 |
services provided : Varicose Veins |
|
 |
 |
|
 |
|
 |
|
 |
|
 |
|
Varicose Veins It is estimated that 50 million people in the United States suffer from varicose veins. Varicose veins can be a cosmetic problem, an annoyance, or a more serious medical problem affecting lifestyle and the ability to perform normal daily activities. These elongated, dilated, tortuous, and painful veins most often occur in the lower extremities. Did you know that the vast majority of vein problems can be successfully treated with non-surgical office based procedures? Dr. Charles M. Sheaff, MD was among the first in the Chicagoland area to use EVLT to treat saphenous vein reflux, and he now brings this and other advanced techniques to Jacksonville. Currently, most patients who have varicose veins caused by an abnormal saphenous vein are treated with this safe, effective, relatively painless procedure. It is performed in a convenient, comfortable and private office setting. Dr. Sheaff brings over 20 years of experience in treating varicose veins to his practice in Jacksonville. His private practice in Schaumburg, Illinois treated over 5,000 cases of varicose veins over the years. Services
Information on Varicose Veins and Treatment Options
Varicose veins can be more than an unsightly annoyance - they can be a serious medical condition requiring medical treatment. The problem of varicose veins can be attributed in large part to the erect posture of the human animal, which places tremendous hydrostatic pressure on the veins in our legs. At regular intervals inside the tubular structure of the veins of the leg are tiny valves that force the blood to flow upward toward the heart. When one of the valves "blows," pressure on the valve below it is increased, making it more susceptible to damage - a kind of cascading effect. When one or more of these valves are damaged, a varicose vein results. The symptoms vary, depending on the severity of the condition. The most common medical indication, however, is a deep, cramp-like pain in the legs which is aggravated by standing up for prolonged periods of time. The pain is usually gone in the morning, since lying down decreases the pressure in the leg veins and thus relieves the pain. Those who have varicose veins may also notice swelling of the leg and skin changes, including rashes or a rusty-colored discoloration of the skin. Symptoms may also be worse during warm weather, during a woman’s menses, or during exercise. Some women report pain during sexual activity. Once ulcers, or sores in the skin occur, treatment becomes more pressing. Venous stasis ulcers usually occur around the ankle in skin damaged by long standing high venous pressure. A relatively minor injury is often the precipitating event. We recommend topical treatment for the ulcers while the doctor works to correct the venous insufficiency. Although these small surface veins can produce symptoms such as burning and itching, treatment is usually considered cosmetic. Many treatment modalities are available including topical creams, electrotherapy, injections, and laser therapy. Considering expense, effectiveness, discomfort, and invasiveness, we feel that injection therapy with a series of simple office procedures is usually the best to treat Spider Telangiectasia. The usual cause is an inherited tendency toward weak valves, but the condition can be aggravated by anything that increases abdominal pressure, including pregnancy, heavy lifting, chronic constipation or an upper respiratory problem which results in severe coughing. How Are Varicose Veins Treated? Treatment of varicose veins should be tailored to the individual’s anatomic and physiologic specifics. In general, treatment is directed at preventing reflux in the long and/or short saphenous veins (the primary surface veins running down the leg) and at destroying the branch varicosities. Each may be accomplished by either removal or ablation. Some of the methods are discussed below. In order to be effective, compression garments should provide at least 20-30 mmHg pressure at the ankle with graded compression gradually decreasing up the leg. Higher pressure may be needed for more serious venous disorders resulting in edema and ulcerations. Wearing compression garments may delay progression of disease or at least provide a level of comfort. They will not reverse existing varicose veins or venous insufficiency. EVLT (Endovenous Laser Treatment) If high venous pressure from an abnormal long or short saphenous vein is contributing to varicose veins, then the saphenous vein should be addressed first, which traditionally meant a vein stripping. EVLT (Endovenous Laser Treatment) was developed as a less invasive way to ablate the abnormal long or short saphenous vein without a major operation. It is an effective alternative to stripping. For the long saphenous vein (the most common problem), a catheter is inserted in the vein near the knee using ultrasound guidance and through a tiny puncture wound. Also using ultrasound guidance, the catheter tip is positioned near the saphenofemoral junction and the laser fiber is inserted. A specialized tumescent local anesthesia procedure is used and the laser is activated and the fiber gradually withdrawn. The connective tissue in the wall of the vein is altered, and as a result, the vein heals shut or is ablated. This relatively non-invasive office procedure takes less than an hour and is successful in greater than 95% of cases. Normal activities are resumed immediately, although there is often some aching and a feeling of tightness for a week or two. Deep vein thrombosis, or a clot in the deep vein, is a risk with EVLT or surgical stripping, but is exceedingly rare (less than 1% in our experience). Also, whenever the long saphenous vein is removed or altered, one must consider that it is one conduit used for heart bypass that would no longer be available. Injection Sclerotherapy (Phlebosclerosis) A common method of treating varicose veins today is to inject a sclerosing chemical into the vein, destroying its lining. The injection is guided by direct vision, palpation, or ultrasound. The leg is then bandaged tightly for a period of time, allowing the vein to heal shut. Several treatments are usually necessary. The method is primarily for branch varicosities, but with sequential injections, it can be used to ablate the saphenous vein. The Injection Sclerotherapy (Phlebosclerosis) treatment is usually not completely effective in closing the varicose vein along its entire length. Pockets may remain, trapping a bubble of blood as a tender lump. This trapped blood can be aspirated, or if left alone, the body will eventually resorb it and it will go away. Sometimes skin stains will appear as stagnant blood leaches out of the vein. These are simply a cosmetic problem and will fade over several months. Serious complications are very unusual. Allergic reactions to the chemical are extremely rare. Occasionally, some of the chemical may leak out of the vein, causing a small chemical burn which will heal slowly, leaving a small scar. In the past, the gold standard for treating larger varicose veins was stripping, or surgical removal of the affected vein. That's still a viable option in some situations, depending on the extent of the disease and the underlying pathophysiology. Both the saphenous vein and branch varicosities may be stripped. Stripping of the long saphenous vein involves a 1–2 inch incision in the upper thigh or groin area and a 1/2 inch incision in the area of the knee. The vein is removed by pulling it out from above with an inversion technique. The saphenous vein in the lower leg is usually not stripped except in cases with particularly advanced disease. The branch varicosities are removed through a series of small puncture wounds placed along the length of the visible vein. Hook avulsion and other mini-invasive techniques are used so that the incisions are quite small. However, several incisions are still needed, and the procedure is tedious for the surgeon, and it is difficult to achieve complete removal. While surgical stripping is the most invasive treatment method, it is also the most effective. Areas of bruising, swelling, and numbness are common, but are temporary. A compression wrap is applied and left in place for 2–4 days. SEPS (Subfascial Endoscopic Perforator Surgery) Large dilated surface veins and ulcers are occasionally related to damaged valves in the veins that connect the deep and surface systems. Interruption of these perforating veins to prevent pressure buildup used to be a complex procedure with considerable morbidity. Our vein care specialists are trained in SEPS (Subfascial Endoscopic Perforator Surgery), which is a mini-invasive procedure where these abnormal perforating veins are interrupted through small puncture wounds using videoscopic technique.
No single approach is best for everyone. That is precisely why we offer a multidisciplinary approach with several treatment options. At one end of the spectrum, injection therapy is a simple office procedure but may require several treatments and may not prevent future recurrence. At the other end, full surgical stripping is the most invasive, but offers the most durable solution with a single procedure. The advent of EVLT has allowed us to treat even the most severe disease in an office setting without major surgery. Often, a combination of methods is appropriate. The best approach is dictated by each individual’s anatomy, physiology, lifestyle, and other medical conditions. Each form of treatment has its advantages. The injection method is less expensive than stripping, but it may involve as many as two dozen return visits to the doctor. And only one leg can be done at a time. With stripping, both legs can be treated at once, and the treatment is complete after one session in surgery and one visit to the surgeon's office for removal of the stitches. Generally, too, in patients who have recurring problems with varicose veins, stripping is a more effective treatment that lasts longer. Does Wearing Support Hose Help? Patients with bad varicose venous disease can improve the circulation in their legs by wearing heavy-duty surgical stockings that effectively compress the veins so they are not carrying blood. In patients prone to recurrence of the problem, wearing these stockings as much as possible will delay another episode. If it were possible to wear them all the time, it would even prevent the problem. But a word of caution: support hose are not going to take the veins out of circulation unless they are providing a fair amount of pressure. The so-called support hose that are available at hosiery counters won't do it; real support hose must be purchased from a store that carries medical/surgical supplies. Support hose are rated by the numbers of millimeters of mercury pressure applied at the ankle. The pressure should be at least 25 millimeters to do any good. Hose are available in pressures up to 80 millimeters, but you'd probably need a crowbar to get those on! The rated pressure should be shown on the box - if not, you can be sure it's less than 25 millimeters and you might as well save your money. Spider veins are small veins very close to the surface of the skin. They often occur over larger varicose veins, but other causes can include trauma or too-tight girdles or hosiery. They occur more often in women than in men. Treatment of spider veins is usually done for cosmetic reasons. There are several approaches. Spiders can be treated with a laser, but this is very expensive, ranging from $300 to $400 per session, and sometimes requiring as many as five or six sessions. Spider veins can also be injected with a sclerosing chemical, like larger varicose veins, or destroyed with electric current. If the spiders are small, all these methods will work well without leaving a blemish. However, the treatment we prefer is the injection of a concentrated salt solution. This works more slowly, but the spiders just slowly shrivel and disappear over three to four weeks. Another advantage is that, with this technique, there is less chance for skin stains. What if Deep Veins of the Leg are Involved? When the valves in the deep veins are gone, stripping or sclerosing the superficial veins will not be beneficial. But some experimental techniques to put new valves in the deep veins are being tried to manage cases when there are serious medical problems, such as recurrent ulcerations at the ankle. These usually involve taking a valve out of a vein in the arm and transplanting into the leg. The success rate so far is only about 50%. |
home | mission | services | patients | doctors | contact
© 2013 Dr Charles M Sheaff MD, FACS