Non-Surgical Treatments for Varicose Veins: Exploring Effective Alternatives - Surgery

Dr. Huang Zhihui reply Surgery

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Hello Mr.
Hsu: Regarding your issue with varicose veins, I would like to share an article titled "Treatment of Varicose Veins" published by Dr.
Luo Ru-gong, a specialist surgeon, in the Health World e-newsletter.
I hope this information is helpful to you.

Dr.
Luo Ru-gong
mailto:[email protected]
http://www.vein.com.tw
1998/04/01
Treatment of Varicose Veins
In Taiwan, the traditional treatment for varicose veins has primarily focused on surgical removal.
About a decade ago, physicians began introducing "sclerotherapy," a method originating from Europe that has been in practice for nearly a century.
Due to its non-invasive nature and the fact that it does not require hospitalization, it quickly gained popularity among patients.
Over time, scholars and physicians worldwide have accumulated years of treatment experience, continuously improving techniques and establishing the role of sclerotherapy in the treatment of varicose veins.
However, sclerotherapy has shown limited effectiveness on larger vessels and, after further evaluation, has revealed a significant drawback: a relatively high recurrence rate.
Consequently, the European medical community, which has been at the forefront of varicose vein treatment, has returned to surgical methods about a decade ago.
Traditional varicose vein stripping surgery has undergone technical improvements, leading to the development of "Ambulatory Phlebectomy" and "Perforation INvagination Stripping." When combined with sclerotherapy as an adjunctive treatment, this approach currently appears to be an ideal "package."
The current status of varicose vein treatment in Taiwan is as follows:
1.
Conservative Treatment: The simplest and most effective method, where patients manage their own treatment, though it is not a permanent solution.

2.
Traditional Stripping Surgery: Most surgeons in hospitals, large and small, are capable of performing this procedure.

3.
Sclerotherapy: Approximately one hundred physicians "occasionally or frequently" perform this procedure, with both surgical and dermatological specialists involved.

4.
Microsurgery: To my knowledge, only three surgeons are performing this technique.
(This point is for reference only.)
5.
Perforation INvagination Stripping: Previously, there was no Chinese translation for this term.
I have named it "Perforation Stripping" based on the spirit of the procedure.
Aside from myself, I am unaware of other physicians performing this.
(If there is an error, I apologize in advance.)
Below is a detailed description of various treatment methods:
1.
Conservative Treatment: What is conservative treatment? It refers to non-invasive therapies, which are a reverse approach compared to surgical or sclerotherapy methods aimed at removing varicose veins.
In other words, it seeks to alleviate the discomfort and complications caused by varicose veins without removing the veins themselves.
Simply put, it involves wearing compression stockings.
Varicose veins occur only in the superficial venous system.
The deep venous system in the lower limbs, embedded between muscle layers, has limited space for pathological dilation due to surrounding pressure.
Similarly, wearing appropriately pressured compression stockings will limit the abnormal dilation of the superficial venous system.
After prolonged use, all discomfort and symptoms caused by varicose veins, including pain, cramps, swelling, and stasis dermatitis, will gradually diminish as venous reflux is eliminated and venous return improves.
However, this is not a fundamental treatment; once the stockings are no longer worn, all symptoms will reappear.
I like to compare "conservative treatment" to "condom therapy." Proper use of condoms can achieve nearly 100% effectiveness in contraception, but if they are not used continuously...
Generally, compression stockings with a pressure of 25-32 mmHg (Class II) can yield good therapeutic effects.
They should be worn before getting out of bed, can be briefly removed while showering, and ideally should be worn from after bathing until bedtime.
They can be removed at bedtime.
If used correctly, putting on and taking off Class II compression stockings is not as troublesome as one might imagine and does not take much time.
High-quality compression stockings are not only lightweight, thin, and comfortable but also less likely to cause skin allergies or irritation.
2.
Traditional Stripping Surgery: This is the most effective and least recurrent aggressive treatment for varicose veins.
This principle has never been denied by any physician.
However, the surgical approach has undergone significant changes in the past decade, initiated by European surgeons, leading to the emergence of "microsurgery" and "Perforation INvagination Stripping." Traditionally, varicose vein surgery involves the removal of the great saphenous vein or the small saphenous vein.
If there are varicose side branches outside the main trunk, additional incisions are made to remove these branches.
Most patients undergoing traditional surgery have numerous complex side branches, resulting in many scars of varying sizes on their legs.
Although varicose veins are removed effectively, many patients still hesitate to wear short skirts or shorts.

Taking varicose veins in the great saphenous vein territory as an example (most patients fall into this category), here is the typical process for a patient undergoing traditional surgery:
1.
Hospitalization: Usually, patients are admitted the day before surgery for basic examinations.
They are discharged a week after the stitches are removed.

2.
Anesthesia: General anesthesia with endotracheal intubation or spinal anesthesia.
(For most surgeries, the risks of anesthesia are greater than those of the surgery itself.)
3.
Surgery: First, a 5 cm horizontal incision is made in the groin area of the affected limb to locate the great saphenous vein.
The main branches of the great saphenous vein are ligated and severed one by one, and the vein is ligated and severed at the point closest to its junction with the femoral vein.
Then, a 2 cm incision is made on the inner side of the ankle to locate the distal end of the great saphenous vein.
After ligating and severing the distal end, a stripping device (a flexible multi-strand steel wire) is inserted from the ankle end of the great saphenous vein and pulled out through the groin incision.
At this point, the vessel is tied at one end and a cone is placed to prevent the vessel from slipping off, while the other end is pulled forcefully to remove the segment of the great saphenous vein from the groin to the ankle.
The remaining varicose side branches are treated through additional 1-2 cm incisions, allowing for the removal of 5-7 cm of vein per incision.
After all wounds are sutured and bandaged, elastic bandages are applied, and the patient is returned to the ward.

4.
Postoperative Care: For two to three days post-surgery, patients generally avoid getting out of bed unless necessary due to pain.
Many patients report that it takes two to four weeks of recovery before they can return to work.

In summary, the commentary on traditional surgery...

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Reply Date: 2000/11/21