Alain Tanbe, MD, a Vascular Surgeon at Mercy Hospital talks about varicose veins.
Interview conducted by Ivanhoe Broadcast News in December 2018.
When we’re talking about varicose veins. It’s something that is very common. But could you explain for our viewers who may not struggle with them, what they are and what is going on in the body?
Dr. Tanbe: Sure, varicose veins are very common disease that we see in the US. There’s over twenty million suffering from this problem. What happened is the veins will bring the blood back up our heart. Inside the veins we have valves, we have plenty of valves, their job is to prevent the blood from going back down. But one these valves are leaking blood is going up in the vein but leaking back down in the legs. These veins are working backward, and that’s what causes the problem of varicose veins.
What do they look like when you’re physically looking at someone’s body?
Dr. Tanbe: They can range. They can be from all the spider veins they are like small blue lines on your legs or progress and become those bulging veins under the skin that you can personally see and so this is a variety. And then unfortunately some patients will have discoloration over the skin and develop from wounds.
That was my next question. Is it dangerous for patients and is it painful?
Dr. Tanbe: So in general, they are not dangerous unless they progress to the level of what we talked about where there’s wounds because these wounds can get infected and this is where the problems starts. Some varicose veins might bleed. And this is another one of the complications that can happen with this. But yes, they are very annoying and that’s the majority of the time and why we fix them.
And where do they usually appear?
Dr. Tanbe: It’s on the lower extremities from the waist down, the general is basically they start around the ankle and then they block and basically build up the calf in the thigh and again they can happen anywhere on the lower extremities.
What causes them and are some people more prone to this problem than others and why?
Dr. Tanbe: Yes, there are risk factors for it, basically, genetics play a big role in it. Every single job that especially where you’re standing or sitting puts you at higher risk. So basically everyone is at risk of having varicose veins.
What are the symptoms and who is most at risk?
Dr. Tanbe: The symptoms are basically throbbing and aching, cramps or Charlie horses at nights. Dry skin and itchiness in the legs, swelling, those are all related to the varicose veins.
And you said anyone who sits or stands. Why is that?
Dr. Tanbe: Remember when we were talking about the vein with these valves not working well what happens it was gravity; your legs are the lowest point of your body. So basically, whenever you’re standing or sitting blood is being drawn back to the bottom of your body and this is what caused the problem. The aching starts because the blood is setting there. And what happened is the longer the blood sets there the skin gets stained and gets thin and this is what develops the wound after.
Talk to me a little bit about treatment doctor. Before VenaSeal what could you do?
Dr. Tanbe: Oh, treatment has changed dramatically throughout the years. What we fixed, there’s two troublemaker veins if we call them that they are in your legs. They’re called a greater Saphenous and the lesser Saphenous. These veins they used to do vein stripping. They used to yank these veins out which was a big procedure: you come into the hospital, you have an incision in your groin, another incision around your knee. And then they literally used to yank it out. That progressed to basically a laser or and RFA, which is heat induced closure of that vein. When we close that vein blood will reroute around this vein without going to the trouble to make your vein that is leaking. And then the last generation VenaSeal is instead of heating and burning the vein, we inject clue inside the vein.
You inject glue?
Dr. Tanbe: Correct. It’s medical glue.
Okay. So how does that work?
Dr. Tanbe: Once I go inside the veins and I’ll show you after the glue, the glue, it’s a medical glue that help basically close the vein And we shut it down by putting the glue and pressing on the vein so we close the entire length of the vein. And once the vein is closed, and this is a thirty minute procedure, the blood will automatically shift in to the main vein, this is not the main vein in the legs.
I’m going to re-ask that again. Can you explain for me how this glue works to seal?
Dr. Tanbe: Sure, so once I’m inside the vein we have the glue gun which I will show you after. Its medical glue so once we have the glue inside and deliver it, and this is done under ultrasound, we press on the vein and the vein will shut down along the length of it and the blood will reroute in to the main vein. This is not the main vein in your body but this is the trouble maker vein.
Can you explain to me how the glue seals?
Dr. Tanbe: Once we have the glue inside and delivered, we press on the vein and the vein will shut down along the length of it and the blood will reroute into the main vein. This is not the main vein in your body, but that this is a troublemaker vein.
What’s the next step; does the glue take time to settle?
Dr. Tanbe: It happens right away. We check before, basically at the end of the procedure this is where we check that everything is closed. That Saphenous vein is closed, and it happened right away.
Is the patient under general anesthesia?
Dr. Tanbe: Absolutely not. Because again with the previous with the stripping used to be big incisions but this is done through one needle hole. And you can barely see it basically.
Can the patient feel anything or is it just a little numbing.
Dr. Tanbe: It’s a numbing medication you know how you go to the Dentist and they numb up your gum this is exactly same thing. So, I will numb up the area and then once I go inside the vein there is no pain. And this is the difference between this generation of treatment and the laser. Because the laser I have to inject multiple needles sticks to numb up the entire leg and to prevent the patient from feeling the heat. Again, not the big procedure compared what it was before. But this is taking it to an extra level of your not feeling anything at all.
How long does it take, and how long is the recovery?
Dr. Tanbe: So the procedure takes anything between twenty and thirty minutes. The patient walks in and walks out. This procedure being gentler than the one before, you speak that with a Band-Aid and you can go back to your activity right away.
How long before patients start seeing a visible difference in their legs?
Dr. Tanbe: It will take up to one month to see the visible but the symptomatic part this is where it’s resolved within a few days.
So the burning and aching goes away?
Dr. Tanbe: Yes. And this is why mainly we do it just to get the symptoms away. And it’s also, so since you asked, it’s also help with the cosmetic part of it. And usually help these big vein bulging, varicose veins decompress and help us treat it the future if, we need to take them out or like that.
Is there an ideal patient for this procedure?
Dr. Tanbe: I believe that every patient that suffered from varicose veins is a good patient. And that’s why these patients with doing ultra sound first and that’s how we know that this is the problems that you have, the venous insufficiency or leaking veins. And this is how we find the patient and then based on that this is the treatment that we will go with.
So when you say leaking that is actually blood leaking out?
Dr. Tanbe: Correct. So these valves when they don’t close as they’re supposed to blood is going up and leaking back down.
On the flipside is there anyone for whom this isn’t a good procedure?
Dr. Tanbe: It’s rare that this patient doesn’t fit that, basically patients who are allergic to that medical glue but I’ve never seen this before. But in general, or the patient’s that some patients have some torturous veins and we should be able to tell that by doing the ultra sound before, but again this is very, very, very rare.
Just for clarification it’s one step so you’re not going through the groin?
Dr. Tanbe: I go through around the knee or below that. This is one of the advantage of this glue is I can actually treat the entire length of the vein compared to the heat and use that were only able to treat from the knee up. And the reason for this is the nerve is very close to the vein below the knee and with the heat you risk it injuring the nerve next to it. But with the glue there is no risk at all.
Is this something that’s covered by insurance?
Dr. Tanbe: It is covered by most insurance. Currently it’s covered mainly by Medicare actually and then the other private insurance are working towards this. But at this stage it’s only Medicare.
And how new is this doctor? How long have you been using it?
Dr. Tanbe: It’s funny you ask because until something gets approved here in the US it takes a long time, which is a good thing. So this product has been out in Europe for eight years now.
Eight?
Dr. Tanbe: Eight years. And in the US basically it’s been two years now and in Maryland it’s been around five to six months.
Is there anything I didn’t ask you that you want the people to know?
Dr. Tanbe: Well I just wanted to make sure that they know that this is the treatment for varicose. A lot of patients just sit there and just suffer through the pain and the aching and the swelling in their legs and think that’s fixed where you think it’s going to be super complicated, it is absolutely not. Again it’s done through one needle stick and you can go back to work the next day. So the treatment is very simple. One more thing to mention about varicose vein is we don’t jump to do the procedure right away. There’s a period of conservative management and this is what basically we push all the patient’s to try to do. Conservative management is with compression socks. So compress twenty to thirty compression basically knee-high, that they need to wear this all day long and that should take care of some of their symptoms. The patient that does not respond to that medical therapy, this is what you recommend the procedure for.
And we’ve been trying to get in touch with your patient Miss. Nolley. And she and I have talked on the phone but we just have connected yet. Can you tell me anything about her case?
Dr. Tanbe: She’s also been suffering for this feeling of aching for many, many years in her legs. She thought that it was related to something else and thankfully her primary physician set her and told her that could be your vein causing this.. And when we examined her, her symptoms fit everything related to varicose veins. We did the ultrasound and obviously we saw the leaking veins that she had. She had to fix. She had to actually have both legs fixed with this. She can tell me this she called other friends right away.
END OF INTERVIEW
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