Greetings / Hinterland
Friday 02 June 2023
VASCULAR SURGERY. The first treatment is the medical one. The operating room is instead reserved for cases in which particular complications arise.
Among the diseases that are part of chronic venous insufficiency are varicose veins. We are referring here to varicose veins of the lower limbs and, in particular, of the saphenous veins. They affect 35-40% of the population, especially females, being able to exceed 40% in women over 50 years of age. Davide Foresti, a vascular surgeon who collaborates with Politerapica di Seriate, explains it.
The vein does dilate
Varicose veins can be defined as a permanent dilatation of a vein that takes a tortuous course and its walls undergo an alteration associated with inflammation. Its causes are mainly genetic and therefore familiarity is an element to consider. However, they can also be favored by sedentary work, hormonal balance (post-pregnancy varicose veins are known), overweight and smoking. Varicose veins could also be a consequence of other pathologies such as deep vein thrombosis and arteovenous malformation (this is the rarest). During the diagnosis phase, the specialist will have to distinguish between the different causes because each one will have a different therapeutic path.
Not always just aesthetic
The problem is almost always only aesthetic, continues Dr. Foresti. Sometimes, however, it also manifests itself with symptoms such as heaviness, edema, swelling. In the most important cases, tingling and nocturnal cramps may also occur. The latter will be investigated carefully. Often, in fact, they can be due to inflammation of the nerves and collaboration with fellow physiatrists will therefore be important. As can be seen, the multidisciplinary approach around the patient is also applied for varicose veins. There are also possible complications. These can be phlebitis, in 3% of cases, haemorrhage or ulceration, both in about 1%.
The role of the ecocolor Doppler
Diagnosis is clinical and color Doppler ultrasound is important. This tool allows you to correctly understand the cause of varicose veins and therefore the best therapeutic treatment. The color Doppler ultrasound then becomes indispensable for the specialist to set up the appropriate surgical approach. The Doppler, in fact, is a tool that allows you to quickly, effectively and reproducibly evaluate the hemodynamics of the superficial veins and choose the most suitable and targeted treatment. Every vascular surgeon must therefore also be a skilled sonographer and must always perform this examination himself together with the diagnosis and planning of the intervention.
Medical and surgical therapy
The first treatment for varicose veins is the medical one. It provides for the adoption of elastic-compressive knee-highs and supplements based on flavonoids, oxerutin, centella, centella asiatica and coumarin. These are intended to limit the inflammatory component that underlies the symptoms. The therapy must be continued for 2-3 months to ensure its effectiveness.
Surgery is reserved for cases where complications occur or when symptoms do not lessen with medical therapy. As already mentioned, the causes of this pathology are mainly genetic. It is therefore necessary to explain to the patient that, after surgery, the possibility of recurrence remains. The most pessimistic cases speak of 30% of cases 10 years after the first surgery.
The surgical approach can be of two types: conservative or ablative. It is ablative when the vein is removed or when it is obliterated (closed off). Instead, it is conservative when the venous heritage is preserved. We are talking about approaches based on stripping methods, laser or radiofrequency ablation and traditional sclerotherapy.
New surgical methods
Today, new scenarios are opening up in surgical therapy with great advantages for the patient, explains Davide Foresti. The main innovation of recent years is represented by endovascular techniques of mechanical and chemical closure of segments of the saphenous veins. These are techniques that revolutionize the traditional sclerosing approach and greatly improve the long-term effects compared to it. The first advantage is that the new methods allow it to be performed even in an outpatient setting. The other advantages are no less important. In fact, these new methods allow a rapid return to daily activity together with a significant reduction in discomfort and the appearance of hematomas after surgery. They are an important tool in the hands of the surgeon who knows them. In fact, this allows him to choose the most suitable treatment for that specific disease of that specific person, concludes Dr. Foresti.
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