THERAPIES
The surgery therapy
Surgery of the varicose veins
This kind of surgery is very popular, as varices strike half-living
population. It has been object of growing scientific interest bringing
several innovations, but at the same time is also object of many in
vogue and not always real rumors.
The traditional surgery of varicose veins was based on the removal
of the sick saphena and related veins, with different techniques,
as the well-known stripping. This kind of therapy is still used today
in the cases of advanced stage disease with thrombi phlebitis risk.
The modern techniques allow to perform these operations with small
cuts in local anesthesia in outpatient departments or day hospitals.
The large saphena vein is generally removed from groin to knee (short
stripping) and only rarely to ankle (long stripping). The small saphena
is generally stripped from knee to ankle or just interrupted at knee.
In the last 12 years several other surgical treatments have been proposed,
mainly devoted to the correction of blood circulation insufficiency.
These improvements have been possible thanks to the development of
the diagnosis techniques reported in the previous sections and to
deeper knowledge of circulatory mechanisms. Some of the operations
are based on the interruption of the veins in selected points (indicated
by Eco Doppler) to correct and preserve the whole system.
Other operations are plastic valvularies whose aim is to strengthen
the venous walls in correspondence of the dilated valves and to reset
blood circulation in the right direction (from the periphery to the
heart). These conservative and restoring operations are not very invasive
and can be done with an out- patient treatment.
Moreover these kinds of operations, if done in early stages, can bring
very good and stable results and prevent the course of the illness.
Today the periphery varicose veins are generally stripped together
with the major operations through micro-cuts (less than 1mm). When
there is no problem with the saphena veins, these operations can be
done with an out-patient treatment in local anesthesia. The advantages
of micro-cuts reside in complete absence of pain, very rare possibility
of complications and complete disappearance of any surgery traces
in two-three weeks. In some cases the esthetical result is "incredible".
These veins are the majors responsible of the venous diseases and
in selected cases it is useful to interrupt these vein. Several techniques
are described to perform this kind of operation. The most updated
and efficient techniques is that named video assistita
Sclerotherapy
Sclerotherapy is a procedure where a chemical is injected into veins,
causing them to scar and seal off. After this procedure the legs are
compressed by elastic bandages to reduce bruising and bleeding and
to favor healing. This technique is very useful in several cases,
but not in every case. In the past sclerotherapy has been used to
treat almost all cases and the results were not always very satisfying.
Precise indications reveal that sclerotherapy is mainly indicated
for the complete removal of small veins left after surgery, for microvarices
and capillaries and for veins diseases not associated to safena vein.
Before sclerotherapy coagulation factors must be checked. Moreover
a plan for the entire therapy is scheduled. Generally several injections
are required. Usuall one week shoul pass between an injection and
the following. With a highly experienced physician performing the
treatment the side effects are very limited. Sclerotherapy is relatively
pain-free. Some lumps in the treated veins may develop. This is coagulated
blood that disappears in few days. Development of brown spots on the
skin at the site of the treated blood vessel is also possible: these
spots are probably made up for the presence of a form of iron in the
blood. With medical therapy the spots can almost completely disappear.
Integrated therapies
Synergic effect of surgery therapy together with sclerotherapy to
eliminate peripheral varices is a good example on how a combination
of more techniques can bring interesting results, difficult to reach
applying a single therapy. Medical therapy, use of bandages and elastic
stockings, physical therapy, therapies using polarized light, iperbaric
chambers and oxygen ozone are other therapies that can be used in
combination with each other to reach stable and satisfying results.
Oxygen-ozone therapy
In the last years the ozone therapy has been widely used. Ozone has
several interesting applications. It can kill bacteria, viruses and
fungi. Moreover it stimulates the immunity system, the metabolism
of lipids, glucoses, and in the osteoarticular diseases it has an
analgesic, anti-edema and anti inflammation action.
In the field of vascular pathologies oxygen-ozone therapy is mainly
used to treat the diabetic foot, ulcers in the legs, and cellulite.
This therapy can be performed in different ways:
1) sub-skin injection of oxygen-ozone in cellulite regions and along
safena vein;
2) local application with the aid of a polyethylene bag on ulcers;
3) Big self-emoteraphy. This therapy is performed in the case of ulcers,
specific viruses infection.
The treatment is free of side effects.
The international Medical Ozone society (I.M.O.S. in Italy) is the
scientific society that controls the use of the O2O3.
Polarized light therapy
Recently a new technique using polarized light has shown to produce
a stimulating action on the cellular regenerator tendency of the ulcers
and other wounds (like bed-sores, traumatic and surgery wounds) making
healing faster. It has also an analgesic and anti-inflammation action,
with a further advantage that does not have any side effect on the
skin, as the wavelength is higher than that of the UV rays.
Skin transplant
In case of ulcers skin transplants can be performed. The transplant
can be done during the principal surgery of the veins.
Before this treatment specific local antibiotics are applied for few
days. The transplant treatment is pain free and the side effects are
very limited. After the treatment the patient can go home, but a complete
rest is prescribed for 4 days, to favor the taking root of the new
skin. It is suggested to lay in bed during these days with the leg
lightly raised (5-8 cm with respect to the trunk are sufficient)
In the following 4 days the patient can stand and walk for few minutes,
in order to avoid the swelling of the foot and leg. On the 8th days
the bandage is removed and the doctor can evaluate the result of the
transplant. In rare cases it is necessary to repeat the transplant
or part of it. A complete healing of the wound needs 1,2 months. During
this time medications are done every other day.
The lymph edema
Often looking at a swollen leg the important function of drainage
of the peripheric liquids by the lymphatic system is forgotten. This
vascular system runs prevalently close to the veins throughout the
body. Several diseases can hit his system. These diseases are independent
or associated to the vein diseases. If the swelling is caused only
by lymph dysfunction it is called lymph-edema. If it is related to
venous diseases is called flebo-lymph edema. An acute inflammation
of the lymph system, is generally caused by a bacteria infection that
brings as a symptom a swollen leg with red, shiny and stretched skin
and it can be confuse with thrombus phlebitis. The consequences of
this diagnostic mistake can prevent the complete healing. At the same
time deluding results are obtained when the presence of lymph edema
associated to vein disease is not taken in the right consideration.
In this case, the treatment of the veins will not be accompanied by
the reduction of the edema. In simple words the leg will continue
to be swollen.
To have an exact diagnosis ultrasounds made by a high experienced
specialist is able to distinguish the alterations due to cellulite,
lipodistrofie and serious limp edema. This diagnosis is essential
in order both to obtain satisfying results and to avoid expensive
and not useful treatments.
The anti coagulant therapy
In the case of deep venous thrombus or superficial thrombus phlebitis
that therapy with anti coagulants must be followed by a specialist
through specific tests of the coagulation function (PTT test), as
well as of the platelets
During the therapy with anticoagulants, that can lasts for several
months, even years, it is necessary to follow a particular diet to
avoid rapid change of the coagulation times.
The elastic stockings
They are seen like nightmares. The elastic stockings are very
important instruments to prevent and to treat all the venous diseases.
Their use is fundamental during the medical therapy and the sclerotherapy
and after the operations.
The medical therapy
The medical therapy is always suggested, for diseases at the beginning
or advanced stage and as a good support for the stripping and sclerotherapy.
For the stripping patients the medical therapy represent, together
with the elastic bands, the best method to prevent treated veins to
recur.
Concentric layers of different tissues that have different functions
form the veins. When they are sick the modern drugs can restore their
functions. Several types of drugs are available.
Some drugs, called venous trophic act directly on the muscle receptors:
they reduce the swelling and improve the muscular function of the
venous walls.
