The ILVO (Intraluminal VenousObstruction)procedure
1. Venous catheterization with ecographic guidance.
2. The insertion of a guide wire in the vein.
3. The introduction of a catheter over the guide wire.
4. The removal of the guide wire.
5. The introduction of the laser fiber-optic through the catheter.
6. The removal of the catheter.
7. The laser is ready for the treatment.
8. The use of laser light.aplicarea luminii laser.
9. The fiber is retracted 3mm and the process is continued.
Varricose disease, evolution and complications.
This is the most modern surgical treatment of varices without stripping- the removal of the defficient veins. It is the thermic photocoagulation with tissular contraction and the destruction of collagen in the vascular wall; leading to the obliteration of the affected veins.
Advantages of the procedure : it is minimally invasive, it does not require hospitalization, it is performed under local anesthesia, it is quick, with minimal discomfort, the absence of scar tissue and post-operative pain, minimal or inexistent secondary effects, a quick return to normal activity, and excellent esthetic results.
The high incidence of varicose vein disease (15-30%) in the adult population make it one of the most prevalent vascular diseases. Hidrostatic varices are permanent, pathologic dilations of the superficial veins of the lower limbs (the greater saphenous vein-internal, the lesser saphenous vein-external). Every vein has interior valves that prevent the backflow of blood. If the veins become disfunctional, blood stagnates in the veins which leads to dilations of the veins and chronic venous insufficiency and its unpleasant functional and esthetic symptomatology.
Of all the risc factors for the appearance of chronic venous insufficiency such as: standing for long periods of time, pregnancy, sustained physical effort, excessive heat and humidity, obesity, hormonal imbalances, traumas of the lower limbs; it is believed that genetic predisposition is the most important factor.
Varicose vein disease affects both genders equally; although women generally seek medical treatment more often due to esthetic reasons. The evoultion of the disease is slow, usually painless,
which accounts for the fact that pacients seek medical help late in the evolution of the disease, usually 10-15 years after the onset when complications have already appeared and surgical treatment is more difficult. The most frequent symptoms of the disease include the sensation of tired, heavy legs, numbness of the legs, cramps, tingling, swelling, and the typical aspect of advanced cases: multiple, unsightly, venous dilations.
The most important thing for the patient to realize is that varicose vein disease can be treated!
Left untreated in a timely fashion-the first 2-3 years of the evolution- varices can have severe complications. There are three serious complications of varicose vein disease: superficial varicose thromboflebitis (varicoflebitis)-the coagulation of blood in the interior of the veins, trophic changes of the tegument-changes in the color of the skin, varicose eczema, dermatitis, and the onset of varicose ulcers, and the rupture of the varices with the risk of a massive hemorrhage.
Varicose vein disease must be treated due to both the symptoms and unpleasant aspect as well as the risk of severe complications.
There are a variety of surgical procedures available for the treatment of varicose vein disease.
These range in complexity from the classical surgical procedure of vein stripping to the most modern method of outpatient laser therapy.
Almost all cases can be treated on an outpatient basis with excellent results both from an esthetic and etiologic(causal) point of view. The rate of recurrence after most modern therapeutic methods is less than 5% at 10 years from the intervention compared with 25-30% for classical surgical methods.
Due to the minimally invasive nature of this new procedure it can be easily repeated in the rare case of recurrence.
Laser therapy (ILVO-intraluminal vein occlusion) is a minimally invasive procedure performed on an outpatient basis. It is performed under local anesthesia thus eliminating the risk factors associated with general anesthesia and the unpleasant side effects of general anesthetics. It is a great leap forward in the surgery of hidrostatic varices.
It is the most modern surgical treament of varices that does not involve stripping ( the physical removal of the affected vein). It consists in the thermic photocoagulation, tissular contraction,and the destruction of the vascular wall collagen. This leads to the obliteration and the destruction of the treated veins.
Laser therapy is ideal for patients in the early stages of varicose vein disease, with a small to medium level of venous insufficiency, and before the onset of complications. This therapy is not well-suited to patients that have arterial circulatory problems, deep vein thrombosis, or associated pathologies. Tortuous veins or veins with malformations cannot be treated with laser therapy due to the technical difficulties of introducing a catheter. As not all forms and stages of varicose vein disease can be treated with laser therapy the success of the treatment is dependent on careful patient selection.
In spite of these limitations, our experience of over 5 years has demonstrated that a large percentage of the cases theoretically too advanced in their evolution to be successful candidates for laser therapy have responded well to a combination of laser intraluminal venous occlusion and minimal surgical interventions on the more difficult veins.
The key to the therapeutic success of this technique is the experience of a physician trained in vascular surgery and the access to a well equipped clinic.
ILVO is performed with the guidance of ecodoppler ultrasonography and is a quick and minimally discomfortable procedure. Using a venous point of entry or a small 2-3mm incision the fiber optic is introduced in the affected vein (the greater or smaller saphenous vein) up to the junction of the saphenous and femoral veins. Under ultrasound guidance the laser obliterates the vein from the inside out. The procedure is quick, and after approximately 3 hours the patient can leave the clinic and go home.
This revolutionary method has clear advantages for the patient: the absence of scarring and bruising, no post-operative pain, it does not harm the surrounding tissues, and hospitalization is not required. Along with the obvious esthetic advantages the patient also benefits from the impressive results. The success rate is over 98% with a minimal repermeabilization rate.
The Ortomed Alex Bucur Clinicdedicated from its inception to bringing revolutionary techniques in orthopedics, vascular surgery, plastic surgery, and pediatric surgery, offers its patients complete services in vascular medicine:
A professional consult based on modern equipment – color Doppler ultrasonography, volumetric digital measurements – and on classical clinical skills – the clinical examination and a frank and sincere conversation between the patient and the vascular surgeon.
The treatment of reticular varices, telangiectasies – “spider veins” – with sclerotherapy, or surface laser coagulation.
The treatment with intraluminal laser (ILVO) of varicose disease with the latest generation of MedArt 426 810 nm laser, and single-use intra-venous kits.
The additional minimally invasive treatment with small phlebectomies, without sutures or scarring.
Surgical procedures alternative to laser therapy for patients with advanced stages and complicatins of varicose disease.
The clinic has a complete vascular surgery department, capable of treating any stage of varicose vein disease and performing classical surgery should the need arise without transferring the patient to another service. The training of the personnel and the equipment of the clinic with intensive care technology permits the management of any intr-operative or post-operative complications in the unlikely possibility of their appearance. The clinic can also provide less costly classical surgical treatment where there are therapeutic indications for this type of therapy.
Images before and after the treatement:
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location.
The Ortomed Clinic is in the central part of Cluj-Napoca, close to the Oncology Institute and the Botanical Gardens.
