There a many methods available to treat leg vein conditions. Vein Specialists need to take into account what is available and patients need more information. Today’s guest blog is by Cornelis Bruijninckx –
“Nowadays there are numerous ways to treat patients with varicose veins. Although most methods are equally effective, they differ greatly at several levels.
They differ at the level of the principle of the treatment: firstly eliminating the reflux in the superficial venous trunks (great and/or small saphenous vein) or firstly removing (or closing) the visible secondary varicose veins? The last method results, apart from relief in complaints, immediately in an aesthetically satisfying outcome, and in many cases the causative reflux in the superficial trunk will diminish or vanish in time. On the other hand a combined ablation of the refluxing superficial venous trunk and removal of the secondary varicosities might constitute a more durable procedure. This ablation of the refluxing superficial venous trunk might be reached by ultrasound guided stripping of the trunk or catheter-based techniques. Catheter-based techniques may use endovenous thermal destruction (applying laser or radiofrequency energy), mechanochemical destruction (combination of rotating wire tip and injection of sclerosing agent) or deposition of a glue to occlude the venous trunk. The thermal technique requires several injections of an anaesthetic over the length of the trunk to be treated. The last two techniques are painless, apart from the punction that is needed to introduce the endovenous catheter, although the mechanicochemical ablation may give rise at times to well tolerable pinch feelings. Lastly there is the well-known ‘old’ technique of sclerosing of varicose veins, which saw a revival by the introduction of the so-called foam sclerotherapy, meaning injection of a liquid sclerosans that has been upgraded to a foam by intense mixing of the liquid with air (or CO2 from a bottle). This foam is far more effective in sclerosing larger veins than the liquid form.
Physicians with the necessary experience in treating patients with all these methods know in which patients and under which circumstances which technique would be best suited. However, they are limited in the use of these techniques by reimbursement regulations of health care insurance companies and/or the governments. That is why in most of the European countries most patients with varicose veins are treated with old-fashioned in-hospital venous stripping except in the Netherlands and the UK where endovenous thermal techniques have been favoured the last decade. However additive foam sclerotherapy, which is indicated for treatment of wrinkled refluxing venous trunks or refluxing perforating veins, has been excluded from reimbursement in both countries. Mechanicochemical ablation recently has been admitted for reimbursement in the Netherlands, however the more expensive glue technique still is excluded as is the primary removal of the secondary varicosities.
In conclusion, venous specialists should be familiar with (nearly) all treatment strategies for varicose veins and with the local reimbursement regulations that limit use of the various techniques.“
Cornelis M.A. Bruijninckx is a Vascular Surgeon and Vein Specialist based in Rotterdam