& lt China Medical Experts Forum > Professor Zhang Qiang, Director of Vascular Surgery, Dongfang Hospital affiliated to Tongji University.
At present, the incidence of varicose veins of lower limbs has accounted for about 5% of the total urban population. Based on such a high incidence rate, vascular surgery has sprung up all over the country in recent years. Varicose veins of lower limbs have become the primary disease in vascular surgery clinics or wards everywhere.
The traditional varicose vein operation is to peel off the trunk of great saphenous vein and peel off the varicose veins of legs through multiple incisions. Due to many incisions and great trauma, the hospitalization time of patients is generally about one week.
In recent years, minimally invasive treatment of varicose veins has gradually emerged.
Laser endovascular occlusion (EVLT) is a kind of laser with special wavelength, which intervenes in the trunk of great saphenous vein through optical fiber and then seals the vein. This technique avoids some complications caused by stripping great saphenous vein to some extent. For example: hematoma, saphenous nerve injury, etc.
There are other technologies similar to the principle of laser therapy: RF closure technology and cryoclosure technology. The common point of these three techniques is to avoid stripping the great saphenous vein. However, there is nothing to be done about varicose veins of the lower leg, which is often combined with traditional stripping surgery. Clinically, the recurrence rate of laser treatment is high, mainly in the case of inexperienced doctors and excessive caliber of great saphenous vein. In addition, the discomfort caused by thigh string phlebitis after one week of laser treatment is also one of the chief complaints of many patients.
Trivex technique is designed for patients with varicose veins in the lower leg. It uses subcutaneous light source to locate varicose veins, and then uses trivex system to remove varicose veins. This technique only needs to make two incisions in the calf, which can solve the problem of varicose veins in the calf. However, curettage technique is not suitable for the treatment of great saphenous vein trunk. Also, scraping is not strictly minimally invasive. It seems that the incisions are few and small, but the subcutaneous trauma is greater.
Injection of sclerosing agent sounds like a good technique, which requires no anesthesia, no surgery and low cost. But injecting hardener has great risks; First of all, if the sclerosing agent is injected and extravasated, it will lead to skin necrosis. Second, once sclerosing agent flows into deep vein, it can lead to thrombosis, and in severe cases, pulmonary embolism occurs. In recent years, a series of improvements have been made to the injection of hardener, such as the emergence of microbubble technology, which can make the plugging effect better and reduce the concentration and dosage of hardener, thus greatly avoiding the previous complications. But the curative effect of sclerosing agent injection on the trunk of great saphenous vein is poor. Because of the high recurrence rate and the domestic medical environment, it is not widely used in clinic.
In recent years, vascular surgery in all parts of China has adopted the above technology and made great progress and achievements in the treatment of varicose veins. However, there are still some problems in the treatment of varicose veins in China.
First, the problem of overtreatment. Varicose vein surgery is a common operation, and the preoperative diagnosis should be simple and clear for most patients. It should be said that for an experienced vascular surgeon, a definite diagnosis can be made through physical examination. In this way, most patients do not need to do deep vein ultrasound and angiography before operation. In fact, a considerable number of medical institutions use deep vein angiography, which puts patients at risk of a series of complications caused by angiography. Such as contrast agent allergy or thrombosis. At the same time, radiography obviously increases the treatment cost of patients and prolongs the waiting time of surgery. However, venography is necessary for inexperienced doctors or clinically difficult cases. After the operation, it is also inappropriate for many medical institutions to treat patients with varicose veins with antibiotics. Because the operation of great saphenous vein belongs to aseptic operation if there is no infectious ulcer, and there is no evidence of using antibiotics. These unscientific measures before or after operation can be regarded as "overtreatment" to some extent. There are factors such as doctors' ideas and academic level, and it is undeniable that they are driven by economic interests.
Second, the choice of operation. Many medical institutions rely on the equipment owned by the institution when choosing the operation method, rather than the specific situation of the patient. Because the equipment for treating varicose veins is expensive, laser, RF and curettage equipment are all above several hundred thousand RMB, and most hospitals only buy one of them. Therefore, in marketing, most hospitals will only publicize their own equipment and technology and exaggerate their treatment scope. It is not difficult to understand that some hospitals say that laser is the best way to treat varicose veins. Another hospital claims that radio frequency is the best treatment for varicose veins. These statements are actually unscientific. As mentioned at the beginning, each device has its advantages and disadvantages, so we should choose one or a combination according to the specific situation of patients.
Third, the evaluation of treatment effect. Strictly speaking, varicose veins are the clinical manifestations of many diseases. Varicose veins themselves are not harmful to the body except for the beautiful changes in images, but some complications brought about by the long-term development of varicose veins, such as thrombosis, ulcer and edema, are the main factors affecting patients' daily life. Therefore, the main purpose of treating varicose veins is to prevent these complications or for cosmetic purposes. The effect evaluation of varicose veins should focus on the improvement of patients' feelings and quality of life, and the long-term effect should be followed up. In some medical institutions, varicose veins do disappear in a short time after injection of sclerosing agent, but most patients will relapse after several years because the sick main vein is not treated. For the evaluation of laser and radio frequency surgery, it has also been found in recent years that if it is not operated by experienced doctors, the trunk of great saphenous vein may be reopened, leading to recurrence. Although there are only two incisions in curettage, the scope and area of the trauma are mostly under the skin, so the subcutaneous congestion after operation is more serious, and the bandage takes a long time, which makes it difficult for China patients to accept the relatively slow recovery after operation.
In addition, because the varicose vein operation cost is not high, the benefit is very low for medical institutions, so there will be the above-mentioned over-medical treatment: the patient's hospitalization time will be unnecessarily prolonged and the cost will be unnecessarily increased.
If we understand the problems mentioned above, we should know that we should not blindly tell the patient what technology is the best, but should tell him what is the most suitable after examining the patient. Standardize the treatment process of varicose veins, and the hospitalization time should be within two days. (Unless, of course, the patient suffers from other physical diseases)
With the maturity of minimally invasive technology and the shortening of hospitalization time, the treatment of varicose veins has become unprecedented simple, which makes patients who were worried about surgery choose surgery again. I predict that there will be more and more patients with varicose veins in vascular surgery, and the requirements for doctors are getting higher and higher. As a vascular surgeon, we should persist in scientific treatment and keep innovating.
Interview with Zhang Qiang, a famous expert in vascular surgery in Shanghai
Professor Zhang Qiang is the director of vascular surgery in Shanghai Oriental Hospital affiliated to Tongji University, and one of the top experts in the treatment of varicose veins and deep vein thrombosis in China. You can search "Dr. Zhang Qiang's personal website" in Baidu and conduct online consultation in the patient consultation area. Maybe you can get the help of Dr. Zhang.