By Christina Hennessy, Danbury News Times, Monday, April 22, 2013
A planned Florida vacation was still weeks away, but for Kate Joo, the procedure she was undertaking on a recent afternoon would make that sojourn even more enjoyable.
“We timed it well,” she said of her efforts and that of her doctor, Alex Afshar. “It’s going to be shorts season soon and beach season.”
With a quick, minimally invasive, in-office procedure, the 34-year-old Ridgefield resident was taking care of a varicose vein problem, which not only had caused cosmetic concerns, but also had resulted in a constant aching and heaviness in her legs, as well as difficulty sleeping.
More than 24 million Americans have varicose veins, according to the Severna Park, Md.-based Vascular Disease Foundation. For some, the twisted, bulging veins prompt no additional symptoms. For those with symptoms — which can include swelling, leg heaviness, aching, cramps, itching and even blood clots — varicose veins are more than a cosmetic issue.
The vein treated by Ashfar during her most recent visit was the second of two veins that had been giving Joo problems since the birth of her third child. A week earlier, Afshar had closed one in her right leg. On this day, he focused on the left. Using ultrasound technology, Afshar, who runs Newtown-based Vein Institute of Connecticut, threaded a catheter into the affected vein and delivered the controlled heat that would collapse the vein.
The process, known as radiofrequency ablation, is one of several new techniques that have given patients an alternative to traditional vein-stripping surgery. The latter entails a trip to the hospital and general or spinal anesthesia. Surgeons make small incisions in the leg, thread a thin wire into the vein, attach it to the vein and then pull out the vein. The incisions are closed with stitches and bandaged.
Afshar said such a procedure can result in scars and require blood transfusions, as well as a multi-day hospital stay. The new procedures represent a breakthrough in what physicians can offer their patients, he said.
“There is no discomfort during the procedure and no pain after the procedure,” he said. A small bandage was all that remained after Joo’s procedure. “A patient can get on with normal activity right off the table. And, most procedures are covered by insurance.”
Those interviewed said it is important to undergo a consultation and check with insurance prior to any procedure.
Since only local anesthesia is needed, the patient is alert during the procedure.
“It took me a year to get here,” said Joo, who was recommended to Afshar by a friend. “It was on the list, but I kept moving it off, week to week and month to month.”
But the promise of a quick and successful treatment, with no downtime, no discomfort and a chance to get back into her busy daily routine ultimately sold her. “The fact that I could walk out and drive out of here and continue on with life made this an easy decision.”
All techniques seek to achieve the same outcome, which is treating venous reflux — in other words, removing veins with defective valves. As blood is pushed upward toward the heart, propelled by the contraction of muscles in the lower leg, valves shut to prevent reverse flow. A dysfunctional valve, however, allows blood to travel backward, which can put pressure on the vein walls. The veins enlarge and push out toward the skin causing ulcers in some cases, particularly where skin is thin, such as at the ankles.
Varicose veins can be brought on by many factors, including heredity, multiple pregnancies, obesity and prolonged standing or sitting. Blood clots also can put you at risk.
For Joo, her post-op recommendations include wearing compression stockings for 48 hours after the procedure and then a week of wearing them daily, morning to night. Joo also must keep active, such as walking 30 to 40 minutes a day.
Just as an ultrasound prior to the procedure revealed the veins that were causing the problem, a follow-up ultrasound will determine whether the veins are closed, Afshar said.
“Once the vein is closed, the blood will be rerouted toward healthy veins and the circulation will improve, which prevents further varicosities,” Afshar said. “This is not, however, a cure, but rather a treatment. However, for most patients, once they get this procedure done, they will be OK for many, many years.”