RENAISSANCE OF VEIN TREATMENT
Posted in General on May 7, 2019
Vein problems have plagued humans since the beginning of time. Fortunately our understanding of vein problems has seen dramatic improvement and technological advancements that have led to a dramatic increase in the number of treatment options available.
The first description of varicose veins dates back to 1550 BC, where varicose veins were described as “serpentine windings” in an ancient Egyptian scroll, now known as the Ebers Papyrus. During this era it was felt best to leave veins alone; “Thou shall not touch something like this”.
During the Greco-Roman era, Hippocrates of Kos, 460 BC – 370 BC, who many believe to be the father of modern medicine, described varicose veins, and counseled against performing vein surgery. The term “varicose” is actually a derivative of a Greek word meaning “grapelike”, and was used by Hippocrates to describe varicose veins
Roman physician Aulus Celsus, 25 BC – 45 AD, was one of the first to describe operating on varicose veins. A century later, Greek physician Aelius Galenas (Galen), 129 AD – 216 AD, described phlebectomy, a vein procedure that is still in use today!
“Vein stripping” was described in detail by an Arab surgeon Abu Al-Qasim Khalaf Ibn Al-Abbas Al-Zahrawi, 936 AD – 1013 AD, also known in the West as Abulcasis.
In the 19th Century venous sclerotherapy was pioneered by Frenchman Joseph Petrequin. Sclerotherapy refers to injecting a medicine into the vein that results in the destruction of the vein.
In 1890 German physician Friedrich Trendelenburg described tying off the great saphenous vein a few centimeters from its end, also known as great saphenous vein ligation. During 1896 an Australian surgeon, Jerry Moore, recommended tying off the great saphenous vein at a slightly higher level, where the vein connects with the deep vein.
Over the course of the 20th Century the concept of performing vein surgery, to deliberately eliminate blood flow in diseased veins was validated. The purpose of these procedures was to divert vein blood from unhealthy to healthy veins. Although early vein procedures were highly effective, the procedures were typically performed using general anesthesia. These procedures were commonly performed in hospital operating rooms, or ambulatory surgery centers.
MODERN DAY TREATMENTS:
Between 1999-2002 two different types of “thermal ablation” procedures hit the market. These procedures were revolutionary in advancing vein care in the United States, and around the world. Because these minimally-invasive alternatives don’t require general anesthesia, doctors can perform these procedures on an outpatient basis.
Thermal ablation procedures leverage the concept that if a dysfunctional vein is no longer open, then this simulates the same effect as surgically removing veins with disease. In both situations the blood flow in the diseased veins are eliminated, which in turn forces vein blood to flow through remaining, non-diseased veins.
The two major forms of thermal ablation vein procedures are radiofrequency ablation (RFA) and laser ablation (AKA endovenous laser ablation / EVLA). Radiofrequency ablation uses a catheter that has an active tip on its end. Thus allowing it to cauterize the target vein using radiofrequency energy. Laser ablation of works by using a catheter, which has an active tip on its end, to cauterize the target vein using laser light energy.
More Recent Treatments
Several “non-thermal” vein procedures are now available.
“Non-thermal” ablation procedures are a method that shuts down blood flow in superficial veins, without using heat energy. By avoiding heat, these procedurest eliminate the risk of any injury stemming from heat to surrounding tissues. They also reduce the amount of local anesthetic one may require to perform the procedure. Non-thermal procedures that have become FDA approved over the past few years include VenaSeal closure system, Varithena microfoam, and ClariVein.
The VenaSeal closure system uses an adhesive product to seal saphenous veins closed, without using thermal energy. VenaSeal adhesive is a cyanoacrylate polymer that comes inside a small jar, looking similar to translucent honey when outside the body. The doctor administers VenaSeal adhesive into the target vein by using a long catheter that connects to a dispensing gun. Conceptually, the delivery system is similar to a caulking gun that connects to a long delivery tube. When the polymer comes into contact with blood the VenaSeal product instantly “polymerizes”, occluding blood flow within the vein. VenaSeal has proven to be safe and effective, and has the FDA stamp of approval (2015). VenaSeal allows saphenous veins to close without risk of heat-induced nerve injury, and requires no bandages after the procedure. After VenaSeal procedures patients immediately return to work and full sporting activity.
Varithena microfoam is a product that is a mixture of liquid medicine – polidocanol – along with oxygen. The Varithena microfoam comes in a small canister (that looks like a can of shaving cream!). The treating physician withdraws an appropriate amount of the foam product into a syringe. This solution is directly administered into the target using a catheter.
ClariVein is a minimally invasive procedure that uses a combination of mechanical and chemical forces to occlude the target vein. This process uses a rapidly rotating wire to cause mechanical trauma to the wall of the vein. It also gets a supplement from simultaneous administration of medicine to help occlude the vein. ClariVein uses a very slim catheter that the doctor inserts through a pin-sized skin entrance point.
In addition to saphenous vein treatments, physicians employ several minimally invasive procedures they use to treat “perforator” or bridging veins. This may be the cause of ulcers (wounds) that can develop around the ankle.
Overall, the increasing range of technological advancements for treatment options allow doctors to be more helpful. Vein specialists are now able to diagnose and treat patients with a variety of vein problems. This yields higher degrees of accuracy, less risk of complication, and faster return to full activity.