Vein problems have plagued humans since the beginning of time. Fortunately, our understanding of vein problems has improved dramatically, and technological advancements have led to a dramatic increase in the number of treatment options available.
The first description of varicose veins dates back to 1550(BC), where varicose veins were described as “serpentine windings” in an ancient Egyptian scroll, known as Ebers Papyrus. During this era it was felt best to leave varicose veins alone; “Thou shall not touch something like this”.
Above: Ebers Papyrus
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During the Greco-Roman era, Hippocrates of Kos 460(BC)-370(BC), considered by many to be the father of modern medicine, described varicose veins and counseled against performing vein surgery. The term “varicose” is derived from a Greek word meaning “grapelike”, and is thought to have been adopted as a medical term by Hippocrates.
Above: Hippocrates of Kos
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Roman physician Aulus Celsus 25(BC)-45(AD) was one of the first to describe operating on varicose veins, and a century later Greek physician Aelius Galenas (Galen) 129(AD)-216(AD) described phlebectomy, a vein procedure still used today! The procedure is much more comfortable today, given we now have anesthetic options!
Above: Aelius Galen
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“Vein stripping” was described in detail by an Arab surgeon Abu Al-Qasim Khalaf Ibn Al-Abbas Al-Zahrawi 936(AD)-1013(AD), known in the west as Abulcasis.
Above: Abulcasis
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In the 19th Century, venous sclerotherapy was pioneered by Frenchman Joseph Petrequin. Sclerotherapy involves injecting a medicine into the vein that results in the destruction and elimination of the vein.
Above: Joseph Petrequin
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In 1890 German surgeon Friedrich Trendelenburg described tying off the great saphenous vein in the thigh, a procedure known as "great saphenous vein ligation". Tying off the great saphenous vein reduced pressure in the vein below the point of ligation.
Above: Friedrich Trendelenburg
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In 1896 an Australian surgeon, Jerry Moore, developed a modification of great saphenous vein ligation that involved tying off the great saphenous vein at an even higher level, close to where the vein connects with the deep vein. This procedure became known as "high-ligation of the great saphenous vein".
Above: Jerry Moore
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Over the 20th Century, the concept of performing vein surgery, to deliberately eliminate blood flow in diseased veins was validated. The purpose of these procedures was to divert blood from unhealthy to healthy veins.
Although 20th Century vein procedures were highly effective, these procedures were typically performed using general anesthesia in hospital operating rooms, or ambulatory surgery centers.
Between 1999-2002 two different types of “thermal ablation” procedures hit the market. These procedures fundamentally revolutionized vein care in the United States and around the world. Almost overnight it was recognized that these procedures could get equal (or better) results compared to historical vein stripping procedures, without requiring general anesthesia. This allowed these procedures to be safely and effectively performed on an “outpatient” basis. Quick, comfortable procedures... with great results. Welcome to the new era of vein procedures.
Thermal ablation procedures leverage the concept that if a dysfunctional vein can be sealed closed then this simulates the same effect as surgically removing the diseased vein. In both situations, the blood flow in the diseased vein is eliminated, which forces blood to flow through remaining, non-diseased veins. The two major forms of thermal ablation vein procedures are radiofrequency ablation (RFA) and laser ablation (also known as endovenous laser ablation / EVLA).
The leading radiofrequency catheter in the United States is the Closurefast catheter. The Closurefast catheter has an active tip on its end, which cauterizes the target vein using radiofrequency energy. The active tip on the end of the Closurefast catheter comes in two lengths; either 7cm or 3cm. It's not uncommon to seal 28-35cm of great saphenous vein, and in this case, the 7cm catheter allows rapid treatment (usually takes less than 15 minutes to seal the vein).
Above: Closurefast procedure
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Endovenous laser ablation (EVLA) of works by using a catheter, which has an active tip on its end, to cauterize the target vein using laser light energy.
Over the past 5 years, several “non-thermal” vein procedures have been rolled out. “Non-thermal” ablation procedures eliminate blood flow in superficial veins without using heat energy. By avoiding heat these procedures eliminate the risk of heat-induced injury to surrounding tissues and require dramatically less local anesthetic to perform the procedure.
The VenaSeal closure system uses an adhesive product to seal saphenous veins closed, without using thermal energy. The VenaSeal adhesive is a cyanoacrylate polymer that comes packaged within a small glass jar and looks like translucent honey when outside the body. The VenaSeal adhesive gets administered into the target vein by using a long catheter connected to a dispensing gun. Conceptually, the delivery system looks similar to a caulking gun connected to a long delivery tube. When the polymer comes into contact with blood the VenaSeal product instantly “polymerizes”, occluding blood flow within the vein. VenaSeal has been proven safe and effective and has been FDA approved since 2015. VenaSeal allows saphenous veins to be closed without the risk of heat-induced nerve injury, and there’s no requirement for bandages after the procedure. After VenaSeal procedures patients immediately return to work and full sporting activity.
Above: VenaSeal Closure System
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Varithena microfoam is a product that is created by mixing a liquid medicine called polidocanol with a familiar gas, oxygen. Varithena microfoam comes packaged in a small canister (that looks like a can of shaving cream). The treating physician withdraws an appropriate amount of the foam product into a syringe and then the foam is delivered directly into the target vein using an appropriately positioned catheter.
Above: Varithena microfoam
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ClariVein is a low-profile, minimally invasive procedure that uses a combination of mechanical and chemical forces to occlude the target vein. ClariVein uses a rapidly rotating wire to cause mechanical trauma to the wall of the vein, supplemented by simultaneous administration of medicine to help occlude the vein. ClariVein uses a very slim catheter that gets inserted through a pin-sized skin entrance point.
Above: Clarivein Infusion Catheter
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In addition to saphenous vein treatments, physicians now have several minimally invasive procedures that can be used to treat “perforator” or bridging veins, which may be the cause of venous ulcers (wounds) that can develop around the ankle. Venous ulcers are sometimes referred to as venous stasis ulcers.
The increasing range of technologically advanced diagnostic modalities and treatment options allows vein specialists to treat problems with higher accuracy, less risk of complication, and faster return to full activity.
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Dr. Peter Ford is the best vein specialist in Charlotte, NC. If you have varicose veins, spider veins, stasis dermatitis, or venous ulcer you should schedule your new patient consultation today.
