Venous diseases are among the most common in European countries. However, until recently there was no alternative to the surgical treatment of varicose veins. Meanwhile, intraluminal vein surgery techniques have shown to be effective, combined with fewer side effects than traditional treatments, although conservatively oriented surgeons are still skeptical of these techniques. In the USA, according to the latest data, about 95% of all vein surgeries are already done by the endoluminal method. Here is a brief overview of current trends in endoluminal vein therapy.
Venous diseases refer to one of the most frequent in the Western world. In Germany, about 40% of women and 20% of men suffer from symptoms of venous disease, which range from fatigue, heaviness, pain and swelling – to non-healing ulcers. Sometimes varicose veins can lead to inflammation of the veins and thrombosis.
However, even at the beginning of the 21st century there was no alternative therapy for the treatment of varicose veins other than conservative surgery. Among surgeons, it was generally accepted that the operation – it the only way to help a patient with such a diagnosis.
In less than five years, a number of endoluminal therapies have been approved in Germany, dividing the venous surgeon community into enthusiastic optimists and pragmatic pessimists. Radiofrequency ablation was approved in 1998 and endovenous laser therapy in 1999, and even medical methods of vein sclerotherapy have experienced a renaissance. These procedures sparked a new discussion about the strategy of vein treatment (in general) and about the successes in this area, and the discussion continues to this day.
Conservative surgeons and phlebologists are skeptical about endoluminal methods, because there is no crossectomy or ligation of the sapheno-popliteal fistula when they are used. This is contrary to the traditional approach, which involves a complete crossectomy and ligation at the level of the deep GSV vein and resection of the SSV segment near the saphenofemoral anastomosis. The correctness of this approach has been proven by many studies.
However, new treatments have spread rapidly and have generated increased scientific interest. Scientists are sure that traditional venous surgery has to compete with new methods and reconsider its status.
Features of new methods of vein surgery
The initial problems and side effects of intraluminal vein surgery methods were long duration of treatment (as with ClosurePlus for example) and excessive energy emission, which was sometimes encountered in the case of endoluminal laser treatment and led to painful for the patient sensations and extensive bruising. However, even initial studies and meta-analyses have shown that the results of these procedures are at least equivalent to the traditional ones. methods using crossectomy. However, the new treatments have proven to have fewer side effects and a lower risk of complications, as well as a high level of patient satisfaction.
Primary study outcomes, early and mid-term outcomes may compete with conventional surgical treatment with crossectomy. Curiously, crossectomy performed in combination with endoluminal treatment did not significantly affect the outcome of treatment. At the same time, the radio wave treatment followed the standard protocols for vein surgery from the very beginning.
Endoluminal laser treatments have been the subject of significant developments since the first publications on their use in 1999 and 2001. The aim of these changes was to achieve a further reduction in side effects while ensuring safe primary closure of the treated veins and the stability of the achieved treatment success. With the introduction of new laser devices with high water absorption wavelengths and new laser devices with a radial or spherical beam section, the side effects have been greatly reduced in recent years. This has been verified by research.
Over the years, new endovenous techniques have entered the vein surgery market, but they have not yet been as widely used as the ClosureFast treatment and laser treatment. We are talking about the method of endoluminal radiofrequency vein surgery, the method of thermal ablation with micropulses of steam and the method of sclerosing catheter (ClariVein).
Analysis of the effectiveness of intravenous methods of vein surgery
The effectiveness of intravenous methods of treatment of venous diseases has been demonstrated in many studies and meta-analyses. Specific benefits offered by intraluminal techniques include:
- no need for general anesthesia,
- quick return of the patient to daily activities,
- improved quality of life and shorter recovery periods.
- The indications and contraindications for intraluminal treatments for venous diseases are those of classical vein surgery.
The therapeutic range of vein surgeries has actually been expanded due to the introduction of new methods. So, for example, thanks to them, it became possible to operate on several veins of the trunk region in one session, as well as to operate on patients who are being treated with anticoagulants, and patients with an increased risk of complicated course of anesthesia.
Endoluminal therapies for venous diseases are intended for the treatment of stem varicose veins. Lateral branches should be treated during the same operation with mini-phlebectomy or foam sclerotherapy, as they are not completely removed after treatment of only stem varicose veins and may lead to a weakening of the effect and recurrence of the disease.
The advantage of the laser is that it emits energy directly from the laser handpiece to short segments of the vein. Hot steam therapy is the only method that can be used for lateral branches of the vein.
Rehabilitation period and prevention of complications
The rehabilitation program is carried out in various ways. Most specialists recommend using compression stockings for one week after surgery. The compression wrap had no advantage over compression stockings. Thrombosis prophylaxis is offered within 5-7 days after surgery. In Germany, prophylaxis is usually given with low molecular weight heparin for 5 days.
Early complications are less common with endoluminal treatments than with traditional vascular procedures, and this claim has been supported by relevant studies. Deep vein thrombosis in the legs is extremely rare. Nevertheless, the risk of a thrombus entering the deep femoral vein in the area of the saphenofemoral fistula was noted, but this problem was solved without negative consequences.
Common side effects of the treatment are intraluminal masses and bruising, which occurred mainly in the case of treatment with a laser with a low wavelength and high energy emission. But these side effects can be greatly reduced by using new lasers with longer wavelengths, with laser beams having a radial or spherical cross section, and by optimizing the energy density.
In addition, paresthesias have been described, which, as a rule, turned out to be completely reversible. The risk of nerve damage increases in the lower leg. In this regard, in the USA, for example, endoluminal treatment is rarely used below the knee joint.
Hyperpigmentation is an unsightly side effect and occurs with very superficial veins. This may disappear within a year but cases of permanent hyperpigmentation have also been described. Postoperative bleeding and wound infection are extremely rare complications.
Thus, traditional venous surgery is increasingly competing with new methods of treating venous diseases, and it may soon have to reconsider your status as the only correct method.
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