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Zapping Varicose Veins

New laser treatment better option than traditional surgery, experts say

MONDAY, April 8, 2002 (HealthDayNews) -- A new varicose vein procedure that uses a laser beam instead of a scalpel appears to dramatically cut both the pain and the cost of treating the condition that plagues millions.

The procedure, called Endo Venous Laser Therapy (EVLT), was so successful in the latest study of 200 people that it zapped varicose veins without a single complication.

And, says its creator, Dr. Robert Min, generally the patients walked out after the procedure, usually requiring nothing more than a surgical stocking.

"This is a new, but very successful, technology. Worldwide, there have been more than 2,000 of these procedures performed, all without a single major or minor complication," says Min, director of Cornell Vascular at the New York Weill Cornell Medical Center. Min will be presenting his research Wednesday at the annual meeting of the Society of Cardiovascular and Interventional Radiology in Baltimore.

What makes this new study so exciting, Min adds, is the number of patients and the length of the follow-up -- 22 months -- during which time 195 patients continued to see good results from the treatment.

Although the laser technique is being used in at least 20 centers in the United States, not everyone familiar with the laser technique shares Min's enthusiasm.

Vascular surgeon Dr. Mark Adelman says an equally new treatment known as VNUS closure may yield even better results. In this procedure, radio waves instead of the laser generate the heat, which are easier to control and thereby reduce bruising and pain even more than the laser technique, according to Adelman.

"We looked at both Dr. Min's laser treatment and the VNUS closure system, and they were equally successful in getting rid of the varicose veins. But the VNUS closure system resulted in less post-operative pain, less bruising and less numbness," says Adelman, director of vascular surgery at Bellevue Hospital in New York City.

A similar conclusion was reached in a study comparing the two therapies, published in January in the journal Dermatologic Surgery. It also noted the VNUS procedure costs about $500 per leg more than EVLT.

According to published reports, varicose veins affect one of every two people over the age of 50 -- with women developing the painful condition almost twice as often as men.

The bulging veins develop because of a back flow of blood from the large saphenous vein, which runs from the groin to the lower leg. Normally, tiny valves attached to the vein work as one-way entry ports, letting blood flow in, but not out. However, because of a variety of factors, these valves can become weak or incompetent, and some of that incoming blood leaks backwards and pools in the nearby smaller branch vessels.

When this occurs, the branch vessels enlarge, taking on the bluish-purple, twisted appearance most people associate with the term "varicose veins."

"The only way to truly effectively treat the condition is to treat the underlying problem by stopping blood flow into the saphenous vein," Min says.

In the past, this has been primarily accomplished by surgically removing the vein itself in an operation that requires general anesthesia, hospitalization and up to two weeks of recovery. The operation carries a price tag of about $6,000 per leg or more. But the treatment fails in 1 of 10 people, and significant pain, bruising and scarring are known side effects.

A more recent option has been a far-less expensive outpatient procedure known as sclerotherapy. In this procedure, a chemical irritant is injected into the saphenous vein, causing it to close. Published studies have shown that the vein reopens in 50 percent of patients and the basic symptoms recur within several years.

The laser treatment, which costs between $2,000 and $3,000 per leg, permanently seals the saphenous vein shut, Min says.

"Local anesthesia numbs the leg, a tiny incision is made inside the knee, and a catheter is inserted up to the groin," Min says. The laser fiber is then inserted into the catheter tubing and turned on, letting the resulting heat seal the vessel shut.

Once the saphenous vein is closed and the back flow of blood halted, Min says the branch veins usually shrink on their own. When this doesn't happen, a few sclerotherapy injections into the tiny branch veins remove the unsightly bulges.

In the latest study, conducted by Min at Cornell Vascular, the saphenous vein has remained closed in 195 of the 200 patients for almost two years.

And Min notes that in worldwide studies of EVLT, done on 2,000 patients, fewer than 5 percent have experienced a reopening of the saphenous vein thus far, with follow-up on some patients lasting as long as 28 months.

As good as the new treatments sound, Adelman and Min both say that neither one has the necessary 10-year follow-up to be declared a complete success.

What To Do

For more information on how varicose veins develop, visit The Mayo Clinic.

To learn more about treatment choices for varicose veins, visit The Venous Forum.

SOURCES: Robert Min, M.D., director, Cornell Vascular, New York Weill Cornell Medical Center, New York City; Mark Adelman, M.D., director, Vascular Surgery, Bellevue Hosptial, and associate professor, surgery, New Yor University School of Medicine, New York City; April 10, 2002, presentation, 27th Annual Scientific Meeting of the Society of Cardiovascular and Interventional Radiology, Baltimore
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