The Author: Latvijas Avīze / Veselības centrs 4
Phlebologist is a physician, who diagnoses vascular diseases, develops therapy plan for the therapy of venous, lymphatic insufficiency, in the events of trophic ulcers, as well as eliminates aesthetically disturbing pathologies.
During the visit, the physician shall collect the history – most frequently asked questions refer to the specific nature of patient''s work, lifestyle, physical activities, harmful habits and heredity, which can promote the development of venous diseases. While patient is standing up, the physician will evaluate the size and localisation of varicose veins, oedema in the ankle region and appearance of skin, as well as measure the circumference of the leg. Meanwhile in sleeping position, the trophic of the skin, oedemas, appearance of trophic ulcers, localisation thereof will be evaluated.
Palapation of the pulse on the arteries of the feet, popliteal and inguinal area is important. Usually, the specialist will perform duplex ultrasound examination of the blood vessels during the examination, which is considered to be a golden standard of vein examination.
After the determining of the diagnosis, the physician offers the most appropriate and gentle solution, considering the form of the disease and financial resources of the patient.
If trunk veins are well, but only lateral branches are impaired, or the network of small capillaries is disturbing, the problem can be eliminated within tens of minutes, without surgical intervention and by means of different methods (sclerotherapy, intensively pulsating light devices, special vascular lasers, radiofrequency devices, etc.).
It is important to remember that the result of therapy can be reached only by complex approach to the problem – starting with precise diagnostics, adequate and minimally invasive therapy and completing with active rehabilitation and long-term observation of the patient.
Four most recognised therapy methods:
- Vein closure with biological adhesive has been worldwide admitted to be a safe and efficient method*. During the operation,a special biological adhesive of body temperature is injected into the vein by means of VenaSeal technology. In half a year, it is completely replaced by body tissue, without leaving any foreign substances in the body. This method does not require cutting or heating of the vein, thus completely excluding the risks of development of damage to the nerves and haemorrhages. The operation is painless, wearing of compression socks is not required after the procedure, bandaging and post-surgical care is not required. It is especially recommended in patients, who have psychological fear of surgical manipulations, as well as certain concomitant diseases, during which the anaesthesia is not recommended.
- Steam microimpulse method has an advantage in terms of the use of sterile, heated steam for vein closure. In contrast to other methods that require compression to compress the wall of the vein, this method requires the steam to freely, under pressure enter the vein. One precise dosed microimpulse can not only close a much larger span of vein, but its lateral branches, because the steam in the vein acts at the distance of 2 cm, entering the ''pockets'' of vein walls. Since thermal influence (C°) on the surrounding tissue is two times lower than that of the laser, the steam method is very gentle. It is especially effective after thrombosis and in the event of repeated surgeries. The steam method is especially suitable for veins that are large in diameter, that have many bends and complex anatomy, as well as in the places, where laser cables cannot be inserted.
- Radio frequency surgery is the oldest and most extensively researched therapy method in the world.. A special ultrasound guided radio frequency electrode catheter that generates heat energy is inserted in the vein through a tiny point-shaped incision. In contrast to laser, which can generate temperatures that exceed 300 degrees, the radio frequency method requires 120 degrees. This permits much more tender and safer closure of the vein trunks, that are situated close to the skin without the fear of possible skin burns during the procedure. It is a high precision method, since the energy power of the device and the duration of treatment is adjusted automatically. It is used for the therapy of veins of different diameter.
- Laser surgery - a method that has been used in Latvia for the longest period of time and the most common method in Europe. A laser probe is inserted into the damaged span of the vein; the laser beam is directed through the opening in the probe towards the internal layer of the vein. The radiation is radial, namely the beam is not directed forward only, it is directed in a sun ray-like pattern. The laser vaporises the water in the vein, the vein closes and the connective tissue gradually fills the place, where the sick vein was located previously. The effect of the new generation lasers on the surrounding tissue is much gentler and the recovery after the surgery occurs very fast. The laser used at Veselības centrs 4 Ltd. with robotised removal mechanism, also ensures high precision and increases the efficiency of therapy. Since there are clinics, where this is the only method used and where the lasers of the previous generation are still used, it is worth asking what technologies are at the disposal of the particular clinic.
Baltic Vein Clinic (BVC) of the Veselības centrs 4 is still the only medical institution in the Eastern Europe, where all these internationally recognised therapy methods are available in one place. Furthermore, they are used with very high success rate, by selecting the most appropriate for each patient.
Certain forms of varicose disease, where, for instance, the branch of the vein is varicose, but the trunk part of a large vein is not impaired, can be treated by using foam sclerotherapy, which is also performed under ultrasound control. It can be used, if the diameter of the vein does not exceed 1 cm. During the procedure a foamed medication, which breaks down the internal layer of the vein, is injected into the vein, as a result of which the vein closes. After the procedure, the patient may walk home. Furthermore, anaesthesia is not required during foam sclerotherapy. The procedure can be performed irrespectively of patient''s age and overall health status. In comparison to other methods, foam sclerotherapy is approximately ten times less expensive and therefore – accessible to a wider range of people.
* Approvals issued by the US Food and Drugs Administration (FDA), pursuant to the assessment of the data of three clinical trails of VenaSeal system sponsored by the manufacturer. Since consumer protection system of the USA ranks among the strictest in the world, this international recognition has a very high level of credibility.