Varicose Vein Treatments Compared
Information about radiofrequency vs. laser vs. stripping therapy for Varicose Veins.
The patient advantages of the radiofrequency procedure (VNUS-Closure®, CELON®, RFITT®) as compared with conventional procedures and laser. In order to be able to compare the different methods, they must all be considered closely.
All methods have a common goal – to eliminate the problem truncal veins to improve the circulation and to improve the appearance of the leg aesthetically:
This common goal can be reached in very different ways:
The truncal veins are each threaded over a long wire and then removed from the leg along their entire length, through an incision on the ankle or knee and a second incision in the inguinal region or the hollow of the knee, by applying a substantial amount of force. This results in tearing of the surrounding connective and lymphatic tissues, and tearing off side branches causing haemorrhaging.
The method is radical, but well tested. Usually, this treatment must be undertaken on inpatients. As a result of the tissue traumatisation and the haematomas, the patient must stop work and refrain from participation in sports following the operation for 2 – 6 weeks. For the same reason, compression stockings must often be worn for up to 12 weeks.
2 The vein laser
Here, the afflicted truncal vein is punctured and, under full anaesthesia (or occasionally under local anaesthesia), the blood in the vein is heated extensively (at the tip of the catheter, temperatures of up to 1200 °C occur), whereby the wall of the vein is damaged and reacts by shrinking and a blood clot develops, which serves to close the remaining opening of the vein.
The surrounding tissues are not torn nor are side branches torn off. However, primarily through the extreme heat, frequent perforation of the vein and the flow of blood into the surroundings are possible, which can subsequently result in phlebitis after the surgery.
The interruption of participation in sports and time off work are, as a rule, clearly shorter than that seen for the conventional stripping and are dependent on the degree of the inflammatory reactions which mostly occur around the area treated. Depending on the extent of these symptoms, compression stockings must be worn for up to 6 weeks.
3 The radiofrequency procedure (VNUS-Closure ®)
The vein is only punctured (no scar) in the area of the ankle or knee, while under local anaesthesia, and a thin high-tech catheter is inserted. By way of this catheter, high-frequency electric impulses (2 million per second) are applied directly all around the wall of the vein, whereby the device and the surgeon constantly monitor the temperature at the tip of the probe, measured by a built-in temperature probe, and keep this at about 85 – 120 degrees Celsius.
As a result, no holes are formed through the wall of the vein, so that there is no flow of blood. The wall of the vein is reliably shrunken and the vein is closed long-term through the electrical impulses and the local heat at the precise position. Afterward, the vein is no longer evident with ultrasound and is generally broken down by the body.
As a result of no tissue traumatisation and disturbances in the lymph flow, as well as the absence of haematomas, our patients, as a rule, are able to work normally once again on the following day and either wear no compression stockings or – in more difficult cases – only have to wear such stockings for a few days.
The procedure is particularly gentle and provides by far the best aesthetic results, especially when it is combined with other particularly careful and gentle methods such as the following methods which are used by us:
We are the only institute to offer these combined procedures and to carry them out in one and the same sitting. Since the modern catheter procedures demand an especially high degree of experience from the surgeon in order to obtain truly good results, they should only be performed at institutes that are specialised in these procedures.
The scientific viewpoint of radiofrequency
In 2006, an international, five-year multicentre study was concluded to determine the “outcome” of the patients following the three different operative procedures and the frequency of relapse (rate of renewed development of varicose veins), which was presented at the University of Heidelberg in January 2007.
Here, it could be shown that the long-term results do not differ between the various procedures-the same number of relapses were observed in all three groups over the course of the five-year follow-up observations (no statistically significant differences could be established).
During the time shortly after the surgery, however, there are substantial differences between the different methods with regard to patient comfort, resumption of work and participation in sports.
Conclusions for our patients
We use the radiofrequency procedure in all suitable cases and have become very specialised: consequently, patients from throughout Europe come to us for therapy at our institute. Through the extremely high frequency of treatments in house, we have acquired the necessary experience and expertise to obtain optimal results. The competitive laser procedure has been becoming less important internationally for some time now and is no longer used by us so frequently because of the accompanying inflammatory symptoms.
If side branches and veins that are not automatically closed in the course of the radiofrequency therapy have to be removed, we generally no longer use the procedure of “mini-phlebectomy according to VARADY” : here, through the use of many small incisions (= small scars), the veins are pulled through the skin using hooks. Aside from the many (usually small, but frequently light or dark, and consequently easily visible) scars, there are frequently injuries to the nerves of the skin in the region of the lower leg. We therefore preferably combine the radiofrequency therapy with the steam vein catheter sclerosis method (SVS) of the side branches or wait for the effects of the radiofrequency on the side branches to disappear on their own after a few weeks. In this way, we spare our patients from scars, even the small scars from the “crocheting method“.
In the event that spider veins are also present, these are also treated during the same sitting with the aid of a special, modern Nd:YAG laser system
In the classical stripping, but also with the more modern laser, healing takes some time because of the associated haemorrhaging, inflammation and swelling. Medical compression stockings (“elastic stockings”) must be worn for up to 12 weeks after the operation.
The radiofrequency procedure, as carried out by us, in contrast, is extremely gentle and our patients can either do without wearing compression stockings entirely or must only wear them for three days, and they can already go swimming again on the day after the treatment (and generally also work fully).
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