OTHER MINIMALLY INVASIVE MODERN TECHNIQUES
In about 20-30% of cases of incontinent saphenous veins, these are too dilated and compromised to preserve them: and this is even more frequent when the history and progression of the disease are longer.
In such cases we have several alternatives for the ablation of the saphenous vein:
1) the minimally invasive surgical technique by invagination stripping on wire
2) endovascular occlusion with laser or radiofrequency
3) ultrasound-guided foam sclerotherapy
These techniques are flanked to ASVAL and complete it by respecting the principles of minimal invasivity, selectivity (the saphenous vein is removed only in the deseded tract safeguarding it as much as possible to be used for by-pass, for which, it should be noted, are to be used still sufficiently intact saphenous veins), the sweetness of the surgical act, the local anesthetic (sometimes with a light sedation, too ), in Day-Surgery and rapid postoperative recovery.
To achieve these kinds of techniques you need an accurate preoperative mapping with Doppler ultrasound and, personally performed by the surgeon, who can help you understand perfectly and better address all phases of the intervention.
In order to realize these kinds of techniques it is necessary an accurate preoperative mapping with Doppler ultrasound, personally performed by the surgeon, that enables to perfectly understand and to better face all phases of the intervention.
1) the stripping by invagination on wire is, compared to the traditional stripping, an elegant technique that requires more dexterity, that can minimize bruising and consequent post-operative pain; it requires an incision in the inguinal fold of a few centimeters and another one at the leg of less than one centimeter, for which sutures are used internal resorbable wires.
2) The endovenous laser (using a procedure known ELVeS: Endo Laser Vein System) and radio frequency (using the procedure called CLOSURE FAST) allow you to release thermal energy which causes the fibrous retraction of the vein wall and the consequent occlusion; those procedures are realized by the introduction of a thin catheter into the saphenous vein through a needle without major incisions. The technical-scientific research has led to progressively improving the physical characteristics of the laser and radiofrequency waves, reducing the problems mainly consisting of hematomas (for vein perforation ), skin retractions and discoloration, annoying and persistent pain along the course of the saphenous vein (for excessive emission of heat at the skin).
These techniques have mainly limitations in their application for tortuous and / or superficial course and excessive dilation of the saphenous vein, higher costs, not always reimbursed by health insurances.
3) The ultrasound-guided foam sclerotherapy consists of the injection into the saphenous vein of a foam composed of a sclerosing liquid and air, under ultrasound guidance, which leads to occlusion through a chemical thrombophlebitis. It is a minimally invasive technique, inexpensive and outpatient, however, requires repeated sessions; there are still some doubts about safety (cases of embolism have been reported and non-infrequent episodes of discomfort may occur mainly in older patients) and furthermore the rate of aesthetic skin complications is more important than surgical techniques.
Naturally, the above described techniques for the ablation of the saphenous vein, must be associated with the removal of varicose collateral, usually in the same surgical time, through phlebotomy.