Op. Dr. Orhan Coşkun
Technology is advancing so rapidly that you start falling behind the moment you hesitate to keep up. Once you fall behind, you need to spend even more time to catch up with its pace. The moment you buy a phone, the upgraded version is already waiting to be released. The healthcare sector is also getting its share from this development and rapid progress. Primarily, with the widespread use of advanced information access technologies and the internet, information on various subjects, including medical matters, has become accessible and assessable to everyone. We clearly see this from the demands of our patients. Most patients come to us expressing their preferred treatment option; stating, ‘I want foam treatment,’ ‘I want to be treated with radiofrequency,’ etc.
The positive aspect of this is that the patient comes informed about their illness and treatments, having been convinced about the latest techniques. The downside is that there may be incomplete or incorrect information and information pollution. Another beneficial aspect is that health professionals now feel the necessity to keep up with developing technology, whether they want to or not, in terms of both technology and knowledge.
Today, a patient receiving varicose vein treatment in Bakırköy can connect to the internet to gather information about the relevance of this treatment, its current status worldwide, and the latest developments.
Now, let’s take a look at the effects of developing technologies on varicose vein disease:
VARICOSE VEINS ARE NOT A DISEASE BUT AN APPEARANCE:
The term ‘Varicose Disease’ provides convenience in usage. In fact, at the core of the disease, there is often insufficient venous valve function. In the first two stages of venous insufficiency, which we can examine in six stages, even before the underlying valve insufficiency progresses, spider veins, which are reddish capillary veins called spider veins, and reticular veins, which are bluish subcutaneous veins, can be observed. These may deserve treatment due to causing pain, itching, cramps, and creating an appearance pollution. Often, the best treatment for these is sclerotherapy (drying) with foam.
Varicose veins refer to a diseased vein that has expanded, lost its elasticity, become twisted, and is visible, sometimes extending beyond the skin surface. Accumulation of excess blood in this vein can lead to pain, cramps, itching, and a feeling of fatigue.
VENOUS INSUFFICIENCY, WHICH CAUSES VARICOSE VEINS, IS ALSO AN OCCUPATIONAL DISEASE
Varicose veins are three times more common in women than in men. During pregnancy, increased progesterone hormone and body fluid levels, constipation, excess weight, and the growing uterus pressing on the abdominal veins make varicose veins more prevalent. Aging, accompanied by decreasing muscle tone, contributes to a decrease in the supportive power on the veins, thus triggering the development of varicose veins. Obesity and constipation increase the pressure in the veins, posing a risk of varicose vein formation. One of the most significant reasons for the development of varicose veins is a familial predisposition. Structural and metabolic similarities among family members can be effective in this predisposition.
People who stand and sit for long hours are also at risk of varicose vein disease. Those who work in professions such as rotating jobs, barbers, salespersons, hairdressers, nurses, surgeons, office clerks, those who work standing or sitting in a fixed position in a factory, bakers, and teachers, by staying in a vertical position beyond the normal for the whole day, are prone to increased pressure in the veins, leading to various forms of varicose veins. In this sense, venous insufficiency and the visible appearance of varicose veins on the surface can actually be considered as an occupational disease. Occupational health professionals, during entrance examinations and periodic check-ups, should take these factors into account. It would be beneficial for them to direct patients to a cardiovascular surgeon for advanced knowledge about venous insufficiency and its forms if necessary. When occupational predisposition is combined with familial predisposition, constipation, obesity, pregnancy, birth control pill use, and aging, encountering advanced forms of varicose vein disease and chronic venous insufficiency becomes inevitable. In these advanced forms, dark brown discoloration of the skin on the legs, edema and thickening of the skin, and the occurrence of ulcers can be observed. Treatment at these stages is more complex and significantly reduces the quality of life.
WHAT ARE THE INNOVATIONS IN TREATMENT?
In the past, for varicose veins, either medication and compression stockings were prescribed, or surgery was performed. Even today, there are many doctors who still apply these methods. The patient used to spend a few days in the hospital for surgery, and after discharge, they were required to take leave from work and rest at home for a while. The pain, hematomas, and swelling in the leg already prevented them from working. Unfortunately, with the accelerated and changing conditions of life, it is not possible for a working person to compensate for being away from work for a long time due to illness. In this situation, patients used to postpone their treatments, resulting in the return of the disease as a chronic and more complex condition.
Today, with the methods being applied, our patients can undergo treatment without taking leave from work and can continue their work, life, and daily activities without the need for hospitalization or staying in the hospital. Varicose veins are treated today without pain, surgery, anesthesia, and without causing workforce and time loss.
When you go to a doctor in the United States, Germany, the United Kingdom, or other scientifically advanced countries in the world for the diagnosis and treatment of varicose veins, the methods used there are also applied for varicose vein treatment in Bakırköy, İzmir, Kadıköy, Bursa, and other cities in Turkey. Moreover, it is done in a more affordable and higher quality way. This is known through the experience of patients who come from abroad for treatment. Turkey is becoming an increasingly valuable destination for Health Tourism every day.
The non-surgical treatment methods for varicose veins are as follows:
VEIN CLOSURE WITH ADHESIVE (VARICOSE VEIN TREATMENT DURING LUNCH BREAK)
The adhesive treatment method, known abroad with the slogan “varicose vein treatment during lunch break,” has also gained popularity in our country with the slogan “varicose vein treatment in 5 minutes.” The procedure is indeed completed in 5-15 minutes. It is used for the treatment of larger veins that cause varicose veins due to valve insufficiency called the Great Saphenous Vein, not for superficial capillary varicose veins. What used to be a treatment requiring days of hospital and home rest is now accomplished in just a 15-minute break at noon, truly representing a transformation.
It can be performed in the clinic, without the need for preparation, anesthesia, incision, or stitches. The patient undergoes treatment and returns to work. A biologically compatible resin is used for treatment. Compared to other treatments, the patient uses fewer or no varicose stockings. Since it is not a thermal procedure, there is no post-treatment pain like in laser and radiofrequency applications. It is one of the best methods for patient comfort. The main drawback is that it is relatively expensive since not every insurance company covers the costs.
MOCA (MECHANOCHEMICAL ABLATION), VIBRATION-BASED VARICOSE VEIN TREATMENT
Similar to the adhesive method, this technique is used for treating large saphenous veins. Local anesthesia is applied to the patient, a catheter (used for treatment) is inserted into the diseased vein, and while administering a drying agent through the catheter, the vein is closed by the rotating motion of the catheter inside the vein. Patients perceive the catheter’s rotating motion as vibration, making vibration-based varicose vein treatment popular. After treatment, the patient can immediately return to work or home, and there are no restrictions on their daily life. The use of varicose stockings may be necessary for about 15 days. Like the previous methods, there is a problem with insurance coverage, and patients often have to pay for the treatment themselves.
EVRF (ENDOVENOUS RADIOFREQUENCY ABLATION)
This procedure involves inserting a radiofrequency catheter into large insufficient veins under local anesthesia, burning and drying the vein with radiofrequency heat. To protect surrounding tissues from heat effects during the procedure, a liquid called tumescence isolates the varicose vein from surrounding tissues. There is no need for hospitalization or a post-procedure rest period.
EVLA (Endovenous Laser Ablation)
This procedure involves sending a laser catheter into large insufficient veins under local anesthesia, burning and drying the vein with laser energy. Similar to EVRF, a liquid called tumescence isolates the varicose vein from surrounding tissues to protect them from the heat effect. There is no need for hospitalization or a post-procedure rest period.
FOAM SCLEROTHERAPY
This method has become popular as foam treatment. It is a technique used for the treatment of both insufficient large veins and superficial varicose veins and capillaries. Local anesthesia may not even be necessary for this method, and it is painless. It has been used in medicine for over 60 years and has been successfully employed in closing capillaries and large varicose veins for the past 15-20 years. The treatment process begins by injecting a drug into the vein, affecting the inner surface of the diseased vein and causing it to dry. It is a method applied in sessions for widespread varicose veins. It does not require the patient to limit their work or social life. After treatment, patients can return to their normal activities.
MICROPHLEBECTOMY
This is a microsurgical method used in the treatment of superficial varicose veins and clusters called venous plexus. It is applied under local anesthesia. There is no need for hospitalization or lying down. It involves removing the varicose vein through needle-hole-sized points using special tools. It does not require stitches, leaves no scars, and is performed with local anesthesia. This stitch-free, incision-free method, performed with only local anesthesia, allows the patient to get rid of large clusters of varicose veins in a single application.
With these five treatment methods, approximately 95-99% of patients can be successfully treated. The remaining 1-5% may require classical surgical interventions. Unlike in the past, these interventions are now performed with smaller incisions, more suitable for the patient’s anatomical structure, and sometimes these microsurgical methods can be combined with the above methods.
CHOOSING THE VARICOSE VEIN TREATMENT METHOD
The methods mentioned above can be used alone or in combination with each other. Following the examination and evaluation by a cardiovascular surgeon who is an expert in varicose vein diseases and treatments, the choice of treatment is determined based on the patient’s condition through a Doppler ultrasound examination that the surgeon or a radiologist recommended for further evaluation. Since the disease does not manifest itself in a standard way, the treatment cannot be standardized.
COMMON MISCONCEPTIONS ABOUT VARICOSE VEINS
There is no varicose vein treatment in summer: This is a misconception. Varicose vein treatment can be done in every season. Seasonal changes do not affect the effectiveness of treatment. However, this misconception arose due to the desire to prevent the treatment area from being exposed to sunlight for a short period (15-30 days) after sclerotherapy and the need for short-term use of compression stockings (3-10 days). After these periods, patients can continue their vacations and enjoy the summer.
Even if I undergo treatment, varicose veins will reappear, so treatment is pointless: If the correct treatment method is applied, and the patient takes care to eliminate varicose vein risks, recurrence of varicose veins is unlikely. Usually, recurrence is due to the treatment being performed by individuals who are not experts in treating the cause but rather the appearance.
Any doctor can perform varicose vein treatment: No. Cardiovascular surgeons who have received years of training in varicose vein diseases and treatments are the ones who will treat this disease most accurately.
Veins canceled in varicose veins are used in heart surgery later: Enlarged veins that have become varicose cannot be used in heart surgery; there are alternative veins in our body. However, it is not uncommon for unqualified individuals, unaware of the value of these veins in heart surgery, to cause premature and exaggerated damage. Therefore, it is crucial to receive the right treatment at the right time.
I used compression stockings and medications, but my varicose veins did not go away: Compression stockings and medications do not provide a real cure. Their purpose is to alleviate symptoms, prevent them from appearing, and slow down the progression of the disease. Additionally, we use them as supportive measures in some treatments.
