
	Medical Edge


	About

	Television

	Radio

	Newspaper

		Participating Newspapers

	Magazine

	Contact


	About Mayo Clinic

	Make an Appointment at Mayo Clinic

Medical Edge Newspaper Column from Mayo Clinic

NEW TECHNIQUES SIMPLIFY VERICOSE-VEIN REMOVAL

DEAR MAYO CLINIC: I’m a snowbird who recently moved here. The move cured my major headache in life: winters in upstate New York. Now I can concentrate on other things that bother me, like my varicose veins. Years ago my sister had her veins stripped after her last child was born. I don’t want to do that. What’s new that could work for me and keep me out of the hospital? — Daytona Beach, Fla.

ANSWER: Two new, minimally invasive procedures are available on an outpatient basis: radiofrequency ablation and endovenous laser treatment. Both procedures are performed under local anesthesia with sedation, and take less than an hour when done by an experienced vascular surgeon.

Patients stay in the hospital for six hours before going home to resume normal — but not vigorous — activities. For the next three to five days, patients wear a small bandage over the treated site and an elastic wrap. Most patients experience immediate relief from their symptoms, and published data report a 98 percent success rate with both techniques. However, not all veins are suitable for radiofrequency ablation.

Here’s how radiofrequency ablation works: Patients undergo an outpatient evaluation, during which an ultrasound exam is performed to determine if the veins will respond to this technique. (If the veins are too large, EVLT is the better choice.) If the patient is a suitable candidate, surgeons insert a narrow tube, or catheter, into the affected vein. The other end of the catheter is connected to the device that generates radiofrequency wave energy. Surgeons use the tip of the catheter to apply energy to the vein walls, which heats them and causes them to collapse.

Here’s how EVLT works: Patients are given a local anesthetic before the surgeon inserts a needle into the greater saphenous vein near the knee. Using ultrasound imaging, the surgeon inserts a guide wire through the needle and advances it up the vein to the groin. This allows surgeons to place the catheter and the laser inside the varicose vein. The surgeon turns on the laser and slowly removes the laser fiber.

As it’s retracted, the laser vaporizes the blood and collapses the vein so that blood can no longer flow through the vein. Because the laser fiber does not have to be in contact with the vein wall, there’s no limit on the width of the vein that can be treated — so this technique is used when large treatment areas are involved.

As you may know, about 15 percent of adults in the United States have varicose veins — and most of them are women. Heredity, age and pregnancy are risk factors associated with developing venous reflux, the condition that causes varicose veins.

Venous reflux occurs when tiny valves within a vein become damaged. This allows blood to flow backward and build up inside the vein. This “backflow” — or reflux — causes further damage to downstream valves and the condition worsens. Other aggravating factors include obesity, physical trauma to the legs and long periods of standing.

— Albert Hakaim, M.D., Vascular Surgery, Mayo Clinic, Jacksonville, Fla.

Additional Resources:
Treatment of Varicose Veins
Appointment Information
More Information on Varicose Veins

READERS: Teaching “stranger danger” alone is woefully inadequate way to keep children safe. Research conducted by the National Center for Missing and Exploited Children shows that most people who perpetrate crimes on children are not strangers in the mind of the child.
Instead, parents need to teach personal safety. Children need to know that appropriate strangers — store clerks or police officers — can help them. Children need to know that they do not need to kiss, hug or touch anyone — relative or not — if they do not wish to. This helps children learn to say no to unwanted contact. And parents need to listen and respect their children’s feelings. Children will likely share their concerns about relationships if parents routinely take all of their concerns in life seriously.

Additional Resources:
"Stranger Danger"

- - -

Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.