By: Jean Johnson for Veins1
Slowly but surely, interventional radiology (IR) is revolutionizing medicine as we know it. While IR physicians have successfully treated many varicose veins for some time with their minimally invasive techniques, a new study by lead author Robert J. Min M.D., M.B.A., Interventional Radiologist at Cornell University, shows that IR works to resolve problems in previously difficult to treat smaller veins. This is potentially good news for the 20 percent of patients or millions of people in the United States alone whose varicose veins are caused by problems in the smaller or non-great saphenous veins.
|What is interventional radiology?
IR uses minimally invasive, targeted treatments performed with assistance from equipment such as X-rays, magnetic resonance imaging (MRI), ultrasound, and computed tomography (CT) to guide small instruments through blood vessels or other pathways percutaneously – under the skin.
IR procedures don’t need the large incisions that have always been required to perform most operations. Instead, catheters – tubes measuring just a few millimeters in diameter – replace scalpels in many IR procedures. These procedures typically require little or no anesthesia and much less cutting of the skin, muscle or other tissues. This results in much less blood loss and considerably less expense than traditional surgeries. Moreover, IR operations require shorter hospital stays – in fact many are performed on a outpatient basis – and shorter periods of patient recovery.
The field of IR first started with a focus on the heart and angioplasty in the late 1960s. Since then, IR experts have pioneered treating a wide range of problems accessible via bodily highways including the arteries, veins, bile ducts and ureters. Body plumbers, IR specialists are vascular experts. Through nicks in the skin the size of a pencil tip, physicians insert thin catheters the size of spaghetti. Then using duplex ultrasound imaging for guidance, they run the catheters through the circulation system or other tubular structure in the body to access the site of the abnormality. Once there these specialists can apply numerous techniques to treat physiological malfunction.
Savvy patients with problems ranging from uterine fibroids to clogged carotid arteries are increasingly seeking out IR as the alternative to major surgery. Because IR eliminates the need to dissect down through the body via a surgeon’s scalpel, recovery times shrink from weeks and months to just hours or days. Indeed, the new IR treatment for varicose veins “can be done as an outpatient procedure, typically in less than an hour, and patients can return to normal activities immediately,” said Min. “There is little to no pain, no general anesthesia and no scar.”
Chairman of the department of diagnostic radiology at Oregon Health and Sciences University, Frederick S. Keller, M.D. agrees that IR is an exceptionally useful way to treat these types of problems. “IR replaces the brutal operation of vein stripping,” said Keller. “Since 2003, particularly, we’ve seen considerable growth in this aspect of the field.”
Reporting on his team’s work at the 30th annual meeting of the Society of Interventional Radiologists in March 2005, Min said, “this new study means that million of patients will now have an effective non-surgical treatment for their varicose veins. Up until now there haven’t been effective treatments for these types of veins.”
Min provides statistics comparing IR treatments or what is known in the field as endovenous laser ablation. “Surgical removal of varicose veins, even in the best series, has about a 25 percent or higher recurrence rate,” said Min. “In equivalent time periods laser ablation has had a recurrence rate of less than 5 percent.”
He goes on to explain that reflux, or the backing up on blood, in smaller veins that are collectively referred to as non-great saphenous veins, is a common but under-recognized cause of varicose veins. IR techniques enable experts like Min to thread a catheter through the venous system to the site of the problem. Once there, they treat the vein reflux with laser energy that seals the vein closed. “Sealing the faulty vein improves the circulation in the leg by redirecting the blood to normal veins,” stated Min’s report. “Abnormal veins are not useful and they actually create more work for the normal veins in returning blood back to the heart.”
The study assessed 192 patients over 56 months demonstrated that the procedure is “very safe, and that no skin burns, deep vein thromboses, or other heat-related complications were reported.” Success rates of 96 percent were documented, and the seven cases that failed were successfully retreated.