Frequently asked questions in vascular medecine

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Frequently asked questions in vascular medecine

My-varicose veins-info.fr answers your questions.

Take a look at the most frequently asked questions in vascular medecine:

Doctor, if you remove my veins, will it impair my circulation?
The veins we remove only account for a small part of the venous return. The most part is done by the deep veins which are never removed. Besides, the varicose veins that we remove aren’t healthy veins, and they no longer function properly. By getting rid of them, the venous return is improved.
Doctor, what is the exact function of the veins you are going to treat?
When they are healthy, the two main veins of each leg, called great saphenous vein and small saphenous vein, bring 10 % of the venous blood back up to the heart. The 90 % left is brought back up to the heart by the deep veins which generally never present with varicose veins. In case of heart attack (myocardial infarction) or peripheral arterial disease, the great saphenous vein might be removed to be used as graft material: this is only possible if the great saphenous vein is healthy or little damaged. Therefore, we thoroughly interrogate our patients to find out if they have any cardiovascular background.
Doctor, if my veins are faulty, and I refuse to have them removed, what could be the risks?
If you wear compression stockings on a daily basis, you’re most likely to be fine. Compression stockings should be at least a class 2. Otherwise, the chronic venous disease will worsen and you might be at risk of a blood clot in a superficial varicose vein (phlebitis) or your skin condition might deteriorate leading to a venous ulcer (a spontaneous wound that appears generally around the ankle and is very slow to heal).
Doctor, I once had a deep venous thrombosis. Can I still have my varicose veins removed?
Yes, you can, but we will take more precautions regarding the risk of thrombosis that can occur after any surgery. So, if you are at high risk for venous thrombosis, we will choose the treatment that best suits your medical profile.
Doctor, I was told treating varicose veins was useless because of the high recurrence rate?
Indeed, recurrence of varicose veins is well documented and depends upon the technique that is applied. For conventional surgery (stripping), the recurrence rate is estimated at 25 % after 10 years. For echosclerotherapy, the recurrence rate is estimated at 25-30 % after 10 years. For laser and radiofrequency ablation, the recurrence rate is estimated at 5-10 % after 10 years. The recurrence rate of varicose veins is, therefore, less significant with the newest techniques.
Doctor, are there any contraindications to the treatment of varicose veins?
With the newest techniques like laser or radiofrequency ablation, there are barely any medical contraindications. On the contrary, the tumescent anesthesia, which is a local anesthesia, allows to treat patients that have been turned down for general anesthesia. Interruption of anticoagulant medicine like warfarin, fluindione or acenocoumarol (COUMADINE®, PREVISCAN®, SINTROM®) isn’t required, as well as for antiplatelet medication like KARDEGIC®, PLAVIX®, EFFIENT ® and BRILIQUE®. Regarding foam echosclerotherapy and microsclerotherapy, any history of deep venous thrombosis or superficial venous thrombosis must be duly noted, so that we can take the necessary precautions, and start a preventive treatment with subcutaneous heparin injections. Pour l’échosclérose veineuse à la mousse et la microsclérose, on s’attache, pendant la consultation avant le traitement, à rechercher des antécédents de phlébite (thrombose veineuse profonde) ou de paraphlébite (thrombose veineuse superficielle). Si c’est le cas, nous serons plus prudent avec ce type de traitement. Dans certain cas un traitement préventif par injection d'Héparine est préconisé.
Doctor, what medical professional should I go to to discuss laser or radiofrequency ablation?
You simply go to your general practitioner who will refer you to the most competent specialist in your area. Generally, specialists are vascular physicians, angiologists, or vascular surgeons. If you are already followed by a vascular physician/angiologist, he/she will give you all the necessary information.
Doctor, if I have problems with my veins, does it mean that my daughter will have the same problems?
Your daughter is actually at risk for varicose veins if you have varicose veins yourself. But this is not a certainty. The varicose vein gene isn’t necessarily passed on from parents to children and the transmission process of the gene can be incomplete. It is considered that when the father is the one affected by varicose veins, the risk of transmission to the children is higher.
Doctor, should I wait until I no longer want to have children before getting treatment for my varicose veins?
With the traditional methods of treatment, waiting was indeed wiser because the recurrence risk was high. With laser or radiofrequency ablation, the decision of treating is made depending upon the level of discomfort that you experience and not the future pregnancies since the recurrence risk is much lower. Thus, if you experience any discomfort with your varicose veins, you can get a treatment even before being pregnant.
Doctor, can men have varicose veins?
Of course they can. Venous insufficiency is a hereditary disease that affects men as well. Women are more often affected because, in addition to the hereditary factor, they also have to deal with pregnancies, contraception, and menopause that spawn hormonal variations responsible for varicose veins worsening.
Doctor, my veins have been unhealthy for 20 years, is it worth treating them now?
It depends on the level of discomfort that you experience (painful legs, tired legs, restless legs, cramps, unsightly varicose veins, risk of venous ulcer). The newest techniques like laser or radiofrequency ablation and echosclerotherapy can simply and effectively relieve your symptoms. It’s never too late to take care of your legs and of your varicose veins.
Doctor, can you remove all of my varicose veins?
Newest techniques like laser and radiofrequency ablation, foam echosclerotherapy, Microsclerotherapy with magnifying lamp or transillumination allows us to treat all types of varicose veins whatever their size. We generally start by treating the largest veins, and then we progressively move to the tiniest. However; in the case of extensive spider veins, it might not be possible to remove each and every small vessel. Therefore, we will discuss during our first consultation what result can reasonably be expected.Le traitement débute par les plus grosses veines puis progressivement nous traitons les plus petites. Par contre, lorsque les varices sont très diffuses, il est utopique de vouloir traiter l'ensemble des varices visibles. Ainsi, lors de la première consultation nous déterminons ensemble ce qu'il est envisageable de faire disparaître.
Doctor, what is the best time of year to get my varicose veins treated?
When the only treatment option was conventional stripping, we used to advice against getting the surgery in the summertime because of the need to wear compression stockings afterwards, and because of the risk of maceration and infection of the scar located in the groin. With the new techniques, the procedure can be performed all year round, especially when it comes to laser and radiofrequency ablation. These techniques are less invasive and there is very little bruising (some patients don’t even have a mark after the procedure). The need to wear compression stockings can be reduced to only one day, depending on your tolerance. Finally, since there is no downtime, and no sick leave, you don’t have to plan ahead, and you can resume your professional activities upon leaving our facility. Avec les nouvelles techniques, notamment le LASER et la RADIOFREQUENCE, on peut intervenir toute l’année. En effet, avec ces nouvelles techniques peu invasives, il y a peu d’ecchymoses post-opératoires (certains patients n’ont même aucune trace d’hématome dans les jours qui suivent l’opération). Le port de chaussette de contention en post-opératoire est recommandé en fonction de votre confort et peut être réduite à 1 jour. Enfin, comme il n’y a pas d’arrêt de travail, vous n’avez pas à vous organiser longtemps à l’avance pour votre activité professionnelle.
Doctor, how does laser or radiofrequency ablation work?
Laser as well as radiofrequency both deliver heat to destroy the inner wall of the vein. The vein isn’t removed per se, like with conventional stripping, but is gradually absorbed into surrounding tissues, after being sealed by the heat. The complete elimination of the vein takes a few months, and is pain-free. Sometimes, the resorption isn’t complete, and the vein is replaced by fibrous tissue that only an ultrasound examination can reveal.
Doctor, how long does laser or radiofrequency procedure take?
Laser or radiofrequency procedure takes approximately 1 to 2 hours, depending on the amount of saphenous veins that need to be treated. You will stay approximately 2 to 3 hours at the medical facility overall.
Doctor, is laser or radiofrequency procedure painful?
Tumescent anesthesia is a local anesthesia that involves subcutaneous injection of saline and local anesthetic on the targeted area. This step might be slightly uncomfortable. Other than that, the procedure by itself, meaning the moment when the optic-fiber catheter delivers laser or radiofrequency energy, should remain totally painless. Sometimes, patients report a mild burning sensation or a slight pulling but they never experience any pain. In case the patient signals an abnormal sensation, the procedure is immediately stopped to avoid any damage, mainly nerve damage. This is made possible because the procedure requires no general anesthesia so that the patient can report back anytime throughout the procedure, for maximum safety. For maximum comfort, painkiller medication is prescribed before the procedure, and, in case of need, antianxiety medication can be added. During the procedure, if you feel stressed, laughing gas (a mix of nitrogen protoxide and oxygen) will be at hand, and will be administered by your physician through a breathing mask to help you relax.Pour un maximum de confort vous prennez un antidouleur avant la procédure, voire un relaxant, si vous êtes sujet(te) au stress. Lors de la procédure nous vous proposont de respirer un gaz relaxant (un mélange de protoxyde d'azote et d'oxygène connue sous le nom de gaz hilarant).
Doctor, I think I’d prefer to be put under so that I don’t see anything?
We prefer you to be conscious so that you can guide us by telling if there is any area that becomes painful during the procedure. Besides, no general anesthesia means that you will be able to leave the facility and go back home right after the procedure. You won’t need anybody to drive you home. Finally, local anesthesia is associated with less side-effects than general anesthesia.
Doctor, will you be able to treat all of my varicose veins at once?
It will depend on the quantity of varicose veins we need to remove, on their size, and on their location. Your wish will also be taken into account. Most of the time, comprehensive treatment requires several sessions. We treat the largest veins first, and then we move on to the smaller ones. Sometimes, the treatment of one large varicose vein will trigger the collapse of its tributaries. Sessions are scheduled at least every 3 weeks.
Doctor, could these different treatments leave marks on my skin?
There is minimal scarring and no marks left with procedures like laser or radiofrequency ablation (it sometimes happens if the vein is too close to the skin). Sclerotherapy and foam sclerotherapy are more likely to leave a transient brown discoloration on the treated area for several weeks after the treatment, sometimes longer up to a year before fading away. To prevent this from happening, we are very careful, we always use the lowest dosage of sclerosants in the first sessions and gradually increase the dosage. Besides, we advise you not to go in the sun for 1 month after the procedure. Les traitements par sclérose et notamment ceux avec la mousse, donnent plus fréquemment des traces qui vont mettre plusieurs mois voire plus de 1 an avant de s’estomper. C’est pour cela qu’avec ces traitements nous sommes progressifs et prudents dans les doses et vous recommandons de ne pas exposer au soleil la zone traitée pendant 1 mois.
Doctor, since laser and radiofrequency deliver heat to the vein, is there a risk of skin or muscle burn?
Before delivering heat energy, tumescent anesthesia is performed, allowing to protect the surrounding tissues: skin, muscles, nerves, but also the surrounding vessels around the treated vein. Tumescent anesthesia consist of a subcutaneous injection of a large volume of saline mixed with local anesthetic all along the vein that will receive laser or radiofrequency energy.
Doctor, I have a pace maker, is it a problem in the event of laser and radiofrequency ablation?
There is absolutely no interaction between your pace maker and our laser or radiofrequency generators.
Doctor, why do you use foam to treat certain types of varicose veins?
Foam echosclerotherapy involves injecting a special foam into your veins whereas sclerotherapy involves injection of the same solution but in a liquid form. Foam is made by mixing the sclerosant with air to obtain a frothy solution. Foam has been in use for more than 10 years now, throughout the world. Foam makes the treatment of large varicose veins more effective than its liquid counterpart. Foam is even as effective as surgery for varicose recurrences.
Doctor, can the foam travel up to my heart or to my brain?
The sclerosing agent, whether in its liquid or foam form, is deactivated as soon as it gets in contact with the blood. The sclerosant only works in the area where it has been injected. It has no sclerosing effect on blood vessels in the heart or in the brain.
Doctor, I have drug allergies, is it a problem?
During our first consultation, a thorough interrogation allows us to collect your medical and surgical history, including your allergies, so that we refrain from using any medication or material you might be allergic to (iodine, latex, lidocaine, sclerosing agent, Band-Aid...)
Doctor, I’m pregnant. Is it still possible to perform sclerotherapy for varicose veins?
No. Sclerotherapy is not recommended during pregnancy. Besides, the hormonal modifications during pregnancy is responsible for the appearance of more varicose veins, which are susceptible to fade after delivery and breast-feeding. Consequently, we recommend wearing class 2 compression stockings from the end of the first semester on. After delivery, we wait six months before considering sclerotherapy.
Doctor, will I have bandages after the procedure?
In case of laser or radiofrequency procedure, strips will be placed over the wounds allowing you to shower. Strips work like a closure system, so that there is no need for stitches, and are waterproof. Strips will fall off by themselves within a few days. In case of sclerotherapy or foam echosclerotherapy, we put a cotton pad and a Band-Aid that you will only need to keep for about an hour. Compression stockings will be worn only if you tolerate them and feel comfortable wearing them.
Doctor, will I have scars on my legs or on my thighs after the procedure?
It depends on the type of procedure that we will perform. With laser or radiofrequency ablation, or with foam echosclerotherapy there is virtually no scar. With phlebectomy, minimal scars of 1 to 2 mm will be noticeable for a few weeks, and then will disappear completely. With conventional stripping, there will be a definitive scar of 3 to 6 cm in the groin area.
Doctor, can I resume my daily chores and go back to work rapidly after the procedure?
Yes. You can go back to work upon completion of the procedure. There might be some minimal discomfort, like some pulling sensation in the thigh or the leg, but there is need for a sick leave. There is no downtime after a laser or radiofrequency procedure.
Doctor, will I have to wear compression stockings or bandages after the procedure?
It depends on how you tolerate them. After a laser or radiofrequency procedure, we generally recommend wearing compression stocking until the end of the day. After that, if you feel comfortable with compression stockings, you can go on wearing them. After foam sclerotherapy, compression stockings will only be required in case of mild discomfort after the injection, and only for 8 days.
Doctor, I have planned a trip 4 days after a laser or radiofrequency ablation. Will I be able to leave?
We will advise against it. Even though the new procedures are simple and effective, they remain medical procedure and shouldn’t be taken lightly. Complications can always occur, and we advise you against long trips up until the first follow-up visit that takes place 8 days after the procedure. You can reach us anytime on our cellphones in case of need.
Doctor, will I still experience pain in my legs after the procedure?
If we remove the saphenous veins responsible for the symptoms you experienced, there is no doubt that you will be relieved. Sometimes, there is some remaining pain or discomfort in situations where the venous system is overexerted: standing for a long time, scorching heat, and long rides in car.
Doctor, will I still experience heavy legs after the treatment of my varicose veins?
If we remove the faulty vein responsible for your symptoms, you will certainly be relieved. On the other hand, you won’t be totally relieved if varicose veins aren’t the only cause of heavy legs, which is the case for example with lymphedema.
Doctor, will I have to wear compression stockings after the treatment of my varicose veins?
You won’t need to wear compression stockings on a daily basis. However, in certain situations like long rides in train, car, long flights, or standing for a long time, you might feel the need to wear them.
Doctor, will there be remaining varicose veins after a laser or radiofrequency procedure?
Laser or radiofrequency procedure involves closure of the main varicose veins at the origin of the venous disease, which are the saphenous veins. Most often, they are not visible under the skin. We generally wait for a few weeks after a laser or radiofrequency procedure before implementing any complementary treatment to the remaining veins because they may spontaneously collapse.
Doctor, will I have to see you on a regular basis to treat my varicose veins?
It depends on the cause of your varicose veins, their size and their extent. During our first consultation, we will perform a clinical and an ultrasound evaluation so that we can explain to you the different steps of your treatment and how much time it will take.

Disclaimer:
Informations provided on this website are not intended as and does not constitute medical claims or advice, and should therefore not replace the advice of trained medical professionals and healthcare service providers which are the only persons capable of making the right diagnosis and establish the appropriate treatment. This informations must not be used for diagnosis, treatment, prevention, or cure of diseases or other medical conditions for oneself or others. People with health issues and medical conditions should seek the assistance of properly trained healthcare providers.

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