New products in the treatment of varicose veins

Sclerotherapy, endovenous treatment, surgery ... What are the treatments against varicose veins? What are the results of these interventions? The answers.

Summary

1. Understanding the formation of varicose veins
2. Symptomatic treatment of varicose veins
3. Surgery for the most important varicose veins
4. Sclerotherapy in other cases
5. Treatment of small varicose veins
6. Endovenous treatments
7. Clip and Chiva

Varicose veins and heavy legs are very common conditions often associated with venous insufficiency . It is estimated that three out of four people will have varicose veins in their lifetime and that for one in four people, the symptoms will be embarrassing enough to warrant medical treatment or intervention . So what are the possible treatments and in what cases are they indicated? What are their advantages? The response with experts from the National Agency for Accreditation and Health Assessment (Anaes).

Understanding the formation of varicose veins

To understand the techniques used in the treatment of varicose veins, some anatomical details are necessary. The blood circulates in the legs in a deep venous network , located in the heart of the muscles and in a superficial network , located under the skin.

It is this superficial network that is affected by varicose veins . He understands : 

• two main veins , the great and the short saphenous veins , which bring a small part of the blood into the deep network
• secondary veins , smaller.

To prevent blood stagnation in the superficial veins, anti-reflux valves are distributed throughout their journey. In case of failure of these valves (so-called venous insufficiency), reflux occurs and the vein dilates, forming a visible varix under the skin .

Our health record is devoted to vascular medicine. The treatment of varicose veins has changed dramatically in recent years. The surgery which was the treatment of reference is not necessarily proposed in first intention. A specialist at the Bordeaux University Hospital explains why.

Vascular medicine is the specialty that supports the diagnosis and medical treatment of diseases of peripheral vessels:

• arterial diseases : including arterial disease of the lower limbs (15% population after 65 years)
• diseases of the veins : venous thrombosis "phlebitis" (300000 people / year in France), varicose veins, leg ulcers (3% population after 60 years)
• microcirculation diseases (capillaries): Raynaud phenomenon (10% of the population)
• lymphatic vessels diseases (lymphoedema): lymphedema of the arm in 15% of patients treated for breast cancer.

Varicose veins are common in the population (about 20%) but venous symptoms such as heavy legs are even more so (50%). They can be the subject of a treatment request for aesthetic reasons but they can also, when they are important, be complicated by abnormalities of the skin of the legs which can go as far as the ulcer. 

It is important to treat thembefore this stage. To treat venous symptoms such as heavy legs, the only effective treatment is elastic compression by socks or stockings, whether there are varicose veins or not. To treat varicose veins, it is necessary either to remove them (conventional surgery by stripping which pulls the varicose veins), or to stop them in reaction to a chemical injected into the vein (sclerosis) or to the heating of the vein by a radiofrequency current or a laser. 

The treatment of varicose veins has changed dramatically in recent years. Surgery, which was the standard of care, is no longer offered as first-line therapy except in some cases where varicose veins can not be treated with more modern methods. 

First-line treatment can be:

• or echo-sclerosis , that is to say the injection of a product mixed with air to form foam directly into the varix under control of ultrasound. This gesture does not require anesthesia, lasts a few minutes and can be repeated in case of incomplete efficiency. It is practiced by vascular doctors in ultrasound room
• either a heat treatment . This gesture is practiced in interventional radiology or surgery room, under local anesthesia. A catheter is introduced into the vein to be treated and the doctor activates segment by segment the heating by laser or radiofrequency. He performs this procedure under local anesthesia "tumescent" (that is to say by injecting around the vein a liquid containing the anesthetic but which takes off the vein from the surrounding tissues to avoid burning them. under control of ultrasound, that carries out the vascular doctor itself.

Echo-sclerosis can treat varicose veins of moderate diameter, while thermal procedures can treat larger varicose veins. The surgery is reserved for the treatment of varicose veins of large diameter and particularly sinuous. 

The CHU Bordeaux currently offers all these methods of treatment. Echosclerosis and heat treatments are done at Saint-André Hospital and surgery at the Pellegrin Hospital Group.