Less-invasive treatments for varicose veins

Dec. 15, 2012 @ 04:56 PM

 Barbara Greenberg wasn’t happy with the bulging varicose veins on the sides and backs of her legs.

She wasn’t happy with the “achiness” and “heavy legs” she had endured for years.

And she wasn’t happy when newcomers would show up at canoe outings in the mountains near her Ashe County home because it meant they would see her in shorts.

But it wasn’t until she fainted because of severe cramps in her thighs that she finally took action.

Her Internet search for solutions to her varicose vein problems led her to Wake Forest Baptist Medical Center and John Regan, M.D. Over the course of a few months, Regan performed two procedures on Greenberg’s left leg – laser ablation (sealing) surgery on the great saphenous vein and phlebectomy (removal) of surface veins – and treated her right leg with an injectable medicine as part of a clinical trial. She went home the same day after each procedure.

“Where I was having these cramps in my thigh that laid me out on the floor, since then I have not had one,” Greenberg said.

And her ugly, bulging veins? “They’re gone,’’ she said. “One hundred percent gone.”

Regan is an interventional radiologist, which means he uses image-guided procedures to diagnose and treat disease. He specializes in vein problems, including varicose veins, spider veins, skin ulcers and deep vein thrombosis (sudden, severe leg swelling). An estimated 25 million people in the United States suffer from varicose veins, with women two to three times more likely to have the problem than men.

Regan’s minimally invasive surgery techniques involve making small incisions with specially designed tools that he guides while watching imagery on a screen. For example, Regan was able to see inside Greenberg’s leg while performing the laser ablation procedure to shrink and seal the wall of her saphenous vein. When the vein closed, blood was rerouted to other healthy veins.

The phlebectomy, also minimally invasive, used small incisions to remove the veins on the surface of the skin that were connected to the saphenous vein.

“With the increased use of ultrasound, we can now better diagnose problems, tailor treatment more specifically to the abnormality in the patient and just generally be more creative in what we do to minimize the procedure and really target what is bothering them,’’ Regan said.

“We commonly see people who deal with these problems for years and years and then finally get to the point where they say, ‘I can’t take this any more and I’m going to do something about it.’”

Whether the problems with veins are painful or simply cosmetic in nature, Regan said, “Things can be done to improve the patient’s lifestyle and improve their self-image as well.’’

Regan has worked at Wake Forest Baptist for 19 years and has become a leader in his field, watching the previous standard treatment of “vein stripping’’ – surgery in which a wire is inserted into the body with incisions and the vein pulled out – fall by the wayside.

“With minimally invasive procedures, patients are up and walking immediately,” he said. “There’s virtually no down time. Potential complications are eliminated. And, actually, long-term outcomes seem to be better with less-invasive procedures.’’

Regan said he became interested in minimally invasive techniques for treating vascular problems during the latter part of his time in medical school.

“I thought there was an opportunity to develop a clinically oriented practice in interventional radiology,” he said. “We’re primarily dealing with people who have correctible medical problems.

“We can make them look better. We can make them feel better.’”

Chris Koontz, 48, of Winston-Salem, had been running for nearly eight years and over time had noticed a dull ache in his legs at night, in addition to bulging veins on his calves.

“It was so slow in developing,’’ he said. “You’re not cognizant that’s what causing your problem. You just live with it. And slowly, over time, it becomes part of your routine, your sensation.’’

Like Greenberg, he did his own research on the Internet and wound up calling Regan, who did laser ablation surgeries on Koontz’s legs.

Koontz was quickly back on his feet. He’s now back to running, and said he feels 20 years younger.

“It’s been night and day, the freedom,” he said.

For Greenberg, the surgery on her left leg was problem-free; she only had to walk several times a day and keep the leg elevated for a couple of weeks. With the injection in her right leg, she noticed a gradual improvement and an end to the thigh cramps as her varicose vein faded away.

She said she was pleased to have been able to have her legs repaired using the combination of surgery and medication. As an added benefit, she received compensation for participating in the clinical study of Varisolve, the microfoam medication that was injected into her right leg.

The medicine is produced by BTG, a London-based pharmaceutical company. Regan has worked with Varisolve for several years, from its early trial stages.

Greenberg said that with a clinical trial, “There’s always the fear, what if something goes wrong?

“But it felt comfortable that I was in good hands, and Dr. Regan was the one teaching this procedure and doing this study at other hospitals around the country.”