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All about veins
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Venous Forum
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Therapy – Surgery or Laser?
The media are full of news about new treatment methods, and patients are frequently confused by the variety
of options offered: Operation, minisurgery, laser, obliteration, foam obliteration, trivex, VNUS closure etc.
Which method suits me best?
As mentioned earlier, we differentiate between several forms of varicosity.
In the planning of an adequate procedure it is important to find out whether the large vein valves are still
closing adequately. If an inguinal vein valve does not close, blood flows back from the inguinal region into
the saphenous vein (vena saphena magna),. That condition is called valvular insufficiency in the saphenous veins.
In case that the valve does close but varicose veins can be felt in the upper or lower leg areas, the condition is
called varicosis of lateral saphenous branches. Various mixed forms can be found between.
Endolaser
Treatment of valvular insufficiency in the saphenous veins
Through a small cut in the knee area, a laser probe is inserted into the long vein in the upper leg
(vena saphena magna). The laser energy emitted from the tip of the probe brings about obliteration of the vein.
After-care with surgical stockings to be worn over a week. Method may be applied under local anaesthesia
(tumescence anaesthesia) and replaces vein stripping in connection with the inguinal cut as practiced formerly.
Recovery is significantly faster so that patients can return earlier to daily life activities
Minisurgery
Treatment of lateral saphenous branches
Through minimal cuts of 2-4 mm, the enlarged veins are resected by the “hook method(Varady)”.
The method replaces former procedures performed through skin incisions of up to 2 cm length, and may in many
cases be carried out under local anaesthesia (Varady’s technique). After-care with surgical stockings to be worn over
three weeks. Minisurgery proves outstandingly successful in combination with endolaser.
Endoscopic methods
Laparoscopic surgery in the treatment of ulcer of the lower leg (ulcus cruris)
Ulcer of the lower leg (ulcus cruris) results in most cases from the malfunction of perforant veins.
These veins need ligation, though incisions into skin areas already damaged should be avoided.
A camera is applied to the perforant vein, to facilitate ligation by a clip. The operation is performed under
general anaesthesia and should only be chosen to treat severest cases of varicose veins.
Trivex
Treatment of lateral saphenous branches
Basically, a light rod is inserted under the vein net and the varicose veins are then severed out the tissue in sight.
Transilluminated miniphlebectomy
Treatment of lateral saphenous branches / perforating veins
Basically, a light rod is inserted under the vein net and the varicose veins are then resected by hook technique. Very protective intervention in cases of extended varicosity of lateral saphenous branches, severe skin or tissue sclerosis (dermatoliposclerosis) or lymphatic oedema (lymphatic blockade). Excellent method also in combination with endolaser.
Foam obliteration
Treatment of lateral saphenous branches / perforating veins
In principle, the obliterating agent is frothed onto the affected area and introduced into the vein,
in most cases under ultrasound supervision. The method is appropriate for the treatment of residual
varicosity after earlier surgical intervention. After-care is recommended with surgical stockings to be worn over
2-7 days.
Obliteration (Sclerosing)
Treatment of spider-burst
Classic method for the treatment of smaller or smallest changes. Basically, an obliteration agent
is introduced into the vein. Subsequent application of a compression dressing causes obliteration and,
in the course, resorption of the vein.
Transdermal laser
Treatment of tenuous spider-burst
Basically, laser energy is introduced into the vein from outside the skin. The skin is cooled at the same time. Method of choice for the treatment of extremely fine, plexiform spider-burst.
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After treatment
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