The Course of Time: Varicose Veins Through the Ages

Evolution is a wonderful thing, but varicose veins are one associated aspect that humans could have happily lived without. Unfortunately, the ability to stand and walk on two legs came with unsightly and unhealthy consequences. But if you think vanity associated with the current “selfie age” triggered a deeper dislike of such visual flaws, think again. Humans have been self-conscious about their varicose veins for thousands of years. And as far as we know, treatments have been around — some more rudimentary than others — since 1550 BCE. We’re fortunate these days to have access to non-invasive medical techniques, but imagine for a moment, living centuries ago with varicose veins — what would you have done, and how would you have been treated? If you think you’re unlucky to have varicose veins, read on to understand the history of varicose veins and find out what people went through before the dawn of modern medical procedures. You might just see your plight in a different light.

 

Chances are, you stumbled upon this blog while researching your own venous situation. Of course, when you have a condition, it pays to know as much about it as you can, for your own peace of mind. So for a moment, let’s briefly revisit the basics: What are varicose veins? They are:

  • Abnormally large, tortuous veins that typically appear in the legs;
  • A cause of aching, swelling, itching, leg heaviness, and skin ulceration

 

So how far have humans come in the research and treatment of varicose veins? And what did people face when they needed treatment? The earliest record of varicose veins is in the papyrus of Ebers, written 1550 BCE, where the author described them as “tortuous and solid, with many knots, as if blown up by air”, and recommended people leave their veins in place.

Ebers Papyrus
Ebers Papyrus – 1500 BC

 

The first illustration of a varicose vein dated from 400 BCE, a votive tablet found at the base of the Acropolis — so that gives you an extra idea just how long varicose veins have been bothering people. It was around this time that Hippocrates, the “Father of Medicine”, suggested people do something about their varicose veins, because he noticed a correlation between veins and leg ulcers. This was the introduction of vein punctures, cautery (using a hot or caustic agent) and compression bandages as a treatment.

ancient depiction of varicose veins
Depiction of a varicose vein – 400 BC

 

Over the next few centuries, the developments in treatments were many and varied. For example, in 270 BCE, two Egyptian physicians made surgery possible through the invention of forceps to block veins and control bleeding. But a low point in surgical history was around 0 CE, when the removal of a varicose vein was too much for even a notorious Roman warlord. He had one leg done and opted out of having the other fixed, saying “I see the cure is not worth the pain.” Today easier, more advanced varicose vein treatments are available with no down time.

 

Mercifully, surgical developments in varicose vein treatment continued. A Greek surgeon realized around 600 CE that the great saphenous vein — the longest vein in the human body — could be ligated or removed. Then in 1485, a landmark development was when Leonardo da Vinci produced accurate drawings of lower-limb veins, helping medical world make sense of how the venous system worked.

da Vinci's anatomical drawing
Leonardo da Vinci – 1485 AD

 

Two centuries after da Vinci’s drawings were rendered, the first documented attempt at sclerotherapy took place — acid is injected to create thrombus — a blood clot. This set the scene for the 1800s, where a flurry of medical developments were made. Charles Gabriel Pravaz invented his injection syringe made of glass, rubber and leather, and Francis Rynd followed up with the hypodermic needle.

 

By the 1900s, critical tools of the trade had been invented, and surgical processes were now being refined and published. Options included saphenous vein ligation; vein perforation to treat ulcers; and application of a special agent to close varicose veins. The links between chronic pelvic pain and vein congestion in that region were discovered, known as Pelvic Venous Insuficiency, and Sven-Ivar Seldinger figured out a technique to access veins using guidewires.

 

Enter the modern age of venous treatment. Since the 1960s, treatment of vascular disease has included the use of guidewires, catheters, angioplasty and stents. If you had vascular issues these days, you were fortunate to have surgeons with many cutting-edge treatment options at their disposal. More recent and sophisticated treatments tended to have impressive scientific titles, such as duplex ultrasound scanning, radiofrequency ablation, foam sclerotherapy, and diode laser.

sclerotherapy
Sclerotherapy uses an injectable medication to close varicose veins.

 

Which brings us to now. Do you have a vascular disorder that concerns you? Rest assured, medical development has never stopped. Perhaps your treatment might include a ClariVein device, which can be used without tumescent anesthesia. Asclera is an option for closing small veins. And VenaSeal is a system that closes veins using an adhesive agent. Your specialists know just the right treatment for you and you have nothing to worry about. The days of the painful surgery that so terrified the Roman warlord are thankfully a thing of the very distant past.

 

history of varicose veins infographic

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Varicose Vein Treatment: EVTA

An estimated 40 million Americans suffer from painful varicose veins. Fortunately, varicose vein treatment is easier and more effective than ever before. Only twelve years ago painful vein stripping surgeries were the norm. These surgeries involved surgically removing the vein, requiring the patient to go under general anesthesia. Vein stripping leaves problematic veins and often results in neovascularity, or growth of new veins. Vein stripping has largely been replaced with minimally-invasive EVTA procedures like laser or radio frequency ablations.

What is EVTA?

EVTA, or endovenous thermal ablation, is a minimally-invasive, outpatient procedure that uses thermal energy to close large, straight veins in the lower extremities. Like all varicose vein procedures, the problematic veins are first diagnosed using ultrasound. With ultrasound, the blood flow in the vein is measured to determine whether blood is returning to the heart properly or pooling in the legs, which is known as reflux. After the diagnosis is made the modality of treatment is selected. Large straight veins, like the Great Saphenous Vein or Small Saphenous Vein, are often ablated.  Thermal energy is either delivered with a radio frequency catheter or laser fiber. The procedures for either modality are very similar, each resulting in highly effective vein treatment. Though similar in process, both modalities have advantages and disadvantages.

EVLA (Endovenous Laser Ablation)

Endovenous laser ablation uses energy delivered through a laser fiber into the diseased vein. The day of the procedure, the patient is offered a relaxing medication like Valium or Nitrous Oxide.  The leg is then prepped in sterile fashion, and the doctor gains access to the target vein using a needle, much like starting an IV.  Through the needle a small wire is advanced allowing a catheter to be advanced to the top of the vein. Then the laser fiber is advanced through the catheter and placement away from deep veins is verified with ultrasound. The doctor will then infuse the area around the vein with an anesthetic mixture called tumescent anesthesia. This serves multiple purposes;  to numb the surrounding area, so the heat of the ablation is not felt, to provide a heat sink so surrounding tissues are not damaged, and to compress the vein so the heat of the ablation makes contact with all of the vein wall. After the leg has been sufficiently anesthetized, the doctor will turn on the device and slowly pull the laser fiber and catheter back through the vein, burning the vein on the way out. A small bandage is then placed on the access site and a compression stocking is put on the leg, which will be worn for a week after the procedure. You are able to return to normal daily activities immediately, the only restrictions being heavy lifting and strenuous exercise. Patients report mild to moderate pain for a few days after the procedure which is well managed with Ibuprofen.

Radio Frequency Ablation

Radio frequency ablation uses radio waves to generate heat to damage and close veins. The process is much the same; patients are offered a relaxing medication and the leg is prepped in sterile fashion. Using ultrasound guidance, the vein is accessed and through a small catheter the radio frequency catheter is advanced to the proximal portion of the vein. The area around the vein is then anesthetized with tumescent anesthesia to ensure the area is numb, to prevent burning of surrounding tissues, and to compress the vein. The radio frequency generator is then powered on and the vein is treated in 7 cm segments as the catheter is pulled back out of the leg. A small bandage is placed on the access site and a compression stocking is then worn for a week following the procedure. Again, you are able to resume normal daily activities with restrictions on exercise and heavy lifting for a week. An advantage of radio frequency over laser ablation is post-procedure pain. Most patients report mild pain while some patients experience no post-procedure pain. For this reason, radio frequency ablation is the preferred modality of thermal ablation used by IVC.

Success Rates and Potential Complications

RF and EVLT treatments both have very high success rates and very low rates of complications. Radio frequency ablation has a success rate of 97% while EVLT has a success rate of 98%. Minor complications for either procedure include bruising, temporary numbness, and a sensation of tightness. More serious complications include deep vein thrombosis, skin burn, and nerve damage, though these complications are rare.

Endovenous thermal ablation is the most effective varicose vein treatment available. If you suffer from painful varicose veins, heavy or tired legs, or restless legs, let the Utah varicose vein treatment experts at IVC guide you to healthy legs!

Varicocele Treatment Options

In the United States, varicocele treatment has traditionally involved open surgery, usually performed by a urologic surgeon, or urologist. In recent years however, a safe and effective non-surgical alternative called varicocele embolization is becoming the treatment of choice for many patients and their physicians

Varicocele embolization is an outpatient procedure that is performed without general anesthesia using light sedation. In this type of varicocele treatment, a small tube is inserted into the neck or groin through a small nick in the skin (about the size of the lead in a pencil). The skin is numbed for this procedure and it is not painful. Next a small catheter, or tube, is painlessly guided up into the abdomen and into the varicocele vein under the guidance of x-ray imaging. A dye is injected to create an x-ray map (venogram) of the vein and tiny metal coils or other embolizing substances are inserted through the catheter to block the flow of blood to the vein. The tube is removed and no stitches are needed. Patients are observed for a few hours and go home the same day. Recovery from varicocele embolization typically takes less than 24 hours and patients often return to work the next day.

Advantages of Varicocele Embolization

The majority of men in the United States undergo surgery as varicocele treatment. This is because they are usually sent to surgeons for evaluation, and many do not know about varicocele embolization. The advantages of this alternative, interventional radiology varicocele treatment include:

* It is as effective as surgery, as measured by improvement in semen analysis and pregnancy rates.

* It does not require any surgical incision in the scrotal area.

* A patient with varicoceles on both sides can have both fixed at the same time through one vein puncture site (surgery requires two separate open incisions).

* General anesthesia is not used for embolization (most surgery is done under general).

* There is a lower rate of complications compared to surgery. Infection has not been reported after embolization.

*It requires less recovery time. Post embolization patients are virtually never admitted to the hospital. Even patients with physically demanding jobs may return to work within the next day or two, unlike post surgical patients.

Blue Cross’ Requirements Prior To Treatment

Blue cross patients are required to wear compression stockings for a three-month timeframe as a conservative measure before treatment can begin. They require that the patient have supervised use over this three-month trial period. This means that the patient most follow up at least one time a month for the three months. During the follow up appointments the stockings will be checked to verify that they are the appropriate size and worn correctly. The patients’ symptoms will also be documented at these follow-ups along with any other problems or complications. After the three-month trial period, all of the documentation will be sent in for authorization and approval.

Conservative Measures Mystery

Even though IVC does not require patients to have tried conservative measures before receiving treatment, many insurance providers do. What are conservative measures? Conservative measures include the use of prescription strength compression stockings, the use of analgesics and NSAIDS, leg elevation, weight loss and exercise.

We all know that prescription strength compression stockings are never fun to wear, especially in the hot summer. However, they do help alleviate some of the symptoms caused by varicose veins. Prescription strength compression stockings are specially fitted to help reduce the pooling that occurs in diseased veins. The gradient pressure design of the stocking is highest at the ankle and lessens as the stocking moves up the leg. The compression stockings are to be worn all day and come in many styles and colors. Prescription strength compression stockings can range from $65 – $125, depending on the style.

Many people already use analgesics for the discomfort they experience from their varicose veins. Analgesics include Aspirin, Acetaminophen (Tylenol), NSAIDS (nonsteroidal anti-inflammatory drugs such as Ibuprofen) and Narcotics. Even though this may be an insurance requirement, IVC does not recommend the long-term use of analgesics to control varicose vein symptoms.

Myth: Exercise will make varicose veins worse. Exercise actually improves the blood circulation through your legs. Any activity involving your legs are good to relieve varicose veins and helps reduce the aching associated with them. Such exercises include swimming, walking, bicycling, jogging, and aerobics. We recommend for our patients to be as active as possible, even after receiving treatment.

Even though going down the conservative measures road is time consuming and somewhat tedious, we will do everything we possibly can to help keep the inconveniences to a minimum.