Endovenous techniques

Each serious and reliable healthcare institution that professionally deals with treatment of veins – phlebology – has to master all available methods and procedures – meaning, it has to choose the best and most acceptable method for every patient.

Therefore, the fundamental motto of Polyclinic Lege Artis should be herein repeated: Each leg has its own story. We approach every patient in a special, individual way: after the diagnostics, we choose adequate treatment procedure, which is very often a collection of different methods.

In Polyclinic Lege Artis we operate on veins using lasers as well – Biolitec ELVeS Radial method and radiofrequency – VNUS Closture method. It is our ultimate choice based on years of resounding experience.

Figuratively speaking, radiofrequency glues the vein wall by ‘cooking’, and a laser does it by ‘scorching’.

The uttermost goal of these methods is to permanently exclude diseased veins from the superficial vein system in order to eliminate problems, stop the disease from spreading and prevent the development of serious complications – vein ulcer, but also thrombophlebitis, deep vein thrombosis, and thromboembolism as well!

Advantages:

  • completely pain-free – no cuts, wounds, scars
  • quick – ambulatory procedure (1-2 hours), under tumescent and intravenous anesthesia (TIVA)
  • return to daily activities immediately
  • current elimination of symptoms (swollen, painful legs, visible veins…)
  • efficient, permanent, without relapse and complications
  • ideal for permanent and quick treatment of vein ulcer (1-2 weeks)

Description of the procedure

European and American Association for Vascular Surgery, as well as Balkan Venous Forum, suggest laser, i.e. endovenous technique of surgery as a method of treatment being minimally invasive to patient’s health, most efficient and most elegant.

Contemporary laser and radiofrequency vein ablation has been applied in the world since year 2000; up until now, more than 100 000 such procedures have been performed. It is characterized by rapidity and precision with minimal number of possible complications.

The procedure takes for about an hour; postoperatively without surgical cuts, without scars, hematoma and swelling, completely without pain. Half an hour after the procedure, the patient can get up and go home; tomorrow, he is ready for all regular activities.

Also, extraordinary aesthetic effect of this surgery, as well as complete lack of postoperative pain, is very significant.

Candidates

Clinically, laser and radiofrequency ablation is performed in varicose veins in which the venous valve in groins and/or knee cave has weakened.
Risk factors are: positive family history of disease (hereditary), obesity, flat feet, sex – female hormones, multiple pregnancies, oral contraceptives, ‘standing’ and ‘sedentary’ professions; age.
Our patients are people who cannot allow themselves a sick leave – they want and have to work the next day, because nowadays, a job is a privilege.
Equally, those who do not want to suffer pain.
Also, elders and ill people who have elevated anesthesiological risk.
Generally speaking, we have many patients, because people nowadays are well informed and know exactly what they want.

Preparation

Dr. Čandrlić will – during the consultative period – provide all necessary instructions regarding the surgery and postoperative period. Individual measure for compression stockings that are worn after the procedure will be taken as well.

Before the surgery, it is necessary to perform laboratory testing, make an EKG, prepare relevant medical documentation in case of some pre-existing diseases and disorders – results are to be brought for preoperative anesthesiological examination to Dr. Čandrlić. It is also necessary to fill in preoperative anesthesiological form, which you will be provided during the first examination.

During the anesthesiologic examination, the patient is provided with information on the type of anesthesia, regime of pre- and postoperative behavior – diet, hydration, activity, taking medication, etc. It is important to memorize that 6 hour prior to the procedure you are not allowed to eat anything; it is only allowed to drink water.

Three days prior to the procedure you should stop using painkillers and blood thinners from the group of nonsteroidal antirheumatics – acetylsalicylic acid (Aspirin, Andol,…). You must warn your anesthesiologist about the possible anticoagulant therapy and therapies of other sorts.

For the sake of safety, everything that is necessary concerning the preoperative preparation, surgical procedure, and postoperative course will be consolidated during the final arrangement for the surgical procedure – personally or over the telephone.

Immediately before the surgery, in his suite, the patient changes into our one-time use clothing; takes premedication – for the sake of relaxation and against anxiety. During the short ultrasound check-up, the vein and puncture spot (needle entrance) are marked with a felt pen.

Course of the procedure

The procedure is performed in a modern, excellently equipped surgical theatre; it is performed under intravenous or tumescent (superficial) anesthesia.

The diseased vein is found using the ultrasound; through a small puncture opening in the skin, a small probe is lead through towards the varicose vein’s confluence – usually in the groin or knee cave. Along the vein, a saline with the local anesthetic is infiltrated using a needle, which served to protect surrounding tissue from high temperature radiated by the laser probe. After the check-up of the position of the probe, we start the machine, radiofrequent/laser energy with high temperature heats the vein wall, so it constricts and closes itself. Blood flow stops through the vein, and blood is redirected into the healthy veins which have the capacity to accept it; the treated vein stays in its place, it is not extracted, and, over time, it scars down.

At the end of the procedure, while patient is still on the operating table, he is dressed up with previously prepared, custom-made elastic compressive stockings.

Recovery

Functionality of circulation remains completely preserved.

Thermically processed vein immediately retreats; usually, a hematoma (bruising) and a passing indurations (local swelling) remain along the treated vein, which disappears during the next two weeks – a period of wearing a compress.

At the spot of the probe entrance, there is a small puncture wound that heals in a couple of days.

Visible varicosities and widening disappear immediately after the intervention; 2-3 months later, the treated vein is not visible anymore, even at the ultrasound examination.

At the end of the surgical procedure, patient is dressed up with a custom-made compressive stocking that will be worn for the next two weeks – the first week continuously, for 24 hours, the second week only during the day. An hour after the procedure, the patient is escorted home.

Precautions and limitations

Elastic stockings of 2nd level of compression are to be worn necessarily during the next 2-3 weeks. They are put on in bed, before getting up; during the first week, they are to be worn during the night as well. They aid ‘bonding’ of the treated vein, accelerate circulation and healing, prevent complications.

Endovenous techniques are indicated with patients who have insufficiency (valve weakening) in superficial vein system. It is contraindicated with fresh thrombosis in superficial vein and acute thrombophlebitis.

Side effects and complications

It can be repeated: usually, a hematoma (bruising) and a passing indurant (small local hardening) remain along the treated vein, which can be painful to the touch – with veins treated by a laser. Also, there can be a feeling of tightening – as if through the leg, at the spot of procedure done – a wire was pulled through. It all disappears during the next two weeks – a period of wearing a compress.

With radiofrequency treatments pain, pricking, or tightening – are completely absent.

Complications are possible, but very rarely; heat damage to the surrounding tissue – skin, fat tissue, nerves, hyperpigmentation – dark colored skin of that area; sometimes phlebitis – vein inflammation or hematoma.

But, with procedure carefully and correctly performed by a reliable and skilled surgeon – complications are almost minor.

Package

Package includes: preoperative examination by an anesthesiologist, surgery under general intravenous anesthesia, postoperative stay under supervision in a suite up until a condition fit enough for a medical discharge, adequate elastic socks fit to the 2nd level of compression, medicines necessary during and after the surgery, 3 postoperative reviews with an additional sclerosation of the treated vein flow, if necessary.

Package does not include: first indicative surgeon’s examination, vein color Doppler, blood test results, ECG, preoperative examinations by other specialized doctors due to comorbidity (pre-existing personal conditions, such as: diabetes, asthma, heart, high blood pressure, lungs, thyroid gland, allergies, etc.). Also, it does not include price for additional overnight stay (if necessary), expenses made prior to admittance into Polyclinic Lege Artis, telephone expenses, customary therapy.

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