28, 6, 2020

3-Stage Approach to Vein Treatment

2020-09-17T17:58:02-07:00

When visible signs of venous disease such as spider veins, varicose veins, or skin changes are present, this is usually the tip of the iceberg, and an underlying vein problem is present. An underlying vein condition (venous reflux disease) can be detected with ultrasound. A treatment plan is focused on treating the underlying vein problems first, then working outwards.

image of an Iceberg as a metaphor for the hidden dangers of vein disease

Iceberg, a metaphor for the hidden dangers of vein disease

How Is Venous Reflux Disease Treated?

Step 1: The Underlying ProblemThe first step is to treat the underlying problem, the venous reflux. The specific pattern of venous reflux was detected by ultrasound. Venous reflux usually starts in the saphenous veins. The saphenous veins are most effectively treated with vein ablation procedures. This involves placing a small catheter within the vein and using heat or a solution to produce injury and eventual closure of the vein. The most commonly used treatments for the saphenous veins are radiofrequency ablation (RFA), laser ablation, mechanico-chemical ablation (MOCA or Clarivein), and in some cases Varithena Foam. The treatment recommendation is customized, based on where reflux is present and other clinical factors.

Step 2: Varicose Veins

After the underlying saphenous vein reflux is corrected, the bulging veins (varicose veins) can be treated by injecting a foamed medication that will cause them to scar and eventually dissolve (foam sclerotherapy), or to remove them using tiny incisions. The most common method is foam sclerotherapy.  This is also known as ultrasound-guided foam sclerotherapy (UGFS).

Step 3: Spider Veins

Spider vein treatment is always considered a cosmetic procedure. If improved cosmesis is a goal of treatment, make sure to discuss this with your doctor and plan on having cosmetic treatment as the last step. Spider vein treatment is accomplished by sclerotherapy, which is an injection of a liquid medication into the spider veins. Most patients use 3 vials, and have an average of 3 treatment sessions.  Ask your provider for an estimate about how many treatment sessions/ vials are necessary to get the results you want.

 

3-Stage Approach to Vein Treatment2020-09-17T17:58:02-07:00

18, 6, 2014

History of Foam Sclerotherapy Treatment of Varicose Veins

2021-11-05T10:56:45-07:00
foam

Foamed sclerosant inside a vein: Once foam is introduced into the vein, it is hyperechogenic on ultrasound. In this picture, a La Jolla Vein Care doctor points to the foamed medication inside the vein. Notice it appears ‘white.’

foam03*

Foamed sclerosant used for sclerotherapy has a ‘foam’ or frothy-like appearance.

In 1994 and 1950, E.J. Orbach introduced the concept of a macro bubble air-block technique to enhance the properties of sclerosant in performing macrosclerotherapy.  Apparently, few vascular surgeons were interested in the subject and the technique languished.  The work of Juan Cabrera and colleagues in Spain attracted attention of some vein specialists and interest in the use of foam technology in treating venous insufficiency was reawakened. Administration of foamed sclerosant was reintroduced in the early 1990s by Cabrerra, who summarized a broad experience in 1997. By the 1990’s, broad use of diagnostic ultrasound imaging made it possible to monitor foam distribution with ultrasound scanning. Some 40 years earlier, and before the development of ultrasound scanning, foam had been used in Germany to treat varicose veins.  At that time, foam was made by special syringes and its distribution was assessed by touch, instead of ultrasound scanning. Tessari , prior to the year 2000 developed an easy way of making liquid sclerosant into foam using two syringes and a three-way stop cock.   By 2000, Sica was able to report a three-year experience using foamed sclerosant in treating saphenous varices.  Since that time, foam has appeared increasingly in general use. Around 2000, Dr. John Bergan began describing the utility and success of foam treatment to physicians in the United States and can be attributed to bringing its awareness to North America. Over the past decade foam has gained world-wide popularity for the treatment of varicose vein tributaries in place of surgery. Varithena foam was recently FDA approved to treat the great saphenous vein with foam sclerotherapy.  Dr. Bergan predicted that microfoam sclerotherapy will eventually replace all other methods.  Presently, it is most commonly used as an adjunct to endovenous ablation of the great and small saphenous veins or as a sole treatment for surface varicose veins.

History of Foam Sclerotherapy Treatment of Varicose Veins2021-11-05T10:56:45-07:00

4, 2, 2014

New Foam Treatment of Varicose Veins

2021-11-04T19:24:26-07:00

In November of 2013, the US Food and Drug Administration (FDA)  approved Varithena,™   a new type of foam treatment for the treatment of patients with incompetent veins and visible varicosities of the great saphenous vein (GSV) system. Varithena is a pharmaceutical-grade, low-nitrogen, polidocanol foam dispensed from a canister device. In two pivotal, placebo-controlled Phase III trials, VANISH-1 and VANISH-2, Varithena achieved a clinically meaningful improvement in the symptoms of superficial venous incompetence and the appearance of visible varicosities and addressed the underlying venous incompetence in the majority of patients treated. Varithena (polidocanol injectable foam) is a sclerosing agent indicated for the treatment of incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein system above and below the knee.  Varithena improves the symptoms of superficial venous incompetence and the appearance of visible varicosities.  Treatment is a minimally invasive, non-surgical procedure that requires neither tumescent anesthesia nor sedation.  Foam sclerotherapy has been used for years by medical doctors. What is new with Varithena, is that the foam is pre-made with low-nitrogen as opposed to room air, and is dispensed in a proprietary canister.   It is not yet available in doctor’s offices. Making Foam

New Foam Treatment of Varicose Veins2021-11-04T19:24:26-07:00
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