Treating varicose veins without using knife

KOTA KINABALU: Patients with varicose veins can now seek treatment with Sabah’s first endovenous laser ablation (EVLA), a non-surgical procedure that uses light waves to eliminate varicose veins.The first breakthrough of the EVLA procedure in Sabah was done using CoolTouch CTEV laser in Sabah Medical Centre on July 5, followed by five subsequent procedures.

Consultant of plastic and cosmetic surgeon at SMC, Dr Charles Lee who has over 20 years of experience, said 50 patients had come to seek treatment for varicose veins in the past year, with 45 of them housewives.

Varicose veins develop when veins, blood vessels that return deoxygenated blood from the outer parts of the body back to the heart and lungs, become abnormally thick or enlarged, forming unsightly blue or purple twists and bulges on the surface of the skin.

The symptoms of varicose veins are heavy legs, tired legs, leg cramps, fidgety legs, pain on calves, aching or swollen legs, itchiness, and long-term effects, including bleeding and leg ulceration.

Although people in Sabah were aware of varicose veins, Lee said they did not know that it could be treated in a minimally invasive nature.

“Our culture is, if we have varicose veins, we cover with sarong or long pants.”

Traditionally, varicose veins is treated with a stripping procedure, a surgery that is done to cut the faulty veins. This procedure which is performed under general anesthetic not only risks having scar on the legs, recovery time could also take up to several weeks.

“In those days, surgeries were done under general anaethetic and patients were horrified,” he said in an interview prior to a medical talk on varicose veins at Sutera Habour Resort here on Wednesday.

The EVLA involves inserting a fibre into a small single needle incision made in the leg. The laser is then activated and as the fibre is moved through the vein, it heats and safely closes the vein. Once the vein is closed, the blood that is circulating through this vein, is rerouted to other healthy veins and the varicose vein vanishes. The whole procedure is done under topical anesthetic.

Lee saw the need for EVLA in Sabah when he realized many patients came to him to seek solution for varicose veins. Even more so when he discovered he had the symptoms six months ago.

“I had leg pain, discomfort, cramp and heaviness on my legs.

“I did not know what I was having because I had no visible vein.”

Lee then sought his friend Dr Peter Chapman-Smith, the medical director of the Skin and Vein Clinic in Whangarei, New Zealand, who performed the EVLA on him.

“EVLA is a treatable disease that can be done as outpatient procedure under local anaesthetic. Patients do not need to be hospitalized and the recovery is quick.”

Chapman-Smith revealed that up to 50 per cent of the population at some point of their lives had the disease but many cases were not treated well or not treated at all.

Despite the number of women seeking treatment is three times more than men, Chapman-Smith pointed out that the symptoms such as heavy legs, tired legs, leg cramps and restless legs affected men as much as women.

The symptoms are also more common in professions which require standing for a long period of time, such as hairdressers and dental assistants, he said.

In addition, family history and hormones play a big role in varicose veins.

“There is a linear relationship between the number of babies and varicose veins. The more number of pregnancy, the more likely it is to have varicose veins.”

However, he stressed there is no relationship between the size of veins and symptoms, as there were patients suffering from varicose veins despite not having visible veins at all.

Although varicose veins is a common disease, Chapman-Smith pointed out that most doctors were not aware of it, thus were unable to give an accurate diagnose to patients.

Speaking about the traditional way of treating varicose veins, i.e. vein stripping, he said it had a high recurrent rate as the treatment could stimulate more veins to grow as well as having a five per cent risk of blood clot to the legs and lungs.

Chapman-Smith recommended using EVLA which he claimed to be the “most elegant, aggressive and therefore very effective” non-surgical treatment.

He has done nearly 1,000 EVLA procedures to his patients.

“I haven’t treated a patient who is not happy about it.”

The main risk of any varicose veins treatment, as he said, was deep vein thrombosis or blot clot to a patient’s lungs which could be potentially fatal.

“For surgery the risk is one in 20, laser (EVLA) is one in 1,500, while injecting foam (foam sclerotherapy) is one in 5,000.

“This shows that non-surgical treatments are much safer,” he said.

The major advantages of EVLA, as Chapman-Smith said, were patients remained conscious throughout the procedure and could resume routine activity on the same day.

Chapman-Smith is a Foundation Fellow of the Australasian College of Phlebology, a member of the Australia and New Zealand Society of Phlebology and a member of the American College of Phlebology. He has also performed nearly 7,000 sclerotherapy to treat varicose veins since 1998.

Foam sclerotherapy is a procedure whereby a chemical and air are injected into the varicose veins to treat them.

The EVLA procedure will cost an average of RM6,500 for each leg, including foam sclerotherapy to treat varicose veins on calves.