Important information on varicose veins treatments


	•	Venous insufficiency is a progressive lifelong chronic disease that affects 50% of the population


	•	It causes cosmetic disfigurement (ugly varicose veins)


	•	It also causes medical symptoms such as pain, heaviness, muscle fatigue, numbness, itching, tingling or other discomfort.


	•	Women are predominantly affected due to the possible role of estrogen (pregnancy, birth control pill, hormones to prevent osteoporosis)


	•	Genetic factors may also be involved (congenital weakness of the venous wall and antireflux venous valves)

There is no one time immediate and permanent cure for this problem, but there are effective treatments that can slow down the progression of the disease, reduce long term complications and improve cosmetic appearance.

At the Montreal Institute for Skin Laser Surgery, we use two different laser systems to treat small varicose veins less than 1 mm in diameter. (Diode laser and Pulsed Dye Laser)

For larger varicose veins, classical injection sclerotherapy is used. This method is effective, medically recognized, and well tolerated. It is generally not painful, contrary to popular belief.

Treatment plan

During your first visit, you will need to complete a medical questionnaire regarding your health status and your veins will be evaluated clinically and by PPG.

The photopletysmograph is a device that calculates venous refill time of the legs and helps us determine a:) if we are dealing with small vessel or large vessel disease b:) the severity of the problem, c:) the possible involvement of the deep venous system.

You will receive complementary information on the treatments as well as possible side effects and preoperative and postoperative instructions.

We will recommend the purchase of medical elastic compression stockings in order to improve deep venous circulation, slow down progression of the disease and increase the efficacy of your treatments by reducing the number of required treatments.

If indicated, and depending on the pathology, treatments will begin during the first visit.

An estimate of the required number of treatments and the fees will be provided once your evaluation is completed.

There are several ways to treat varicose veins and different medical schools of thought. The method which seems most logical to me consists of first treating the highest points of reflux at the origin of the problem, the upper leg before the lower leg, and the large vessels before the small vessels , otherwise elevated venous pressure will cause treatment failure or early recurrence. You must understand we are not treating only the skin but mostly the blood circulation.

We use ultrasound Duplex Doppler to diagnose and treat varicose veins

Since January 2003, we have acquired a duplex Doppler which allows us to visualize the varicose veins under the skin by ultrasound technology. We can now investigate the anatomy of the superficial venous system, localize the principal points of reflux and practice ultrasound guided sclerotherapy for the great saphenous vein and the short saphenous vein. We can now offer many patients an alternative to classical "stripping" vein surgery.

The photo shown above shows venous dilatation resulting from failure of a venous valve and the consequences of chronic venous insufficiency (discoloration of the skin, eczematous stasis dermatitis, skin fibrosis, chronic ulceration, leg swelling)

Ultrasound allows visualization of damaged veins under the skin and precise localization of injection points

Ultrasound guided sclerotherapy is a serious alternative to traditional "stripping" vein surgery for the saphenous veins, often avoiding surgical scars and convalescence.

We also use "foam technique" for difficult cases of saphenous insufficiency

Physiopathology

There exist a deep and a superficial venous system which are interconnected.

There appears to be a genetic predisposition for progressive failure of small unidirectional venous valves, which normally prevent back flow of blood so that it may follow its normal course back up to the heart.

It is a chronic progressive lifelong disease and the failure of a valve downstream will cause the failure of a valve upstream through increased venous pressure, and so on, like a domino effect, more valves will fail.

Sclerosing diseased veins reduces venous pressure in the legs and allows healthy veins to function normally.

Untreated varicose veins increase venous pressure in normal veins and cause their eventual failure.

The final stage of varicose vein disease is stasis dermatitis and varicose ulcer.

Treatment of varicose veins has medical and cosmetic benefits