Dr. Marc LEFEBVRE-VILARDEBO

113, avenue Charles de Gaulle

92200 NEUILLY SUR SEINE

tél. : 01 47 47 22 11

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Varicose veins, varicules and spider veins are aesthetically unappealing and present an embarrassing problem for women.
Spider, varicule and varicose veins are the result of the blood vessel expansion of originally healthy veins. These veins come in different sizes, and are found in different areas. Telangiectasis (Spider Veins) are located in the skin, while varicose veins are located in the fat a bit deeper.

 

All three types of varicose problems can be found on the same leg, or appear alone. They can also cause local pain or discomfort.

 

However, most of the discomfort (heaviness, irritation, cramps, swelling) is related to our modern life-styles. Gravity pushes blood down. Blood does not circulate back up without muscular contractions. The long periods in which we shuffle about or remain seated increase these symptoms called stasis.

 

Spider veins and varicules are not dangerous, but they are not attractive. They will not become varicose veins. Varicose veins never develop in the deep venous system (between muscles), but they can develop complications.

 

Severe complications develop according to the size of the vein, and they include: spontaneous blood clots, haemorrhaging and easy bruising. Chronic complications, such as pigmented dermatitis, oedemas, and sores are often linked to the amount of time varicose veins are left untreated.

 

Unfortunately there is no miracle treatment for the effective removal of varicules and telangiectasis. Whatever method is chosen, it must be preceded by an ultrasound exam in order to rule out the presence of other varicose veins that must be treated immediately.

 

Most often veins are treated using sclerotherapy. The vessel is injected with an irritant which causes it to retract and then disappear (chemical destruction or sclerosis). The injections are performed in the office in one session. On some occasions these varicose veins present the added complication of cutaneous pigmentations.

 

If sclerotherapy is unsuccessful, if the patient is allergic to one of the sclerosis chemicals, or if spider veins are too thin, laser treatment can be the solution. The laser uses heat to destroy the vein through the epidermis. Laser treatment, which takes place in the office, is more expensive because of higher equipment costs. One of the possible side-effects is an excessive whitening of the skin (depigmentation).

 

Schlerotherapy and laser sessions usually last between 15 and 30 minutes and do not affect a person's social life or their ability to work.

 

In those rare cases in which telangiectasis and varicules are present and resist traditional treatment methods, it is possible to combine microphlebectomy (stab avulsion for the removal of varicules) with schlerotherapy. This method can provide real improvement. Treatment is performed under local anaesthesia in the office. Shuffling should be avoided for 3 to 4 hours after treatment.

 

Varicose veins are the result of vein disease, a veritable chronic pathology which degrades the vein walls. Visible varicose veins are really just the tip of the iceberg. Underneath lies a vast network in which the blood circulates from bottom to top, which is basically antiphysiological. These invisible prolongations require a thorough examination of the veinous system. A more thorough clinical exam and sonogram examination will bring about better treatment. There is no one standard treatment: each varicose structure requires its own ideal strategy, and treatment methods are just the technical part of this strategy.

 

Techniques which have been used over the last 100 years, such as sclerotherapy and stripping, have proved themselves to be relatively inefficient: there is a 50 to 65% recurrence rate in 5 years. The most recent studies have shown us that varicose branches are the most important part of the network, and not the saphenous vein trunks as was once thought. This revolution in therapeutic concepts goes against the traditional methods which are still in use today... just out of habit! Newer and more conservative strategies centering on saphenous veins have been developed. They were recently approved by a group of French specialist surgeons and given the name the ASVAL method (selective ablation of varicose veins under local anaesthetic).

 

Despite the difference in networks from one patient to the next, the common factor in all treatments is the extensive ablation of visible or invisible branches. Saphenous veins are preserved, in part or in whole, when exam results allow for it. Branches are removed through invisible incisisions (1 to 3mm) over a period of 2 to 6 months. If necessary, saphenous veins are gently removed without side-effects, or destroyed on site with a laser.

 

All these interventions are performed under local anaesthesia, either in outpatient surgery or in 24 hour hospitalization depending on the size of the network to be treated. Patients can walk in the hour after surgery.

 

Because recovery is fairly simple, the patient can usually get back to an active social and family life on the second day after surgery, and return to work sometime between the 2nd and 5th day depending on the case. However, wearing special support garments such as tights or socks is crucial. 

 

Cosmetic sclerotherapy for varicules and spider veins may be necessary 2 to 3 months after surgery. But even after treatment and without the appearance of residual varicose veins, a patient is never completely cured! Her condition is stable and requires yearly examinations.