Vascular surgery

Varicose veins represent a very frequent disease: it is estimated that up to 56% of men and 60% of women can suffer from significant alterations in venous drainage, resulting in blood stagnation in the leg.

This stagnation leads to an increased pressure inside the veins, with consequent rupture of capillaries, dilation of the so-called “varicose” veins, pigments deposit in the skin, inflammation and possible chronic skin lesions or “skin ulcers”, which can affect up to 2% of the population, up to the possible blood clot, commonly called “thrombosis”.

Given the multiple aspects of the disease and the different degrees of severity, it is necessary for the patient to contact a specialized Vascular Service. Even during the initial stage of venous disease, i.e. in the presence of unsightly capillaries, it is fundamental to provide a correct diagnosis. In fact, more than 25% of cases, apparently only unsightly, actually present an underlying venous condition, worthy of an appropriate evaluation.

Who should schedule this appointment?

This service is recommended for patients with at least one of the following conditions:

• pain, cramps, heaviness, fatigue, swelling, itchiness, tingling, warmth, leg restlessness
• visible capillaries
• dilated veins
• suspicion of phlebitis with the presence of hardened, red and painful veins
• alteration in color and consistency in one or more parts of the leg
• skin lesions on the leg that are not healing within 2 weeks.

Preservation of the saphenous vein

At MediClinic it is possible to perform a very innovative treatment, recognized worldwide and unique in its kind: the conservation of the saphenous vein. In fact, a vein affected by chronic venous insufficiency can always be “repaired” instead of being “destroyed”.

From a strategic point of view, this option that can greatly improve the patient’s life: in fact, it is scientifically proven that this type of treatment has a significantly higher percentage of clinical resolution compared to the removal/ablation.

Instead of the more classic destruction, the restorative treatment closes the affected “taps” of the venous system, redirecting the flow in alternative and physiological ways, thus restoring an appropriate drainage.

Surgery can still be considered a therapeutic option in clinical cases characterized by specific valve incompetence. However, this type of minimally-invasive surgery is performed under local anesthesia and it is always aimed at saving the saphenous vein.

The condition can then originate in the pelvic abdominal vessels, causing abdominal heaviness, flank pain, pain during sexual intercourse, blood and changes in urination. Defined as “female varicocele”, it is one of the main causes of abdominal pain in women, and it needs to be promptly identified to limit the development of the disease.

Minimally invasive treatments

The adopted surgical techniques can be summarized in two main categories: traditional and modern endovascular procedures. The traditional ones are represented for the majority of cases by the ligation and stripping of the affected saphenous axis (large or small saphenous vein). The endovascular techniques developed in the last 10 years represent innovative procedures in the vascular field. They can be performed in the clinic, under local anesthesia. They are not very painful, they involve a very small number of incisions, favouring a rapid recovery: for these reasons these procedures are defined as minimally invasive. The main minimally invasive techniques adopted in Italy are the laser technique and the radio frequency technique.

Minimally invasive laser treatment

This technique involves the occlusion of the affected saphenous vein and not its removal. The procedure consists of introducing a special catheter into the vein, through a small incision, which, through the transmission of laser light, obtains its occlusion. The obliterated vein will be completely reabsorbed by the body within a few months. This technique is called minimally invasive as it requires mini-incisions, very few stitches and is performed under local anesthesia. Post-operative pain is very modest and with increased postoperative comfort compared to the traditional stripping technique. As not all patients can undergo this type of treatment, only expert surgeons can accurately evaluate the individual clinical case and give indication for surgery. The real advantage of this method is the low level of pain, almost invisible scarring and a rapid reprisal of normal activity. Therefore it is particularly suitable for people with intense professional activity but at the same time, thanks to its mini-invasiveness, it can be considered the best choice for adults and elderly patients as well as for young women as the aesthetic result is excellent.

Minimally invasive radio frequency treatment

The technique is comparable to the laser treatment, but the substantial difference lies in the heat generator which in this case is a microprocessor that produces electromagnetic waves. The aim is to produce the gradual occlusion of the vein that disappears and will be completely reabsorbed within a few months. The advantages of this technique consist in its rapidity: the procedure lasts approximately 15 minutes, it can be performed in the clinic and the patient can be discharged within a couple of hours from the procedure.

Ultrasound Guided Sclerotherapy

With this technique, the specialist performs an ultrasound-guided injection with special drugs of the affected vein. The procedure can be performed on an outpatient basis and one session normally lasts approximately 5 minutes. The patient must wear an elastic stocking for a couple of weeks with no particular restrictions. This treatment is particularly indicated in varicose veins of modest caliber and in elderly patients since it is a very simple and painless technique.

Endovascular treatment with organic glue (Cyanoacrylate)

This method was recently introduced and it consists of the ultrasound-guided injection of a biological glue inside the affected vein through a special catheter. The treatment is quick and painless. It is performed on an outpatient basis, with no need for anesthesia, and it does not require the use of an elastic stocking. Patients can immediately resume their normal activities.

Mechanochemical Endovenous Ablation with Sclerotherapy (MOCA)
This technique has recently been introduced in Vascular Surgery. It involves the damage to the internal part of the vein through a rotating catheter and the concurrent injection of a sclerosing drug. Being of recent introduction the results do not allow a correct evaluation. The costs are higher than the laser and radio frequency treatment.

Traditional techniques

Surgical removal of saphenous veins (Stripping)

The stripping is the most used traditional technique for the treatment of varicose veins. It consists in performing an incision at the level of the groin for the isolation of the great saphenous vein or at the level of the popliteal fossa for the isolation of the small saphenous vein. The vein is cannulated with a probe called “stripper” which is released from the skin through a distal counter incision. The removal of the saphenous vein or “stripping” allows the affected varicose vessel to be removed with the improvement of symptoms. To complete the stripping, multiple incisions are made on the skin surface through which the collateral varicose veins are removed. The anesthesiological technique mainly adopted during this procedure is general or spinal anesthesia. Compared to endovascular surgery, this technique is decidedly more traumatic, painful and it does not offer great aesthetic results. It is usually recommended for the most serious cases, where there are large veins, which have arisen for many years.

Selective removal of varices (Phlebectomy)

In many cases, the color doppler ultrasound can document the presence of protruding varicose veins visible to the naked eye under the skin: these are branches of a healthy saphenous trunk. In these cases, it is possible to perform the removal of these veins to prevent the clinical deterioration of the patient and to preserve the healthy saphenous trunk. The preferred procedure is called phlebectomy which consists in the removal of the sick varicose veins through a small incision under local anesthesia. This procedure can be performed in combination with the treatment of the main saphenous axis and it is normally performed under local anesthesia.

Varicose vein treatment with Safena conservation (CHIVA)

CHIVA is the French acronym that stands for conservative treatment of venous insufficiency as it does not include the removal of the affected vein but its binding at specific points identified at the Color Doppler ultrasound examination. This technique is now outdated because it is burdened by a high rate of recurrence, with varices that reform early.

Why choose MediClinic?

MediClinic’s Phlebology Surgery team has performed more than 60,000 treatments using all the main techniques from laser, radio frequency, biological glue, to ultrasound-guided sclerosis, in addition to traditional stripping and phlebectomy surgeries. The competence of the professionals who are part of the team is documented by their constant participation in national and international conferences as speakers and by a whole series of training courses which, for more than 20 years, have been attended by phlebologists from all over Italy. All therapeutic choices are made after a series of accurate instrumental tests, and in line with the standards defined by the most important phlebological societies at national and international level.

To ensure the delivery of appropriate health services to the patient, MediClinic specialists use cutting-edge technologies, diagnostic structures and therapeutic techniques. The latest generation equipment contributes to achieving optimal therapeutic results. In the same way, the modernity of the structures in which the therapies are performed is a guarantee of safety for the patient. The high level of collaboration between the Vascular Surgery team and the other MediClinic teams such as Angiology, Diagnostic Imaging, Orthopedics, Physiatry, Physiotherapy, Podiatry means that surgery is part of an integrated health path consisting of various therapies, all aimed at solving the patient’s problem with a holistic approach focused on its root causes. The team follows precise ethical principles aimed at offering an excellent treatment.