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How Ultrasound Minimizes Incisions in Varicose Vein Treatment

By Dr Ken Seifert – Follow me on +

My name is Ken Seifert, M.D. I work at Optima Vein Care and I will be publishing in this blog weekly to help inform the public about the work we do and the help we can provide you with your varicose and spider veins.

I am a Vascular Surgeon who is certified in Vascular Surgery by the American Board of Surgery. I have been doing surgery on arteries and veins for 35 years. In the last 15 years there has been a transformation in the treatment of varicose veins. This has been mostly due to the introduction of benign, minimally invasive treatments that replaced the dreaded vein stripping operation and also due to the development of ultrasound as a diagnostic tool.

In the last blog I spoke about 2 conditions that can be more difficult to treat. These conditions are incompetent perforator veins and incompetent anterior duplicated greater saphenous veins. One of the reasons they are more difficult to treat is, I believe , because they are often overlooked. Or, perhaps, they are often overlooked because they are difficult to treat!

Perforator veins go between the superficial and the deep systems of veins and have valves that force blood from the superficial system to the deep system. These valves can become incompetent and if they are incompetent, then when you stand you can have painful, bulging varicose veins. There are many perforator veins in each person’s leg and finding the incompetent perforator takes patience and persistence. If the perforator is small, it can be sclerosed but if it is large enough, it will have to tied off through a small incision.

The other unusual problem is incompetence of one of the larger branches of the greater saphenous vein near the sapheno-femoral junction. The most common vein to be incompetent, after the great and the small saphenous vein, is the so called anterior duplicated saphenous vein of the thigh. If this vein has a straight segment near its top end, then endovenous laser ablation is the best method to close it. But sometimes, there is no segment that is straight. If it is small, it can often be closed by ultrasound guided sclerotherapy. I use the ultrasound to place a small hypodermic needle inside the vein and introduce the sclerosent chemical into the vein. But if it is big, then the safest and most reliable way to close it is to make an incision, under local anesthesia, and tie it closed directly.

Fortunately, cut downs through incisions are unusual. And, again because of ultrasound, the incisions can be kept relatively small.

There are other situations in which I make incisions. Lots of them. I’ll talk about that next week.

Laser Closure of the Great Saphenous Vein

By Dr Ken Seifert – Follow me on +

My name is Ken Seifert, M.D. I work at Optima Vein Care and I will be publishing in this blog weekly to help inform the public about the work we do and the help we can provide you with your varicose and spider veins.

I am a Vascular Surgeon who is certified in Vascular Surgery by the American Board of Surgery. I have been doing surgery on arteries and veins for 35 years. In the last 15 years there has been a transformation in the treatment of varicose veins. This has been mostly due to the introduction of benign, minimally invasive treatments that replaced the dreaded vein stripping operation and also due to the development of ultrasound as a diagnostic tool.

In the previous installments of this blog, I have reviewed the crucial role of ultrasound, in both the diagnosis and the treatment of varicose veins. I have talked about lasers, how they work and how we use them, along with fiber optic bundles, to deliver heat to the inside of your incompetent veins to seal them shut, and how we use tumescent anesthesia to make that painless.

This is the most commonly used method to start the treatment of your varicose veins. However, it is rare that this is the only treatment that a person will need.

You can think of the superficial vein system like an upside down tree. The great saphenous vein, or the small saphenous vein is like the trunk of the tree. Most of the varicosities that you see on the surface of your legs are the branches, or even the twigs of this tree.

In order to treat the branches and twigs, we have to first treat the trunk. If we don’t do that, other branches will start bulging or the branches we treat will not go away. It is this problem that has often caused frustration on the part of patients who have had the experience of getting some kind of treatment of their varicose veins that either failed or did not last. Most of the time when this happens, it is because an underlying problem with the trunk was either not recognized or not treated properly.

Most people who have varicose veins in their legs have incompetent valves in the great saphenous vein as their underlying problem. If that is the case, then a laser closure of the great saphenous vein is the first step.

The next most common problem is incompetent valves in the small saphenous vein in the back of the calf. Again, a laser closure of the small saphenous vein will be the first step.

After that, the next most common problem is an incompetent perforator vein. These are small veins that go from the deep to the superficial system and can occur anywhere.

And then after that, the next most common problem is an incompetent anterior duplicated vein on the front of the thigh.

The last two problems are more difficult to treat. Each treatment must be “tailor made” for each individual situation.

I’ll talk about these treatments in the next blog.

Tumescent Anesthesia for Laser Vein Treatment

By Dr Ken Seifert – Follow me on +

My name is Ken Seifert, M.D. I work at Optima Vein Care and I will be publishing in this blog weekly to help inform the public about the work we do and the help we can provide you with your varicose and spider veins.

Last week I wrote about how a laser can be used to produce a concentrated spot of heat. Previously I wrote about how ultrasound could be used to guide the placement of an optical fiber in a person’s vein. Those methods are used to deliver heat to the inside of a vein. Of course, heating the inside of a vein would be very painful, but there is a way to make it painless, using a special type of local anesthesia.

Local anesthesia was first discovered by native South Americans, who chewed the leaves of the coca plant to alleviate toothaches and headaches, and also to get the stimulant effects. The Spanish colonists at first did not believe it, and when they became convinced, tried to control and tax the trade in coca leaves. In 1860, a German chemist isolated the active ingredient, which is, of course, Cocaine. In 1880, European physicians began using Cocaine as a local anesthetic, but the additive properties soon became apparent and a search began for synthetic substances that could provide local anesthesia without the stimulation. This resulted in several chemicals, most notably Novocaine and lidocaine. lidocaine is now most widely used. You may know it by it’s brand name: Xylocaine. Most people’s experience with lidocaine is with dentistry, but also it can be used for medical procedures. It causes painlessness, but usually not complete numbness. A person can still feel pressure, but not pain. There is no stimulation and lidocaine is in no way addictive. However, in large doses it can be toxic, so that limited it’s usefulness in larger operations.

In 1990, a dermatologist tried diluting lidocaine and in very dilute solutions, it still produced anesthesia. He used it in liposuction. In addition, for several decades, lidocaine has been mixed with epinephrine, a naturally occurring hormone that causes blood vessels to constrict. You may know it by the name: Adrenaline. Adrenalin raises blood pressure and increases heart pumping when you are excited or stressed. Again, in large doses it is bad, but by diluting it, it can be used safely. This mixture of lidocaine and epinephrine is diluted in as much as a liter (about a quart) of saline. It can be pumped under the skin under low pressure to make a relatively large area of the body numb. Pumping it causes the skin to bulge up. The technical term for this is “tumescence” so this is called “tumescent anesthesia”.

I can use tumescent anesthesia to make your vein numb throughout its length, so that when I heat your vein with a laser and fiber optic bundle, it does not hurt. You do not feel any pain, or any sensation whatsoever, except for one weird thing: Many people get a taste of broccoli in their mouth. Yes, broccoli. It is thought that this is the result of the heat on the iron in your blood.

That’s it. Heating your vein and sealing it shut, will give you the taste of broccoli for a few minutes. Otherwise, you feel nothing as it is happening.

By Ken Seifert, M.D.

Laser Vein Technology & Technique

By Dr Ken Seifert – Follow me on +

My name is Ken Seifert, M.D. I work at Optima vein care and I will be publishing in this blog weekly to help inform the public about the work we do and the help we can provide you with your varicose and spider veins.

In the last few weeks I have written about ultrasound and its crucial importance to the entire endeavor of the treatment of varicose veins. That is appropriate. Ultrasound is the most important development that has made the modern treatment of varicose veins possible.

But lasers are also important and now is the time to talk about them. The word “Laser” is an acronym that is a word in which the letters are made up of the first letters of other words. In this case LASER is Light Amplification by Stimulated Emission of Radiation. It is possible because of the way electrons in atoms gain and lose energy, by absorption and release of electromagnetic radiation. Electromagnetic radiation occurs in many forms: As light, as microwaves like in your microwave oven, as heat, as X-rays, as UV light that gives you sunburns and as radio and television waves. The difference between all these types of electromagnetic radiation is in the length of the wave. Your eye has cells that are sensitive to a certain narrow range of wavelengths and interprets different wavelengths of light in that range as different colors. A laser is made up of atoms of a materiel in which the atoms can be raised to a higher energy and can stay that way for a brief period of time. If one of them loses its energy and produces a little light, it will stimulate the others to do the same. If you put the material between two mirrors, and make one of the mirrors not quite completely reflective, then the light produced by the atoms loosing energy will bounce back and forth between the mirrors further stimulating other atoms to loose energy and produce more light. Some of the light produced this way will escape from the mirror that is not quite fully reflective and that light has some special properties that make it useful: The light is all one wavelength, that is all one color and it is all going in one direction. This is different than the light that comes out of light bulbs. Light bulb light is of a bunch of different colors and is going in every which way. The bunch of different colors are interpreted by your eye as white. Also, the light from a laser can be very powerful.

Lasers can be made that produce this powerful light in wavelengths other than the visible wavelengths. This can include infrared wavelengths. Infrared wavelengths cannot be seen, but can definitely be felt. This is heat, and lasers can be made that produce lots of heat and using fiber optic bundles, that heat can be delivered to a spot at the end of the fiber optic bundle. Since fiber optic bundles can be made very small, about the diameter of a toothpick, and are somewhat flexible, I am able to put this inside a person’s vein and deliver that heat to a spot that I can control very precisely. Temperatures of 300 degrees can be produced at this spot.

Of course, this would hurt terribly, but by combining this technology with another technique developed by plastic surgeons, I can make it completely painless.

Last week I described how I could place the fiber in a person. Next week I will describe how I make it painless.

Click to learn more about laser vein treatment offered by Optima Vein Care.