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Modern Vein Treatment Options - Chemical and Electromagnetic Modalities

1/18/2011 4:53:00 PM by Nu Vela Laser and Vein Center

Sclerotherapy of leg spider veins at Nu Vela Esthetica,LosAngeles, CADespite the fact that all veins carry blood and their major role is to transport blood back to the heart, not all veins have the same size, shape, depth, and most importantly, they become diseased because of different reasons. Veins in the lower extremities for example, get enlarged because of the building up of high pressure from blood pooling there when the one-way valves in the veins do not function properly. This is not the case for facial veins because of the relative position of the head with respect to the heart. In the latter case, heredity and exposure to damaging Sun rays appear to be the most important contributors.

Traditionally, diseased veins, such as varicose veins, were ablated by surgery. The good news is that, nowadays a vein doctor rarely needs to resort to surgery and hospital stay by patients is seldom needed. Advances in medicine and medical technologies in the past decade have been so tremendous in the field of vein treatment, that minimally invasive technologies as diverse as the veins themselves have evolved and replaced vein ligation and stripping surgery.

The absolute goal of minimally invasive vein treatment systems is the same; that is, to destroy the targeted veins, so that blood re-routes itself into healthy veins. Currently, this is achieved by either chemically destroying the vein walls by using chemicals with low-toxicity that are consumed locally in the veins without significantly leaking into the body, or by means of electromagnetic radiation; visible, infrared, radiofrequency, or microwave radiation that selectively target the blood in the veins or the vein walls carrying the blood. Here, it should be pointed out that all these radiations are considered quite safe because they all are low frequency radiations that we are exposed to everyday. These radiations are effective in destroying diseased veins, not because of their frequency, but because of their highly focused nature.

Among the chemical based vein treatment systems
sclerotherapy is the most common vein treatment modality. Sclerotherapy entails the injection of a chemical directly into the diseased vein using a tiny needle. Sclerotherapy, the oldest vein treatment system with a history of more than 150 years, is up to now the gold standard for treating leg spider veins. These veins are superficial and their ablation does not require the injection of large amounts of chemicals. Sclerotherapy, however, should be used cautiously for the treatment of facial spider veins because of the possibility of the injected chemical causing retinal damage or even blindness. Sclerotherapy is also not suitable for the treatment of large veins becuase these veins require higher concentration of chemicals and larger amounts. To this end, foam sclerotherapy, a technique that injects a foamed chemical instead of a fluid chemical was introduced. The aim was to increase surface contact area, exposure time, and minimize the risk of the chemical travelling to the brain and the amount of chemical needed for vein ablation. Foam Sclerotherapy is nowadays used mainly for leg branch varicosities.


Electromagnetic-based vein treatment systems; on the other hand, use either hand-held devices for topical applications, or laser fibers and catheters that are inserted and guided inside large varicose veins using Ultrasound imaging, a technique known as endovenous ablation. Topical applications are most suitable, as you may be able to anticipate, for superficial fine veins, such as facial reticular and spider veins laser treatment; whereas, endovenous ablation, either by means of a catheter generating radiofrequency or a laser fiber is the treatment of choice for the treatment of bulging leg varicose veins, such as the Saphenous vein.

Finally, it should be emphasized that vein treatment with the minimally invasive technologies is a very delicate procedure and that your
vein doctor should understand besides the anatomy of veins, the physics behind electromagnetic radiation, the chemistry of the injected chemical, and he should be an expert in handling ultrasound imaging. It is for these reasons that in the last decade, a new specialty called phlebology was created having as goals the training of vein doctors specialized in minimally invasive vein treatment modalities. Currently phlebology is self-designated specialty, the same as plastic surgery or dermatology, recognized by the American Medical Association, AMA. At present, Dr. John Mauriello, an anesthesiologist by his primary training, is the president-elect of the American College of Phlebology.


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