The KLS Martin diomax 1550 nm diode laser used in our health centre is suitable for both the ambulatory treatment of small spider veins and larger side branches, as well as the surgical treatment of large vein trunks and connecting (perforant) branches. While the ambulatory procedure with local cooling does not require anaesthesia, the operation of the larger vein trunks is performed under local anaesthesia in operating room conditions. The treatment of leg ulcers with low-energy laser is also an ambulatory procedure, skin lesions are also removed in our health centre under utilising local anaesthesia.
The KLS Martin diomax 1550 nm diode laser represents the most advanced type of lasers. The energy of the laser beam is absorbed by the water molecules forming the tissues and by warming them up it takes its effect on the target area. During the surgical procedures a 360 degree radial beam is used which effectively transmits the laser light inside the whole interior surface of the vein.
Before the operation patients go through a detailed vascular surgery examination (physical examination; venous ultrasound; if necessary, arterial Doppler ultrasound; in case of suspected cervical carotid stenosis, neck ultrasound). Blood test, ECG, chest x-ray are also required, currently the medical reports shall be brought by the patient (a few months old reports with negative results are acceptable). We are planning to extend the range of our services, and then these examinations may be performed on site.
The patient shall arrive at VP-Med Health Centre half an hour prior to the commencement of the operation where we do the necessary administration and provide an opportunity to the patient to ask questions. Before the operation the patient puts on the operation room garment. The anaesthesiologist is present at each operation and also examines the patient before the surgical procedure. The operation is performed under local anaesthesia, if necessary, with the assistance of venous medication to make the procedure entirely painless. Right before the procedure, with the use of ultrasound, the removable veins are accurately drawn around.
After cleaning the surgical area with an antiseptic solution and sterile isolating it, a guide wire is inserted to the lumen of the main vein trunk and is led to the afflux in the groin or popliteal. If the treated vein trunk is significantly dilated or the afflux back-flow is increased, we surgically tie the venous confluence in the groin or the popliteal. This is also painless and means an approximately 1.5 cm wound that heals without a trace – this procedure is required in only about 1% of the cases. We determine the starting point of the RF of laser treatment, and then lead the laser wire or the radiofrequency catheter to this point. Subsequently, also with ultrasound control, the treated vein trunk is injected around with anaesthetic solution. The coagulation is performed top down, slowly pulling back the RF or laser catheter under the ultrasound. After the treatment of the main vein trunk, the side branches may also be treated with micro-varicectomy (with a special microsurgery device through small needle holes) but due to the change of concepts over the past years, this is less and less necessary (see our gallery). At the end of the operation compression stockings are applied until the upper thigh. Patients may get up immediately after the surgical procedure and if they have no complaints, they can leave for home in 15 minutes.
The patient changes the bandage at home; the ultrasound control examination is performed 3-4 weeks later. For five days, after the surgical procedure, the patients administer themselves an anticoagulant injection in order to prevent thrombosis. The patient is fully able to work 1-2 days after the procedure wearing elastic bandage or compression stockings, however, doing strenuous physical work or sports is only recommended after 1-2 weeks. There is usually a minimal wound pain; bleedings between the tissues are rare. The severity of postoperative complaints largely depends on the amount and size of the operated varicose veins and on the individual ability to tolerate pain. Most often a burning pain emerges in the inner surface of the thigh on the 2nd or 3rd day after the surgical procedure which resolves after taking traditional painkillers. Sometimes slightly painful nodes appear on the area of the treated veins; these spontaneously absorb within a few months and do not worsen every day life.
The radiofrequency or laser varicose vein operation or the treatment of the smaller side branches and spider veins may be performed on the other side limb within 1-2 weeks.
During traditional varicose vein surgery few surgical incisions are made to expose to the main vein trunks (great saphenous vein and small saphenous vein). At the groin or the popliteal, where the blood flows into the deep vein, the side branches are tied (crossectomy), then the vein is removed with a stripper. During this procedure we cause relatively severe tissue damage and the side branches also tear which explains the significant post-operative pain and bleeding. The incision at the groin is not favourable either, because it might imply the risk of infections and encumber the daily cleaning routine. Not tying down the side branches around the junction does not increase recurrence rates; this has been proven by several examinations. Moreover, if crossectomies are performed along with modern operations (laser, radiofrequency) the re-formation of blood vessels is (neovascularization) is more likely to occur.
The minimally invasive surgical procedures without incisions, inside the vein (endovenous), have been applied for more than a decade. Based on international follow-up the efficiency of the operation and the recurrence rates are the same as the late results of the traditional varicose vein operations, however, the burden of the surgery is significantly lower, the occurrence of complications can be minimised and the improvement of life quality is clearly faster than at traditional operations. In the countries where new methods receive adequate support from insurance companies, almost exclusively the new vein surgery methods are used.
The endoluminal (laser surgery, radiofrequency ablation) surgical methods, which have spread over the past decade, apply a new, costly technique for patient comfort. The advantages of the new methods as compared to the traditional open surgical procedure:
The disadvantage of modern surgical methods is their need for special devices and their relative expensiveness; however, these are compensated by the benefits described above. Currently the Hungarian National Health Insurance Fund Administration does not finance radiofrequency and laser interventions, therefore patients shall cover the total costs of the operation. If we not only take the price of the operation into consideration, but also the time lost at work, the discomfort and pain accompanying the operation, as well as the aesthetical results, the balance is in the favour of the modern surgical procedures.
Each varicose vein treatment is preceded by a detailed vascular surgery examination thus no subsequent complications may be caused by a wound healing disorder resulting from an undiagnosed atherosclerosis; by detecting the cause of the varicose vein disease or the chronic venous insufficiency, not only the visible skin lesion is treated but also the underlying disease.
|Laser varicose vein operation on one limb*||350 000 HUF|
|Laser varicose vein operation on the other limb (within one year)||330 000 HUF|
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Sorry, this entry is only available in Hungarian.37 – year – old lady
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