Since the turn of the century, there have been many technological and scientific discoveries for the diagnosis and treatment of varicose veins, which are also called spider veins. Most of the scientific discoveries were made due to the technological invention called the duplex ultrasound (DUS). All patients with varicose veins of CEAP C2 (a classification system where C = clinical severity, E = Etiology, A = Anatomy, P = Pathophysiology) or higher require a DUS. This process in conjuction with a patient’s history and a physical examination will determine if varicose vein laser treatment is required.
Spider veins lead to venous insufficiency when there is superficial reflex. Unfortunately, this is an extremely progressive process, if spider vein treatment is not sought. Most of the people with superficial venous insufficiency usually also suffer from saphenous vein reflux.
It is common for spider vein treatment to involve the great saphenous vein (GSV) being stripped in order to decrease the chance that poor communication between it and the saphenofemoral confluence and or the thigh perforator will not occur. This is now done using varicose vein laser treatment.
Prior to varicose vein laser treatment, spider vein treatment was accomplished by splitting the saphenous trunk and all its branches closer to the trunk and performing stripping or avulsion phlebectomy. In order to complete the entire process, an incisions need to be made in the groin crease and on or below the knee. Many people have minor surgical complications from this spider vein treatment. In order to perform avulsion phlebectomy, numerous tiny incisions need to be made in the vein, possibly causing damage to the nerves and lymphatic vessels in the area.
Varicose vein laser treatment is another name for endovenous laser treatment or ablation (EVLA). This process uses laser energy to destroy the venous tissue of spider veins. The laser energy is transported to the proper incompetent vein segment through a bare laser fiber which was inserted through a sheath. This vein treatment can be accomplished using a variety of laser wavelengths. The thermal energy delivered to the vein and blood results in permanent venous tissue damage to the area. Typically, this varicose vein laser treatment is continuous as the laser fiber is slowly pulled back through the spider vein, eliminating any incompetence.
Endovenous laser treatment (EVLT) is the most beneficial when used as vein treatment for incompetent truncal spider veins (eg, GSV, small saphenous vein, accessory saphenous veins). It is possible to pass a laser introducer catheter along small and crooked veins. However, if the varicose vein is too crooked, it is very hard to pass through to complete the spider vein treatment.
Prior to endovenous laser treatment, exactly which areas of the saphenous vein are causing reflux is determined by ultrasonography. The ultrasonography is started at the saphenofemoral/saphenopopliteal junction and continued down the leg. Once damage is determined an entry point is chosen that is at the distal end of any incompetent segment. The vein is entered using a micropuncture needle introducer. A surgical marker is used to mark any vital landmarks during this process. These marks are then used during the varicose vein laser treatment.
In preparation for endovenous laser treatment, the leg is prepared and draped. Then a superficial local anesthetic agent is applied to numb the area where the micropuncture needle inducer will be inserted. To be sure the cannulation goes smoothly, ultrasonography is utilized to guide the needle. To continue with the varicose vein laser treatment, the Seldinger technique is taken advantage of for passing a guidewire into the vessel. This guidewire is then passed up the vein to the saphenofemoral/saphenopopliteal junction. Finally the introduce sheath is passed over the guidewire, which will promptly be removed.