Varicose vein treatment has come a long way By VIRGINIA ANDERSON
The Atlanta Journal-Constitution
Published on: 02/07/05
Drs. Abbas Chamsuddin and Brandon Kang pulled up a pair of girdle-thick hosiery onto Robert Dyke’s tender legs.
He’d done this before, just a week ago, and he knew the hose would help get him on his feet fast.
After the doctors finished unrolling the stockings and placed the tops just shy of Dyke’s knees, Dyke stood up.
He put on his gray sweat pants and running shoes. Then, he shook hands with the men and readied to leave the softly lit procedure room at Emory University’s Winship Cancer Center.
“Now, you remember what to do?” Chamsuddin asked.
“Sure,” said Dyke, 49. “Go home, lay down, drink a beer.”
Varicose vein treatment and recovery have come a long way.
Dyke had two varicose veins annihilated Friday. While he didn’t really go home and drink a beer, he did stop by the hardware store and he paid some bills once he got home.
The entire procedure, from prepping with tubes to getting outfitted with compression hosiery, took about 45 minutes. The best part for Dyke was that he felt little pain.
Laser treatment could do for the vein what laser surgery has done for the eyes, some doctors have said.
That’s good news for the 36 million Americans estimated to have varicose veins, and for those who treat them. Medicare began covering the procedure in January, which begins at about $2,500, and other insurers are following suit.
It’s all about a tiny laser used to decimate varicose veins. The laser is cutting out the need for surgery and cutting down the need for a weeks-long recuperation for treatment of the painful and sometimes dangerous veins. Hundreds of Atlantans were zapped last year and within minutes walked out of their doctor’s offices, just as Dyke did Friday.
This year, however, doctors expect the numbers to rise dramatically, on the heels of Medicare’s approval for reimbursement. Already in 2005, Chamsuddin said he has been performing twice as many procedures this year as he did this time last year. Dr. Jean Chapman, a family practitioner in Alpharetta, said she performed 12 procedures last year but already has 10 patients scheduled for the laser treatment.
Middle-aged people like Dyke are trying to fix something before it worsens. Older people are relieved to find help for a problem they have lived with for decades but often avoided treating for fear of surgery.
Doctors treaded gingerly with all patients with varicose veins when the Food and Drug Administration first approved a special laser for varicose vein treatment in 2000. They wanted to see how effective and safe the laser would be.
Doctors have been impressed. The success rate for the laser treatment is about 98 percent for one year and about 95 percent for five years.
Even more important, complication rates are small, with the risk of blood clotting assessed at smaller than 0.03 percent, according to Dr. Todd B. Greer, a phlebologist with Vein Clinics of America, a chain of varicose vein treatment centers founded in 1981 as an option to surgery.
For insurers to cover the procedure, it must be deemed medically necessary, meaning that the varicose veins cause pain, swelling or have led to or could lead to skin ulcers.
Varicose veins — the blue, ropy-looking, bulging veins visible through the skin — occur when valves in veins do not work right. Blood pools in the vein as a result.
The vein becomes damaged, eventually useless and sometimes harmful. Removing the damaged vein remedies the pooling. The blood is simply rerouted to other veins.
“By the time we treat them, they’re not doing their job,” Chamsuddin said. “By taking them out and destroying them, you’re doing your leg a favor.”
For years, the most common way to do so was to strip them, a surgical procedure that took as long as eight hours and required general anesthesia and up to six weeks of recovery. Surgeons cut into the patient’s skin, cut the malfunctioning vein in two places, threw the vein away and sewed the patient back up. Scars often lasted a lifetime.
“Stripping is a very barbaric thing,” said Chamsuddin. “The wound is devastating.”
Over the years, another therapy emerged. In sclerotherapy, doctors injected a solution into damaged varicose veins. The solution causes the vein to dry up. Many doctors still use sclerotherapy on varicose veins and surface veins, too.
Four years ago, however, some doctors began using a tiny laser to treat varicose veins that had won approval from the Food and Drug Administration.
It takes longer to prepare for the laser than to use it.
Dyke had two varicose veins, one in each leg, treated Friday.
As Schubert’s “Ave Maria” played softly from a CD player, the doctors started with an ultrasound view of each leg so they could get a good picture of Dyke’s veins.
Next, they poked a hole into each leg — slightly painful, Dyke said, but not barbaric.
The doctors then injected a few shots of topical pain medicine. That was the hardest part, Dyke said. They then inserted a tiny tube into each vein.
Next, they threaded the laser into the first tube and fired up the lightwaves. The offensive vein was gone in 57 seconds.
The doctors withdrew the laser and repeated the procedure on the second leg. When they were finished, they withdrew the tubes and put an adhesive bandage over the small puncture wound.
Doctors expect to do more and more of the procedures.
“I’m really happy with the laser,” said Greer, a phlebologist with the Lawrenceville clinic of Vein Clinics of America, which has treated thousands and thousands of patients with injectable solutions and is now using the laser treatment, too.
The Lawrenceville clinic where he works has done about 150 laser treatments since Oct. 1. “And it offers our patients no downtime. It really has helped to revolutionize vein treatment.”
Chamsuddin said one patient’s leg swelling went down so dramatically that it changed the entire look of her leg. In turn, that boosted her self-confidence.
“She told me, ‘You can’t believe the effect this has had on my marriage,’ ” Chamsuddin said Friday. “And I said, ‘What could I have possibly done to your marriage?’ And she said, ‘Oh, you helped it a lot.’ ”
The real test for Dyke will be in a few weeks, once the tenderness and swelling caused by the multiple injections subside.
Dyke had not experienced intense pain from his varicose veins, but he had experienced constant swelling in his ankles. He had mild pain and a near-constant throbbing. He hopes those symptoms will subside.
“Check back with me in a few weeks,” Dyke said. “For now, though, it’s great.”
WHAT’S THE CAUSE?
The tendency to have varicose veins is hereditary, but other factors contribute. The biggest is abdominal pressure, most often because of pregnancy. Others include chronic constipation, obesity, abdominal tumors, and prolonged standing and lifting. Women are seven times more likely than men to have the condition.
Varicose veins, which are blue and bulging, can cause pain, fatigue, cramps, pooling and, in extreme cases, skin ulcers. They differ from spider veins, the small blue or purple veins close to the leg’s surface.
Insurers do not reimburse for spider vein treatment, but some will cover varicose vein treatment if the procedure is deemed medically necessary. Here are some options:
• Stripping: Major surgery in which the vein or veins are sliced out. General anesthesia required. Recovery lasts about six weeks, with pain and swelling.
• Sclerotherapy: Uses an injection of saline or other chemicals that decimate the vein tissue. Done in doctor’s office or special clinic. No general anesthesia required. Works on spider veins and varicose veins. Recuperation time minimal.
• Endovenous laser treatment: Uses a tiny laser to destroy the vein. No general anesthesia required. Recovery time minimal.