Methods of Vein Treatment

Methods of Vein Treatment
 
Veins usually generally follow patterns but they can also often do as they wish.  Arteries rigidly follow these patterns much more.  In treating veins, the physician should carefully inspect the problematic area, often with an ultrasound or the use of light penetration to see which veins are going to accurately solve your problem. 
 
Generally, prescription support hose usually help but eventually most will fail over the course of treatment and may not be enough to solve the problem.  You can always add more and more compression (via the hose/stocking), but the issue eventually needs to be dealt with once and for all, to correct the underlying pressure problem.. 
 
Sclerotherapy and foam therapy really can be universally used.  They both work by duration of contact with the tissue by destroying the inside of the blood vessel.  The vessel then contracts and will is eventually absorbed by the body.  There are a number of methods and applications in using this almost universal solution.  The physician may choose to use custom concentrations, different additives, and/or adding additional components to make these solutions perform and do exactly what he/she wants them to do for your particular situation. 
 
For example, if you have a very high concentration of sclerosis with a very small vessel and start to inject the solution in the vessel, the vessel will just constrict down and may actually "explode" before it goes down very far.  The physician must adequately treat the vessel without diluting the sclerosin enough to be able to go down and treat the vessel and the incompetent valves which will re-route the venous blood, thus, correcting the problem.  The doctor should use a very high concentration, limited in volume of use, to close much larger vessels or use other techniques to increase contact to adequately treat the larger vessels.
 
Remember:  Arteries have an intima, media, and adventitia layer that makes them highly elastic.  Veins basically have an intima lining and adventitia sclerosal layer but do not have a strong elastic component so when they stretch out largely, that is the way they stay. Veins stretch but do not return back to their original size.
 
The real idea here has to be clarified with an extreme example.  Years ago, a person might get a leg ulcer that could be huge, foul smelling,  with pigment surrounding it and white greasy tissue weeping serous fluid into the skin.  This serous fluid is very caustic to the skin and breaks it down, so basically, the ulcer never heals.  We can give these people hyperbaric, i.e. high O2 concentration that does help them heal.  These ulcers can be caused by diabetes with poor micro circulation or from arteriosclerosis.  Sometimes, they are caused by venous hypertension from good artery blood coming in and bad venous drainage causing vein congestion, swelling, and edema  that further complicates the tissue problem.  Once you remove the bad drainage vessels regurgitating this blood in re-circulatory pathways and allow the blood to drain reducing the pressure, then allowing the arteries to pump good blood in and veins drain bad blood out, they almost always get better.  Remember:  Phlebology removes the damaged and poorly draining vessels which may be a few inches of these vessels from the thousands, allowing 99% of the veins to remove all of this increased pressured and stagnated blood that is causing the pain, edema, itching, ulcers, swelling, and blood clots.
 
 
All vessels perforate the leg, though, must be thought of as superficial and deep with perforators in between.  If you’ve ever bought a piece of meat, you will see a sheath in the muscle with veins in the sheath and veins down deep in the muscle.  The muscle acts as the pump returning the blood to the heart and there are perforators going between sheath to sheath and muscle to muscle.  These few backup vessels are what we repair to allow the correct drainage of these vessels and the bulging of these bad vessels to go away--and stop this venous sludge, making it also go away.
 
With the new Doppler ultrasound techniques, sclerotherapy, endoluminal, and phlebectomy remove the areas of bad circulation that do not allow the blood to go there and stagnate, and allow the good circulation to take over and send the blood to the heart.  The newest lasers and ultrasounds in the last 5 years have made this possible.  The major leg ulcers, amputations, and blood clots with their complications----such as heart attacks, strokes, and pulmonary embolism just to name a few will significantly decrease.  Increased good health of the patient will occur, however, by re-routing these bad and flawed parts that perforate the circulatory system over to good areas and allow healing and health to succeed.  The problems will become primitive and a thing-of-the-past, and the pain and suffering should be greatly alleviated, as in most cases.  But remember:  With therapy and time, certain occurrences with veins are "recurrent" and must be treated when they happen.  In the meantime, you can be proudly wearing shorts again.
 
John Drew Laurusonis, MD
Doctors Medical Center