was pain free. At a three-month follow-up appointment, his venous stasis ulcers had resolved, and at six months, he was still experiencing relief from venous disease symptoms.
“Not all patients experience this phenomenal degree of success,” says Dr. Schuh. “However, the vast majority of patients experience improvement in their symptoms, which allows them to return to all of the activities they enjoy.”
The Vein Care Institute specializes exclusively in venous disease treatments. The physicians at the Vein Care Institute are experts in their field, having treated more than 20,000 patients with venous disease. More than 7,500 endovenous laser ablation procedures have been performed since the practice’s opening in 2007.
“Minimally invasive treatment of venous disease is not a service filler for our practice,” says Brian Ridge, M.D., vascular and general surgeon on staff at the Vein Care Institute. “Because this is our primary focus, we have developed specialized expertise in the area of state-of-the-art care for venous disease. Having on our team specialists in several different medical fields, including vascular surgery, presents an advantage for us as well, as this enables us to enhance patient selection and best match a patient’s disease with the appropriate treatment modality.”
Patient convenience and comfort is also a priority of physicians at the Vein Care Institute. Four state-of-the-art treatment rooms are available and include ceiling-mounted televisions that patients can watch to decrease their anxiety while receiving treatment.
Vein Care Institute physicians also work closely with referring doctors to quickly accommodate all referrals and follow up with patients for several months after their procedures to ensure successful healing before returning them to the care of their primary care physicians.
“At the Vein Care Institute, we have spent ample time fine-tuning our process, so patients benefit from the best possible care,” says Dr. Dando. “From initial consultation to postsurgical follow up, we strive to provide superior outcomes and a favorable, pleasant patient experience.”
For more information about venous disease treatment, visit
MD News January/February 2011, Denver