Medical - Ask Dr. Ken
Dear Ken, I'm going to have a surgery with my varicose vain on Friday, it will be actually pulled out, but just found out you can have a laser treatment, instead. It sounds less drastic but whats the actual advantages and disadvantages of both, surgery and laser treatment ? Thank you
Hello H - good to hear from you again - laser treatment sounds like a less invasive and more convenient way of dealing with the problem especially if you have found someone who is familiar with the technique and has already had good results. However it is still somewhat early days and you may have to regard yourself as a bit of a guinea pig. Pulling out (stripping) the vein is the traditional method for significant varicose veins and normally produces good results.I am copying some information from an unbiased source which may be helpful as you make up your mind - it mentions heat treatment as well as laser treatment but obviously references to heat treatment should be ignored.Hope this helps - I am very interested to know what you decide and also how you get on.RegardsKen
Dr Ken Prudhoe
Club de Mar Medical Partnership
07015 Palma de Mallorca
Questions to askLaser and heat treatmentIn this sectionDo they work?What are they?How can they help?Why should it work?Can it be harmful?What's the evidence?Do they work?We don't know for sure. These newer treatments for varicose veins aren't done as often as surgery or injections. There isn't much research to say whether or not they work.What are they?Surgery is the only way to get rid of varicose veins completely. But it's a big operation and there are risks. Surgeons have been looking at other ways to remove varicose veins that may be easier and quicker than traditional surgery. One of these ways is closing the vein with heat.Your surgeon can use heat to close your varicose veins in several ways.Radiofrequency ablationIn this method, your surgeon puts a thin instrument into your vein. The instrument produces energy, which heats and seals off your vein. This is called radiofrequency ablation. Surgeons usually use this method for larger varicose veins.If you're having treatment for a varicose vein in your leg, your surgeon will:1Make a small cut above or below your knee, depending on the area being treatedPut the heating device into your vein or thread it through a very thin tube (called a catheter) and then into your vein.Heat the device and pull it back slowly through your vein.The heated device seals your vein while your surgeon pulls it out.Laser treatmentIn this method, doctors use a laser to seal off veins.Your doctor will thread a thin tube (called a catheter) through a small hole in your skin into your vein.They will then place a laser in the tube, and the intense light from the laser will heat your vein and make it close up.You'll be given a local anaesthetic to numb the area, so you'll be awake but you won't feel any pain.Your doctor will then slowly remove the laser, and your vein will seal off as the laser comes out.Laser treatment is quick. It takes just 90 seconds to treat a 30-centimetre (12-inch) length of vein.2The National Institute for Health and Clinical Excellence (NICE) is the government organisation that advises doctors about treatments. NICE says that both radiofrequency ablation and laser treatment are safe enough and work well enough for use in the NHS. But we don't know the long-term effects of these treatments. You should talk to your doctor about the risks and benefits of having one of these treatments.2 3How can they help?Radiofrequency ablation seems to work about as well as having surgery to strip out varicose veins. In one study, 14 in 15 people having radiofrequency ablation were happy with the way their legs looked afterwards.4Radiofrequency ablation may be less painful than having veins stripped out by surgery. But we're not sure. There hasn't been much research.5We don't know how well laser therapy works compared with other treatments for varicose veins. There haven't been any good-quality studies.Why should it work?Usually veins carry blood upwards through your legs to your heart. They have one-way valves in them that keep blood flowing in the right direction.In varicose veins, the valves don't work properly. So blood slips backwards into the vein, causing your vein to bulge. To learn more, see What are varicose veins?Closing up your varicose vein with heat or lasers means blood can no longer flow through that vein, and it flows through your other veins instead. So blood no longer pools in your varicose veins, causing them to bulge.Can it be harmful?Radiofrequency ablation does sometimes have side effects.Between 6 in 100 to 7 in 100 people who have radiofrequency ablation get burns.3 But as doctors get better at using this technique, burns should become less of a problem.Some people get an unusual feeling in their legs after having radiofrequency ablation, especially if they've had surgery on a vein below the knee.3About 2 in 100 to 3 in 100 people get inflammation in the vein.3 Doctors call this phlebitis. If you have phlebitis, your veins can become swollen. They feel hard and warm, and look red. The area can feel sore.More serious problems, such as having clots in your veins (deep vein thrombosis) or a blockage in your lungs (pulmonary embolism), happen in less than 1 in 100 people.3You're likely to get some pain and bruising after having laser treatment.2 But this will go away after a few weeks. Some people also get inflammation after having laser treatment.2What's the evidence?What's the evidence for laser and heat treatment?Sources for the information on this page:Teruya TH, Ballard JL. New approaches for the treatment of varicose veins. Surgical Clinics of North America. 2004: 1397-1417.National Institute for Clinical Excellence. Endovenous laser treatment of the long saphenous vein. March 2004. Interventional procedure guidance 52. Available at National Institute for Clinical Excellence. Radiofrequency ablation of varicose veins. September 2003. Interventional procedures guidance 8. Available at http://www.nice.org.uk/ipg008Perala J, Rautio T, Biancari F, et al. Radiofrequency endovenous obliteration versus stripping of the long saphenous vein in the management of primary varicose veins: 3-year outcome of a randomized study. Annals of Vascular Surgery. 2005; 19: 669-672.Adi Y, Bayliss S, Taylor R. Systematic review of clinical effectiveness and cost-effectiveness of radiofrequency ablation for the treatment of varicose veins. West Midlands Health and Technology Assessment Collaboration Report 2004, No. 49.Published Jan 03, 2008. © British Medical Journal Publishing Group Ltd 2008.