Interventional Radiology: Varicose Veins
Guest: Dr. Bayne Selby – Interventional Radiology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Bayne Selby who is Professor of Radiology and an interventional radiologist here at the Medical University of South Carolina. Dr. Selby, let’s talk about varicose veins. There are some special procedures, I understand, that you, as an interventional radiologist, have to offer patients with this problem.
Dr. Bayne Selby: Yes, and I have to say this is one that sort of came completely unexpected. We think of our specialty as always developing new things. But the truth is, most of them kind of evolve out of similar things we’ve done before. We really didn’t have much to do with the veins in the leg other than doing a venogram, in the old days, to look for blood clots in your legs, things like that. But, recently, people have been looking, as they always are, for less invasive procedures for a common surgical procedure. And one common surgical procedure that was done for people with varicose veins in their legs was called a vein stripping.
The reason they did is because the most common cause for varicose veins, big bulging veins in the legs that most of us get to some degree as we get older, isn’t that your veins are just weak, which is probably what most people think, it’s that one of the major veins that is supposed to be bringing blood up from your foot and calf isn’t working correctly. It’s supposed to have little valves in it to keep the blood from flowing back down to your calf and foot, which is the wrong way. And it’s pretty common, once you get up into your 40s and 50s, and even 60s, to have the valves not work very well, and then the blood flows the wrong way down this vein.
Long ago, somebody figured out, a smart surgeon, that the best thing to do was to just take this vein out, and then the blood could go up the good pathways, and wouldn’t flow back down the wrong way, and you’d get rid of your varicose veins. And this was the procedure, again, that was done for most of the 20th century. It was called a vein stripping. Many people that come to us will have had a parent that had this, because varicose veins do tend to run in families.
Now, the procedure that we do is based on the fact that we need get rid of this vein, but that doesn’t really mean we need to physically remove it. We can physically remove it or we can just close it off. And we now have a couple of techniques that can do that. One is something called radiofrequency ablation, which uses waves to sort of heat up the vein and close it off, and another is to use a laser. We looked at those different options once these things became available and, here, we feel that the laser procedure works better. It’s pretty simple and allows us to put a laser into the vein, close the vein off, and then the varicose veins go away.
Dr. Linda Austin: How long does that procedure take?
Dr. Bayne Selby: This is now done as an outpatient procedure. You come in and go home the same day. The procedure, itself, takes, usually, about 30-45 minutes, depending on whether there are any extra little things we have to do along with it.
Dr. Linda Austin: Is it painful?
Dr. Bayne Selby: No. You really don’t feel much of anything. I have to say, we’re probably a little more gentle than most because we happen to work in the hospital setting, at MUSC. Many people who do this in an outpatient setting don’t want to give any additional medication. But, because we work in our same rooms that we do all our other procedures, and we always have nurses available, and technologists, we treat these patients pretty much like everybody else, so we can usually give them a mild sedative for the procedure, and we really haven’t had anyone complain about the procedure.
Dr. Linda Austin: Sometimes you see folks with just a network of varicose veins all over their lower legs, in particular. Is this an effective treatment for that situation?
Dr. Bayne Selby: The short answer is, no. And that gives me a good chance to give a little primer on what types of varicose veins there are out there. The kind that we’re talking about, if you looked at your leg and said, I wonder if I have something that could be helped, if you have the big bulging veins, sort of big ropy veins, standing out on your leg, this is the kind of procedure that will help you. Those veins are being sort of blown up by this blood that is trying to go down the wrong way. And if we can get that stopped up, those veins will collapse.
The smaller, little, network of veins, which most people call spider veins, and there are a couple of subtypes of those, are a slightly different problem, and they aren’t helped by the fact that you have blood going down the wrong way. But we can’t take care of that by this method. The good news is, there are a few other methods. We don’t do those other methods in interventional radiology. But they are done by dermatologists or plastic surgeons. They involve injecting those small veins.
Dr. Linda Austin: What are the symptoms of varicose veins?
Dr. Bayne Selby: Well, again, because we tend to work in the hospital and we do not think of this as a plastic surgery procedure, we only do it on people that have symptoms. So, again, if you have big bulging, ropy-type, veins but they’re not causing you any problem, you will be able to get somebody, probably, to help you out there, but it won’t be us.
We take care of the people that have symptoms. And I have to admit, it surprised me, how many people do have symptoms from this. The usual symptoms are fatigue, your leg gets tired by the end of the day, swelling, and you’ll usually notice that’s worse in one leg over the other, and you’ll bet pain from it.
When we first started doing the procedure, we would only do patients with those symptoms, we still do, and many times we get a great technical result and I’d really wonder if their symptoms would get better, or maybe their symptoms were related to something else. And, yet, I’d have to say, of all the groups of patients we deal with, we probably get a higher level of patient satisfaction from this procedure than anything else. So, I think these symptoms are very real for the people that suffer from them and are probably relatively undiagnosed.
Dr. Linda Austin: Dr. Selby, thank you so much.
Dr. Bayne Selby: Thank you.
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