The different operative techniques of varicose veins - Interview of Dr. Gerard angiologist

Varicose veins, sometimes accompanied by the sensation of heavy legs, can be treated under certain conditions through surgery. Dr. Jean-Luc Gérard, an angiologist attached to the Henri Mondor hospital in Créteil, answers Doctissimo's questions.

Summary

1. What are the different stages of varicose disease?
2. Are veinotonics effective?
3. When can one consider a varicose vein surgery?
4. Are there any contraindications?
5. What are the different operative techniques?
6. You are a follower of the laser technique ...
7. What are the advantages and disadvantages of different treatments?

What are the different stages of varicose disease?

Dr. Jean-Luc Gérard:  We can distinguish two:

• pre-varicose state with a feeling of heavy legs
• the stage of varicose veins , with veins that are more or less apparent. The veins are said to be incontinent, with increased symptomatology especially when it is hot, when one is in prolonged standing or during menstruation.

Are veinotonics effective?

Yes, even if we regularly hear the opposite. Those who raise doubts base their argument on the lack of study after 1990. They forget all those that had been done before and that all went in the same direction. It has been proven that veinotonics are effective for people who have varicose veins and have sore legs .

When can one consider a varicose vein surgery?

In a purely conservative perspective, only varicose veins larger than 7 mm in diameter should be removed . But young women do not want to wait for huge varicose veins before treating them. If they have a real incontinence of the vein from the groin, even if it is only 5 mm, we will still proceed to the intervention. 

In any case, there is always an arbitration between the aesthetic and the medical point of view .

Are there any contraindications?

They typically concern  pregnant women , those who are breastfeeding , those with a history of phlebitis , those who have  problems of infection , such as ulcers or flu, in the latter cases the contraindication is only temporary.

We must add  all people at risk of arteritis or who have a family history of coronary bypass, diabetes, cholesterol . The echo-doppler essential before an intervention of the varicose veins , will also check the absence of arteritis even subclinical.

What are the different operative techniques?

They are many :

• Stripping is today the "gold standard", the reference intervention recommended by ANAES (NDLR National Agency for Accreditation and Evaluation in Health). It exists in two variants: either by tearing the main vein with the aid of a stripper, or by turning the vein inside (by invagination).
• Sclerotherapy which involves injecting a substance that will irritate the wall of the vein so that it retracts. This technique has been improved with ultrasound-guided injection to be more precise.
• The  endovascular treatment of varicose veins ( by laser or radio frequency ): its purpose is to obtain the occlusion of the varicose vein. For example the Closure system, is a kind of probe that will heat the vein at a temperature of 80 ° C.
• The CHIVA (Hemodynamic Cure of Venous Insufficiency in Outpatients), developed by Dr. Franceschi in 1988, retains the vein by diverting diseased superficial veins to deeper veins. This method preserves the venous capital and gives 2 times less recurrence than stripping and fewer side effects. 
Cryosurgery, which consisted of freezing the vein with nitrogen, was almost abandoned because of a high recurrence rate.
To learn more, read also our article: Varicose veins: which treatment to choose?

You are a follower of the laser technique ...

This involves introducing a laser fiber percutaneously, to burn the vein without surgery . The light is transformed into heat with a certain wavelength (810, 940, 980 nanometers),  heats the blood which will in turn heat the wall . I use the 980 nm which seems to be the most suitable wavelength. His target is hemoglobin and water.
The endovenous laser can be performed in a medical office, the total duration of treatment being about 1 hour, the patient can then return home and continue its normal activities.

What are the advantages and disadvantages of different treatments?

Stripping requires a day or two of hospitalization , an anesthesia loco-regional (epidural) or general, and a  work stoppage of about 3 weeks.
On the other hand,  radiofrequency or laser techniques are practiced on an outpatient basis , with local anesthesia , which removes the psychological problem from those who fear it. Finally the work stoppage is only a week or less. The disadvantage lies in the fact that only the main vein is treated, and not the accessory veins that are dependent on the saphenous vein. But radiofrequency or laser, we can treat secondarily by phlebectomy , outpatient, accessory branches when needed. However, I think it is a technique of the future because it is simple, effective, minimally invasive and should reduce the total cost of treatment.