Varicosity is one of the most common reasons to seek a phlebology or aesthetic consultation. Varicosity is the result of a permanently dilated micro-circulatory venous network on the derma level (thick layer of living tissue below the epidermis). They can be red (0,1 to 1mm) or bluish (1 to 2mm) and are organised in layers, bouquet/clusters, filaments or red sock patterns. Superficial venous deficiency is especially widespread among women (due to pregnancy, contraception or hormonal impregnation). Several factors are also in cause such as family genetics, inactivity, constipation, obesity and certain professions where people remain on their feet for a long time, and being often exposed in the sun or a heat source.
Consulting women often complain about different symptoms such as, leg or calf heaviness worsening as the day goes by, during their periods, or during summer. Oedemas, cramps or pain along the veins can also be a reason to seek treatment. Aesthetic embarrassment is also a very common reason to consult.
When a patient comes to the clinic, she will have to answer some questions concerning her different symptoms, her medical history and if she is already under treatment. Afterwards, a medical examination will be done on a phlebology table, locating the varicose veins by palpation along the great and small saphenous veins. We also look for oedemas near the foot or the ankle, along with trophic disorders (ulcers, dermatitis, eczema, ulcer scars, pigmentation). A Doppler ultrasound enables us to visualise the venous network, to analyse the blood flow and to establish a comprehensive venous cartography. It will check if the deep veins work well and will superficially explore the saphenous veins providing information about their continence and measuring their arches (near the groin). It is then possible to determine a treatment protocol indicating the therapeutic positioning.
The Tessari method producing sclerosing foam will be used. It consists of injecting a sclerosing agent in a varicose vein which irritates the wall and provokes an inflammation. A sclerosis appears (a clot sticking to the wall), then it transforms into a fibrous scar on the vein wall and is then absorbed. Most of the time, several sclerosis sessions are needed over the course of a few weeks. It is recommended to stay out of the sun after the session.
Two methods are possible:
This endovenous saphenous core obstruction technique is done through endovascular delivery under a local anaesthetic using tumescent fluid. Ultrasound assisted, the device is inserted and pushed to the arch, then the fibre is slowly removed along the varicose vein. Laser photocoagulation is to be found all along the varicose vein, compression is then applied. Apart from a few haematoma and frequent induration, there are no consequences. There is very little risk that nerves are touched.
The conventional technique consists in a crossectomy combined with stripping of the great and/or the small saphenous vein. With the emergence of less invasive techniques, phlebotomies as outpatients under local anaesthetic are often associated with foam sclerosis and the results are excellent.