New methods of treating varicose veins

Bulging leg veins have plagued Heidi Frantz since the Woodville woman had her 10-year-old son, Mason.

Despite the worsening pain, the 33-year-old Pemberville Elementary teacher decided against varicose vein surgery the first time she consulted with Toledo vascular surgeon Dr. Steven Gale. Mrs. Frantz overcame her fears, though, and Dr. Gale recently performed surgery using radio-frequency energy to heat and seal the damaged great saphenous vein in her left leg.

"It was not bad at all," said Mrs. Frantz, a breast cancer survivor. "It's like all those fears for nothing. To think, I canceled out once, and it wasn't bad at all."

While varicose veins for some people are primarily a cosmetic concern, severe cases afflict 25 million to 40 million with pain and swelling. Valves in varicose veins are either damaged or missing, causing them to remain filled with blood instead of keeping it flowing back to the heart.

Pregnancies, standing for long periods, aging, and obesity are among factors that increase risks for developing varicose veins.

"Heredity is the biggest risk factor," Dr. Gale said. "It's very, very, very common."

"The vein stays in place, but it's glued closed, or welded," Dr. Gale said. "They get up and walk around right after the procedure."

Before 1999, Dr. Gale said, vein stripping was the standard treatment for varicose veins. That procedure, used since the 1930s, called for a damaged vein to be pulled out of the leg with a tool threaded through it.

Toledo vascular surgeon Dr. Greg Kasper said patients took three to four weeks to recover from vein stripping, which is more painful than ablation. One of his ablation patients jogged four miles four days after surgery, which is uncommonly fast but demonstrates how much easier recovery is, he said.

"It's pretty rare nowadays to find somebody who's not treating these veins that way," Dr. Kasper, chief of vascular surgery at Mercy St. Vincent Medical Center. "Nowadays, patients within a week, two weeks, are pretty much back to normal."

Dr. Kasper said he has used both radio-frequency and laser ablation for at least a decade, and he prefers laser. There is a small chance the vein will reopen with radio-frequency, although there can be more discomfort with laser because the heat is higher, he said.

The company that developed the catheter using radiofrequency energy Dr. Gale uses, VNUS Medical Technologies Inc., improved the device a few years ago, Dr. Gale said. His office, VeinSolutions, which has an operating room, has performed about 5,000 radio-frequency ablation surgeries, he said.

Potential side effects include blood clots, which happen in less than 1 percent of cases, Dr. Gale said. There also could be some bleeding, temporary numbness, or infection, he said.

"These complications are extremely rare," Dr. Gale said.

Typically, Dr. Gale performs radio-frequency ablation on the great saphenous vein, which runs close to the skin on the inside of the leg. Other veins take over if varicose veins are closed off or otherwise treated, he said.

Seven symptoms Dr. Gale looks for in surgical candidates include aching, fatigue, heaviness, burning, itching, cramping, and swelling, he said.

Mrs. Frantz of Woodville, who also has a 2-year-old daughter, Mylie, said before surgery that the pain in her left leg was far worse than her right. Both of her parents have varicose veins too, she said.

"I'm a teacher, so I'm on my feet a lot," said Mrs. Frantz, who teaches second grade. "By the end of the day, they're aching."

On Mrs. Frantz's left leg, a branch of the great saphenous vein came behind her knee, where it was gnarled. Ultrasound was used to guide Dr. Gale, who numbed her skin and made an incision near her knee for the catheter to go into her vein up to the groin area.

"It's kind of like a carpenter: You measure twice and cut once," Dr. Gale remarked while plotting the vein's path.

Replied Mrs. Frantz: "I agree with that thinking."

Part of the vein was twisted too, so Dr. Gale inserted a flexible wire for the catheter to pass over. Dr. Gale injected an anesthetic solution in Mrs. Frantz's vein several times to numb it, which he said typically is the worst part of the procedure.

After completing the numbing so Mrs. Frantz would not feel the heat in the vein, the tip of the catheter powered by radio-frequency energy was heated to 120 degrees Celsius. Dr. Gale heated a vein section for 20 seconds to shrink and close it before pulling the catheter back to the next section, taking about two minutes to complete the procedure.

Ultrasound is essential to ablation, Dr. Gale said.

"It's a very ingenious invention," he said of the radio-frequency catheter.

Contact Julie M. McKinnon at:

jmckinnon@theblade.com

or 419-724-6087.