The state-of-the-art advances in the treatment of varicose veins

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Modern advances in vascular surgery constantly offer new possibilities for the effective treatment of varicose veins. New techniques use small punctures and local treatment instead of invasive and traumatic surgical interventions. Nowadays, we have few innovative options in this sphere. The first one is endovenous laser treatment (ELT) with the help of selective laser radiation. The second one is VNUS Closure FAST system, which uses radiofrequency pulses. The third one is VenaSeal non-thermal vein ablation technology based on the principle of removing affected vessels with the help of biological glue. Each technology is precise and requires modern equipment, which is available for patients in a number of German clinics.

Content

1. General principles of the varicose veins treatment
2. Endovenous laser treatment
3. Radiofrequency ablation using the VNUS Closure FASТ catheter
4. Technology of non-thermal vein ablation VenaSeal
5. How can I undergo treatment in the most specialized clinics in Germany?

General principles of the varicose veins treatment

In recent decades, varicose veins have remained the focus of close attention of doctors all over the world. According to the WHO data, up to 33% of women and up to 20% of men in developed countries suffer from this disorder. Moreover, varicose veins are no longer seen only in older patients; even adolescents are diagnosed with this pathology now. Pathological changes in the veins of the lower limbs are associated with aesthetic imperfection and certain health risks (swelling and pain in the legs, ulceration, and life-threatening thrombotic complications).

The main principle of German medicine consists in the timely diagnosis of varicose veins and early treatment, with a preference for the preventive one. Nevertheless, the following aspects are important, as well:

• Correcting cosmetic defects
• Prophylaxis of serious complications
• Giving preference to minimally invasive and non-traumatic treatment methods
• Comfortable for the patient and free of unpleasant feelings treatment
• Avoiding techniques with an obligatory prolonged rehabilitation period
• Complete restoration of the lower limb function after the treatment
• Applying state-of-art techniques and elaborating individual treatment schemes for every patient

Innovative techniques for varicose veins treatment, in combination with the excellent competence of German doctors, offer few fundamentally different treatment options. Each option will be the most suitable for certain groups of patients, so treating physicians should choose wisely. Further, we will look closely at the safest, most effective, and beneficial interventions for the patients.

Endovenous laser treatment

Endovenous laser treatment (ELT), which includes endovenous laser photocoagulation (EVLP) and endovenous laser ablation (EVLA), is a perfect minimally invasive alternative to the traditional varicose veins treatment techniques. ELT is becoming more and more popular among phlebologists and patients as it replaces extensive surgical interventions. ELT requires appropriate technical equipment and the unique skills of surgeons; that is why the intervention can be performed only in a limited number of high-rank hospitals worldwide. Leading specialists of Vascular Surgery Clinic Duesseldorf, including Dr. med. Najib Jawadi has outstanding qualifications in this sphere.

Surgeons successfully perform ELT in the following clinical situations:

• Varicose disease of the large and small saphenous veins (diameter of the vessel may be up to 1 cm)
• Presence of full-blown symptoms, which significantly affects the patient`s quality of life (e.g., cosmetic defect, thrombosis, trophic ulcers)
• Lack of effect from conservative treatment, including drugs administration and local interventions

The procedure itself is performed in the most convenient for the patient's conditions, under special tumescent anesthesia. Tumescent anesthesia is a type of local anesthesia that doesn`t have high risks connected with general narcosis. A surgeon creates a kind of “liquid covering” from the mixture of a prolonged action anesthetic and a vasoconstrictor drug around the affected vein. The introduction of the mixture requires few small injections along the vessel, which are performed under the visual ultrasound control, if necessary. A doctor's practical experience plays a huge role in the anatomically correct introduction of the drugs and painless performing all subsequent manipulations. Tumescent anesthesia not only suppresses the pain but also provides additional protection to the vascular wall and surrounding tissues. That is why ELT guarantees excellent cosmetic results: unlike traditional methods of treatment, there are no hematomas and edema after this procedure.

After the start of anesthesia action, a surgeon performs venipuncture (receives access to the inner part of the vein) and introduces the probe with a laser emitter (LED) into the affected vein. Vascular Surgery Clinic Duesseldorf is equipped with an ELVeS Radial system and radial laser, which radiates a strictly defined wavelength. Such radiation is selectively absorbed by the varicose vein's wall, producing the most pronounced local effect and causing adhesion (“gluing”) of the vessel`s lumen. After this, the process of aseptic (non-infectious) inflammation starts in the vein, and it is gradually replaced by connective tissue. Such a mechanism of ELT action completely excludes the possibility of restoring blood flow through the vessel and developing disease recurrence. In addition, laser wavelength filtration guarantees safety for surrounding tissues.

During the procedure, a surgeon carefully processes the entire length of the affected vein with the laser. In this case, the reverse-traction technique is applied when the laser sequentially passes all sections of the vessel, from more distant to closer to the site of the puncture ones. High competence of the specialists along with state-of-art system ELVeS Radial and high-resolution ultrasound equipment allow doctors from Vascular Surgery Clinic Duesseldorf to track the most complex veins curves and to select the mode and intensity of laser exposure individually for each patient.

ELT is performed under constant visual ultrasound control and takes less than 30 minutes. Once the procedure is finished, a patient should wear compression socks for ten days in order to consolidate the result. Fortunately, ELT doesn’t require suturing or continuous surgical follow-up.

The innovative ELT technique has already demonstrated a number of significant advantages over traditional surgical interventions:

• Performing it as an outpatient procedure
• Recovery period lasts less than one day
• Absence of the pain syndrome after the intervention
• Minimal cosmetic defect – the presence of 1-2 incisions with a length less than 1 cm
• No signs of varicose veins removed, absence of scars
• Minimal risk of direct infection during the procedure
• Performing the intervention under the local anesthesia, a complete absence of pain during the procedure
• Minimal risk of the disease relapse

Sufficient physical activity is an important condition of total physiological resorption processed during the ELT veins. That is why doctors from Vascular Surgery Clinic Duesseldorf always elaborate individual recommendations regarding physical activity for their patients. Excellent qualifications and wide practical experience of doctors allow performing ELT even after ineffective surgical treatment in the past. In certain circumstances, the procedure can be performed as a percutaneous one – e.g., to treat “spider veins” with a diameter of less than 3 mm.

 

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Radiofrequency ablation using the VNUS Closure FASТ catheter

The innovative Venefit technology with the use of the VNUS Closure FAST system developed by the Swiss company COVIDIEN is successfully applied in Vascular Surgery Clinic Duesseldorf. Dr. med. Najib Jawadi, a leading specialist in the clinic, has perfectly mastered this technique and annually helps hundreds of patients with varicose veins.

The technique implies the radiofrequency ablation of the affected veins with a specially designed catheter – VNUS Closure FAST. Despite its relative novelty in the field of practical medicine, the technique has already been investigated in several clinical trials all over the world.

During the intervention, the high energy of the radio-frequency pulse affects the collagen – a protein, a significant amount of which is present in the wall of the lower limb veins. Under the influence of high energy, collagen is coagulated (“contracted”), so the affected vein is reliably glued and turned off from the systemic blood flow. Blood is naturally redistributed between the remaining healthy veins and continues its normal flow, while the processed vein is gradually replaced by connective tissue and destroyed by the body. Catheter VNUS Closure FAST is extremely precise; if a surgeon is qualified enough to perform the intervention, the catheter doesn`t affect healthy tissues in few millimeters from a varicose vein.

The Swiss apparatus VNUS is a high-tech device; it constantly receives feedback from the catheter located in the vein and allows for regulating the intensity of radio-frequency pulse and vein heating. A surgeon controls the device with the help of a special button in a sterile zone outside the surgical field, which further reduces the already minimal risks of manipulation. The finest control of the VNUS apparatus improves the accuracy of the procedure, as only necessary sections of the vein are processed without affecting nearby healthy tissues. In addition, it provides even heating of the vein and the possibility to select the necessary power and duration of the procedure automatically.

VNUS Closure FAST catheter is a disposable device chosen for each patient individually, based on the surgeon's practical experience. Due to its special construction, the heating element of the catheter, which directly affects the collagen in the wall of the vein, is able to move along the inner surface of the vein freely and process sections up to 7 cm long. In case the surgeon needs to work with tinier sections of the veins, he uses a miniature Closure FAST RFA catheter, which processes sections of veins less than 3 cm long. Catheter VNUS Closure FAST is smooth, without any functional prominences, and has additional protection from sticking to the wall of the vessel. All of these totally exclude possible faults of the method.

Venefit technology with the use of the VNUS Closure FAST system is applied for the treatment of veins of different sizes. In all cases, there is no need for traumatic incisions or additional manipulations; venous puncture for the insertion of the catheter is totally enough. The intervention may be performed at any time of the year, including summer, because it is not followed by pain syndrome, edema of the lower extremities, or cosmetic defects. There is also no need to wear compression socks after the procedure; a patient immediately returns to the usual activities of daily living and mode of dress. As a matter of fact, Venefit technology with the use of the VNUS Closure FAST system is a “one-day” procedure that completely solves all problems with varicose veins.

Technology of non-thermal vein ablation VenaSeal

Treatment of varicose veins at the early stages, before the disease complications arise, is a priority in German medicine. Soft and effective technique VenaSeal is an excellent choice for early treatment of the disease, as it doesn`t have any anesthetic-related risks and side effects. The safety and long-term effectiveness of the procedure are confirmed by the results of multicenter clinical trials, which have been conducted globally since 2010 (e.g., trials Feasibility, eSCOPE, and VeClose Pivotal). Specialists of Vascular Surgery Clinic Duesseldorf have vast clinical experience in treating varicose veins with the help of this technique.

Non-thermal vein ablation VenaSeal, which is also called embolization with cyanoacrylate, is a minimally invasive method of direct intravenous treatment. As for the technological side, VenaSeal implies the introduction of the hypoallergenic biological glue into the affected veins by means of a special pistol. As a matter of fact, cyanoacrylate biological glue has already been used in clinical practice for a long time, but only in 2010 did American scientists start its application in varicose veins treatment. The technique is widely used in the case of affection of a large saphenous vein – the primary source of the lower extremities varicose nodes. VenaSeal application is particularly effective in lesions of venous valves and their impairment, as well.

Despite excellent tolerability and notable clinical results, the VenaSeal technique is not used widely, as it requires special qualifications of a surgeon and related technical equipment of a healthcare institution - Dr. Med. Najib Jawadi has actively applied the VenaSeal technique for more than five years, as Vascular Surgery Clinic Duesseldorf constantly implements innovative and most favorable patient techniques and technologies into the clinical practice.

Undergoing the VenaSeal procedure doesn`t require special preparation from the patient. Before the intervention is started, the surgeon carries out an obligatory ultrasound examination of the lower extremity vessels to assess their state and determine the extent of the manipulation. In the beginning, the doctor conducts small local anesthesia to introduce the catheter into the affected vein comfortably. Only this stage of the procedure is connected with unpleasant feelings and requires anesthesia; otherwise, the VenaSeal technique is completely painless. Once venipuncture has been performed, and the catheter has taken its place inside the vein, an obligatory ultrasound examination is carried out in order to assess the quality of this initial stage.

Further actions require maximal attention and professional competence from the surgeon – 0.1 ml dosages of VenaSeal glue are introduced every 3 cm along the vein, and it is crucial to select appropriate sites for this. After the application of VenaSeal glue, the doctor compresses the vein from the outside for immediate ablation (“gluing” and switching off from the systemic blood circulation) and performs a controlled ultrasound examination. Due to the high qualification of the specialists from Vascular Surgery Clinic Duesseldorf, the whole procedure takes less than 45 minutes.

VenaSeal technique has the shortest recovery period among all methods of varicose veins treatment and a number of additional advantages:

• Instant cosmetic effect – the result of the intervention reveals itself in few hours after the completion, and there are no signs of the performed surgical procedure; a patient can return to the normal life and even sunbathe
• No need for uncomfortable compression socks, as compression of veins directly during the procedure, is totally enough
• No need for any other rehabilitation procedures after the intervention
• Sensitivity of the skin is completely preserved since the technique doesn`t imply anesthesia, intensive heating of tissues, or hematomas formation.
• Absence of allergic reactions since VenaSeal glue is a natural product
• The technique is successfully used in patients with low pain threshold or in the presence of contraindications to anesthesia providing (e.g., in elderly patients with severe concomitant disorders)
• The technique is completely safe and does not require general anesthesia, invasive surgery, tissue heating, or the administration of toxic substances

How can I undergo treatment in the most specialized clinics in Germany?

Leading German hospitals, including Vascular Surgery Clinic Duesseldorf, provide help to German citizens and international patients, as well. International patients often apply for the treatment in German clinics because, in their native countries, innovative methods of treatment enter clinical practice much later. Respectively, doctors have the less practical experience and prefer using more traumatic and less effective traditional techniques. German specialists provide help to thousands of patients from Europe, the USA, and eastern countries annually.

If you are going to receive medical help abroad for the first time, you can face certain technical and medical difficulties. This is natural, as different countries have different requirements for medical documentation, pre-operative examination, medical insurance, etc. To facilitate the process, administrative work and organizational aspects of work with international patients are provided by the official partner of Vascular Surgery Clinic Duesseldorf – medical tourism operator, Booking Health company. Our specialists are not afraid to work with the most complicated clinical cases since we have wide practical experience in this sphere.

To start planning your medical trip, you should leave a request on the website of the Booking Health company. It should be noted that the request with medical documents will be more informative for our doctors. After this, our patient case manager will contact you to provide help in such important aspects:

• Choosing the most appropriate clinic and doctor for your case
• Getting an appointment on a convenient date and time
• Preliminary organization of the necessary preoperative examination
• Getting an invitation for treatment from the clinic for faster medical visa receiving
• Arranging transfer from the airport to the clinic and back to the airport
• Assistance of interpreter and personal medical coordinator
• Providing medical insurance in case of complications (cover amount is up to 200 000 euros)
• Preparation and translation of medical documents and recommendations from the clinic
• Help in further communication with your treating physician, if necessary

We will always provide you with innovative and effective treatment by the most qualified surgeons worldwide. Improving and preserving your health is our aim, do not hesitate to contact us.

 

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Choose treatment abroad and you will for sure get the best results!

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Authors:

The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova, Alexandra Solovey. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

 

Sources:

Centers for Disease Control and Prevention

Johns Hopkins Medicine

Google Scholar

 

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