Varicose veins treatment (varices)
Definition
Varicose Veins are a pathologic enlargement of some veins of the lower limbs and they represent the second stage of the Chronic Venous Disease.
Symptoms
They can cause heavy legs, edema (swallen ankles), restlessness, itch, formication, pain, burning sensation and night spasms. In the most severe cases, and if long-standing, thrombophlebitis, eczema (red and itchy lesions), skin discoloration together with hardening of the skin (lipodermatosclerosis) and in even more severe cases ulcers, can occur.
Medical And Surgical Therapies
Before starting any kind of treatment, It is important to undergo a complete Echocolour-Doppler Ultrasound test to understand the causes leading to the development of the varices and the best approach to remove them.
Microsurgery
Indications: any kind of patient can undergo this procedure.
Type of anesthesia: local.
What does the surgical operation consist in? This technique consists in removing small varicose veins through microincision (less than 1 mm). There’s no need of stitches after the procedure and there’s not scars.
Type of hospitalisation: outpatient.
Postoperative care: the patient can walk immediately and he can be discharged after about 30 minutes. The patient must wear an elastic stocking for two weeks.
Traditional Surgery
Indications: candidates are patients suffering from advanced chronic venous disease with excessive enlargement of the great saphenous vein or with abnormalities in the course of the great saphenous vein and who therefore cannot undergo endovascular treatments (laser or radiofrequency)
Kind of anesthesia: local with sedation.
What does the operation consist in? A small cut is made in the groin (about 4-5 cm); the sick part of the great saphenous vein is removed and the operation is completed removing the varices by means of small incisions (about 2-3mm).
Type of hospitalisation: Day Hospital
Postoperative care: after about 15 minutes from the surgical operation deambulation starts again ad after about two hours the patient is discharged. The patient must wear an elastic stocking for about two weeks.
Endovascular Surgery (Laser and Radiofrequency)
Indications: candidates are those patients whose stage of disease is advanced and whose great or small saphenous vein has got specific ultrasound/sonographic features.
Type of anesthesia: local.
What does the operation consist in? a small incision is made (about 2-3 mm) in the thigh or in the leg; a Laser fibre or Radiofrequency catheter is inserted into the vein to be treated; an ultrasound-guided tumescent anesthesia of the venous axis is performed and the vein is occluded. The surgical operation is completed removing the varices by means of small incisions (about 2-3 mm).
Type of hospitalisation: outpatient.
Postoperative care: the patient can walk immediately and he can be discharged after about 30 minutes. The patient must wear an elastic stocking for two weeks.
Tipo di Ricovero: ambulatoriale
Decorso post-operatorio: il paziente può deambulare dopo circa 10 minuti dall’intervento e dopo circa 30 minuti può essere dimesso. Il paziente deve indossare una calza elastica per circa due settimane.
Sclerotherapy
Indications: any kind of patient can undergo this procedure. It is usually recommended for those patients who cannot udergo the surgical operations mentioned above (whose effect is more long-lasting).
Type of anesthesia: none.
What does the operation consist in? A liquid sclerosant drug or a foamy sclerosant drug, called sclero-foam), is injected into the vein to be treated.
Type of hospitalisation: outpatient.
Postoperative care: the patient can walk immediately and he can be discharged after about 30 minutes. The patient must wear an elastic stocking for at least two weeks.
Hemodynamic treatment (CHIVA or ASVAL)
Indications: any kind of patient can undergo this procedure.
Type of anesthesia: local/assisted local.
What does the surgical operation consist in? This technique includes many scheduled surgical operations within a few months one from the other with the aim to facilitate the passage of the blood flow from the sick superficial veins to the deep ones. Small cuts (from 2-3 mm to 4-5 cm) in one or more parts of the thigh or leg are done through which some kinds of veins are tied up. The removal of the varices is not supposed to be done, they usually disappear after some time.
Type of hospitalisation: day-hospital.
Postoperative care: according to the different stages the patient can walk immediately or after about 20 minutes and after about 30 minutes he can be discharged. The patient must wear an elastic stocking for at least two weeks.
