Category Archives: Venous Diseases and Varicose Veins

Interventional Treatment in Varicose Veins

Non-invasive treatment methods can be divided into two main groups: thermal and non-thermal. Thermal methods are radiofrequency and laser ablation, while non-thermal methods are classical foam (sclerotherapy) and new generation bioadhesive (glue) methods.

How are Endovenous Laser (EVLA) and Radiofrequency (RF) Ablation Procedures Performed?

Both applications are performed in the operating room. Sedation + local anesthesia or spinal anesthesia is preferred. In the EVLA and RF ablation methods, a laser or RF fiber is inserted into the great saphenous vein from the ankle or knee under ultrasound guidance. After the position of this fiber is confirmed by ultrasound, local anesthesia is administered throughout the vessel. The laser or RF fiber is withdrawn and the entire vessel is occluded using laser or RF energy. The occluded vessel is gradually shrunk and destroyed by the body.

Endovenous Treatment of Varicose Veins

What are the Characteristics of Non-thermal Methods?
In the non-thermal methods, as in the thermal methods, a catheter is inserted under ultrasound control from the ankle or knee into the main vein to be treated and the position of the catheter is confirmed by ultrasound. In contrast to the thermal methods, it is not necessary to anesthetize the vein in the non-thermal methods. In the classical foam method, which we call sclerotherapy, a foam sclerosing agent is injected into the vein. In adhesive methods, new generation bio-adhesives are injected into the vein, which glue and seal the vein walls.

What are the Advantages of Endovenous Techniques over Classical Surgery?
• The patient has no incisions and scars, only a needle puncture.
• The process after the procedure is less painful than with the classical method.
• Patients can walk the same day.
• Patients return to their normal lives in less time.
• Since non-thermal methods do not use heat, recovery is much faster and discomfort after the procedure is much less compared to thermal methods.

What is the Hospital Process and Recovery Process for Endovenous Techniques?
The patient comes to the hospital in the morning of the procedure and is discharged 3-5 hours after. The procedure takes 20-30 minutes for each leg under standard conditions and is performed with either superficial general anesthesia (sedation) or local anesthesia. Patients walk immediately after the procedure.

Depending on the thermal effect of the thermal methods, there may be a slight burning and tingling sensation along the procedure area for 1-2 days.

With non-thermal methods, there is almost no discomfort after the procedure.

Both methods should be followed by medical treatment with compression stocks of appropriate pressure and size for 1 month to accelerate the healing process.

Endovenous Treatment of Varicose Veins

Tags: endovenous treatment of varicose veins, treatment of varicose veins with laser, treatment of varicose veins with radiofrequency, treatment of varicose veins with adhesives, treatment of varicose veins with foam, sclerotherapy, foam treatment, local anesthesia, endovenous treatment, endovenous ablation, ultrasound, doppler

Cosmetic Treatments for Varicose Veins

How are Cosmetic Interventions Applied?

Cosmetic interventions are performed on an outpatient basis. The patient is not hospitalized in any way. They can resume their normal life immediately after the treatment.

What is Sclerotherapy?

Sclerotherapy is a method of treating small and sometimes medium-sized varicose veins. It involves injecting a sclerosing agent (a vasoconstrictor) into the vein with a fine insulin injector, which stops the blood flow in the vein and closes the vein. It is recommended that the treatment be performed outside of the summer months to ensure greater treatment success and minimize some side effects.

How is Cosmetic Treatment Performed with Laser and RF?

1. Superficial (transdermal) laser: using a pen-shaped probe, laser energy is transmitted through the skin to the capillary varicose veins. This is an effective method that has been used for years. However, because the laser beam must penetrate the skin to reach the vein, side effects such as color changes of the skin may occur. It is also necessary to avoid the sun for several weeks after the procedure. Therefore, it is not recommended to perform the procedure in summer.

2. Superficial RF: Capillary varicose veins are accessed through the skin with a hair-thin needle and RF energy is supplied. It is a new and effective method that has been widely used in recent years.

Since the RF energy is given directly to the capillary varicose veins after passing through the skin, the skin is protected. Therefore, side effects of the laser are less frequent with this method. Moreover, since it is not necessary to avoid the sun after the treatment, it can be used even on the hottest days of summer, and the patient can go to the sea the next day.

Are the procedures painful?

The procedures are not very painful, yet local anesthetic creams are applied to the skin 15 minutes before the interventions in order to minimize the possible pain.

Can Cosmetic Interventions Be Done by Anyone?

No. Since the procedures have a low risk of complications, they should be performed by doctors who are experts in this field. In our clinic all procedures are performed by our experienced and specialist doctors.

Cosmetic Treatment Options for Varicose Veins

Tags: cosmetic treatment for varicose veins, laser, foam treatment, sclerotherapy, radiofrequency, capillary varicose, aesthetics, leg aesthetics

Surgical Treatment in Varicose Veins

Can You Give Information on Surgical Treatment in Varicose Veins?

Classical varicose vein surgery, which was used on almost every patient until 10 years ago, has now begun to give its place to new methods such as EVLA, RF ablation and sclerotherapy.

However, it is still used in some advanced cases and in cases unsuitable for RF and EVLA.

What Type of Procedures are Performed in Classic Varicose Vein Surgery and How Large are the Incisions?

Depending on the characteristics of the patient and the disease, one or more procedures such as stripping of the main superficial vein, valve repair, or ligation of the perforating veins may be used.

The patient has 2 small incisions of 1-2 cm in the ankle region and 2-4 cm in the groin region. In addition, to remove the varicose vein packs visible from the outside, incisions of half a cm in size can be made on each pack. Also, if perforating vein ligation is performed, there may be 3-5 cm incisions in some areas of the leg. Information about the procedures and incisions that will be made should be obtained from your doctor prior to surgery.

Are varicose vein surgeries performed under general anesthesia?

Although classic varicose vein surgery can be performed under general anesthesia, it can also be performed under spinal anesthesia.

How Long Do I Have to Stay in the Hospital and How Soon can I Return to Work or Daily Life?

It is necessary to stay in the hospital for 1 night after the surgery. Under normal conditions, you can be discharged the next day after surgery. For operations performed early in the morning, it is possible to be discharged in the evening of the same day.

After surgery, a rest period of 5-7 days is recommended for reasons such as pain and swelling, but this period may vary from person to person. It is best to check with your doctor about this issue and then make a decision.

Surgical Treatment in Varicose Veins

Tags: surgical treatment in varicose veins, surgery, vein removal, varicose vein surgery, varicosity, valve repair, stripping, anesthesia

Varicose Veins and Chronic Venous Insufficiency

What is a Varicose Vein? How does it Develop?

The veins transport used and contaminated blood from the body to the heart. The veins in the legs carry blood in the opposite direction of gravity (from the bottom up). In these veins there are valves that facilitate the flow upwards and prevent the accumulation of blood downwards. In addition, the movement of the leg muscles also plays an important role in transporting blood from the legs to the heart. However, if the valves are damaged, some of the blood will flow back during transport from the legs to the heart and collect in the leg veins. Varicose veins are a disease caused by this mechanism and usually affect the leg veins.

What Factors are Effective in the Development of Varicose Veins?

• Standing still for a long time
• Long silent sitting (deskmen)
• Genetic predisposition
• Being female
• Obesity

What Types of Symptoms are Observed in Varicose Veins?

• The most common complaint is leg pain that worsens throughout the day. Leg pain typically occurs later in the day with prolonged standing/sitting without movement.
• Feeling of heaviness, throbbing, tingling, numbness in the leg
• Itching
• Cramps in the legs
• Restless legs before/in sleep
• Clearly visible leg veins (capillary veins or larger veins)
• In later stages, color changes (hyperpigmentation) and sores (venous ulcers) on the legs

Do Varicose Veins Cause Cardiac Problems?

No. Varicose veins do not directly cause a problem with the heart, but in the later stages of varicose veins, coagulations that occur in the structurally defective veins can be dangerous. This condition, called deep vein thrombosis (DVT), can cause serious pulmonary problems if the clots enter the lungs.

How Many Types are Varicocele Veins? How do They Look?

Damage to the venous valves and increased downward pressure (venous insufficiency) results in varicose veins of various sizes. Although there are different classifications in scientific articles, they can be roughly divided as follows.
• Varicose veins in deep veins: They do not cause visible problems, but symptoms such as pain, cramps, tingling, restlessness, heaviness occur and there is a risk of deep vein thrombosis.
• Varicose veins in superficial veins: In addition to the discomfort caused by the disease in the deep veins, various visual disturbances occur depending on the size of the affected vein.
1. large varicose veins: these are varicose veins that protrude from the skin and are 4-15 mm in diameter.
2. medium varicose veins: these are varicose veins that protrude slightly from the skin and are green in color and 2-4 mm in diameter.
3. capillary varicose veins: these are red-purple varicose veins that do not protrude from the skin and are less than 1-2 mm in diameter.

What should be considered to prevent varicose veins?

Knowing that one of the most important factors in the development of varicose veins is genetic predisposition and family factors, obviously it is not possible to completely prevent varicose veins. However, it may be possible to reduce the risk and delay their development by making some adjustments to living conditions and habits.

Avoiding very hot environments (e.g. sunbathing, sauna, steam bath, etc.) is one of the factors you should consider.

Especially for people who work at a desk or stand for long periods of time, such as teachers, a 5-minute walk at certain intervals (every 30 minutes) is a useful protective measure, as this ensures the effect of contraction of the leg muscles on the veins. In addition, aerobic sports (walking, running, swimming, cycling, etc.) that exercise the leg muscles play a protective role in relation to varicose veins. Wearing high heels reduces the contraction of the leg and thigh muscles during walking. Therefore, we can say that wearing high heels for a long period of time accelerates the development of varicose veins.

What Happens If Varicose Veins Left Untreated?

Varicose veins that are not treated by a medical specialist can lead to a reduction in quality of life due to symptoms such as pain, restlessness, itching and cramps. It can even lead to loss of work due to the discomfort, which gets worsen over time. In addition, conditions such as clearly visible leg veins cause aesthetic problems. Color changes and sores that may occur subsequently can lead to irreversible consequences despite serious treatments.

Which diagnostic methods can be used for varicose veins?

• The most used diagnostic method (it can even be called a scanning method) is venous Doppler ultrasound. The procedure takes about 15-20 minutes, and during that, the patient is not exposed to radiation and is not in a closed environment as in MR -tomography scans. It can also be performed safely in pregnant women.
• Tomography and venography can also be used in advanced and complicated cases.

What is the Purpose of Varicose Vein Treatment?

The treatments used in the treatment of varicose veins are aimed at the symptoms of the disease. The main purpose of treatment is to relieve symptoms such as pain, restlessness, cramps, to eliminate appearance complaints and to prevent recurrence of symptoms through post-treatment follow-up.

What Methods are Used in the Treatment of Varicose Veins?

We can consider the treatment of varicose veins from two points of view: interventional and medical (medication therapy).

• Interventional Methods
1. Classical Surgery
2. Endovenous Laser Ablation (EVLA)
3. Endovenous Radiofrequency Ablation (RFA)
4. Mechanical Ablation and Foam Sclerotherapy
5. Venaseal method
6. Aesthetic Purposes: Sclerotherapy (foam therapy), laser therapy, radiofrequency therapy

• Medical Therapy
1. Medication Therapy
2. Compression Socks

Varicose Veins and Chronic Venous Insufficiency

Tags: varicose veins and chronic venous insufficiency, varicose veins, what is varicose veins, venous insufficiency, vein, tortuous vein, reflux, valve failure, capillary varicose veins, large varicose veins, genetics, family factors, swelling in the legs, visible veins

Pulmonary Embolism

What is Pulmonary Embolism?

Pulmonary embolism (PE) is the term used to describe the clot (thrombus) that has formed in the deep veins of the leg, breaks off from the site where it formed, and occludes the pulmonary artery. Depending on the size of the piece or pieces that have broken off from the clot in the leg, PE can cause an occlusion in the main body of the artery or in one or more of its branches. When one of the main arteries is blocked, it is called a “massive pulmonary embolism” and the situation is very serious.

Who are the candidates for PE?

The source of PE in almost all cases is deep vein thrombosis (DVT). A thrombus (blood clot) that has formed in the deep veins of the leg detaches there, occluding the pulmonary artery and causing PE. People who are at risk for DVT are therefore also at risk for PE.

Apart from these, fatty substances in the marrow of the broken bone, amniotic fluid during pregnancy or birth, and drug abuse are also rare causes that can lead to PE.

What are the symptoms of PE?

Depending on the prevalence and severity of the development of PE, one or more of the following symptoms may occur:

• Breathing difficulties
• Achy chest pain
• Coughing
• Coughing up blood (hemoptysis)
• Palpitations
• Low blood pressure
• Sudden cardiac arrest

How is PE diagnosed?

Doppler ultrasound is initially performed to diagnose DVT in a patient who has possible symptoms and who is suspected of having PE. However, Doppler ultrasound does not reveal PE, it only reveals the presence/absence of DVT, which can cause PE.
Although the D-dimer test rises in PD, it can also rise in many other conditions. Therefore, by itself, it is not conclusive for the diagnosis of PE. However, it may play a role in the clinical course of the patient diagnosed with PE.

Echocardiogram is a very useful, simple, painless, and inexpensive method for diagnosing pulmonary artery embolism. However, the definitive diagnosis of PE is made by a pulmonary angiogram, which is performed using computed tomography.

Pulmonary Embolism

What are the treatment options of PE?

1. Medication Therapy
Anticoagulant (blood thinning) medications: The diagnosed patient should begin taking these medications immediately. They are available in tablet form (Coumadin or new generation anticoagulants) or as injections (heparin or low molecular weight heparin). The effect of the injection forms starts immediately after administration, while the effect of the pill forms starts 12-48 hours after ingestion. The effect of anticoagulant medications used in long-term treatment should be monitored closely because of the risk of re-clotting and bleeding.
Systemic Thrombolytic Therapy: this involves the intravenous administration of various clot-dissolving medications. Its effect is more pronounced than that of anticoagulants, but because the risk of major hemorrhage is higher than with anticoagulants, this is a treatment method that is almost no longer used.

2. Surgical Treatment
In some cases, it is possible to surgically remove the piece of clot that has lodged in the pulmonary artery. However, this operation, which is quite risky, is used only as a last option.

3. Percutaneous Interventions
These are the most widely accepted methods today. In these procedures performed in the angiography room, the patient is placed on the face and an incision is made in the popliteal vein. Depending on the condition/severity of the patient and the disease, one or more of the following procedures may be planned.
• Applications for DVT
• Pulmonary thrombolytic therapy: injection of clot-dissolving drugs into the pulmonary artery.
• Thrombolytic therapy with ultrasound accelerated catheter: This is a method that uses high-frequency ultrasound waves while simultaneously delivering clot-dissolving medication into the pulmonary artery.
• Percutaneous aspiration thrombectomy: It is possible to completely aspirate the clot with a device guided to the pulmonary artery.

Tags: pulmonary embolism, vein, coagulation, pulmonary thrombosis, filter, shortness of breath, chest pain