Serving Boone, Blowing Rock, Banner Elk, and other towns of the North Carolina High Country
Founded 05-05-05
May 3, 2007 issue
Story by Sam Calhoun
When symptoms of varicose veins—swelling and pain in the legs, discoloration of skin around the ankle or ulcerations around the ankle—become a problem, two minimally evasive treatment options are offered in Watauga County.
The first—covered in the March 22 issue of High Country Press—is EVLT, endo venous laser treatment, that involves inserting a laser fiber through an incision to the sapheno femoral junction near the groin. The laser energy seals off the vein for about two minutes, cutting the blood flow to tributary varicose veins, and then the laser actually melts the vein from inside the leg.
The other method is called RFA, radio frequency ablation. A catheter placed into the greater saphenous vein is advanced to the sapheno femoral junction. Once there, prongs at the end of the catheter open and come into contact with the vein wall. The radio frequency is then turned on and the catheter is pulled back slowly. The catheter heats the inside of the vein to 85 degrees Celsius, resulting in fibrosis of the vein. “It literally glues the vein together,” explained Dr. Paul Dagher, FACS (Fellow of the American College of Surgeons), of Watauga Surgical Group, 965 State Farm Road in Boone.
The old, painful method of removing varicose veins was called ligation and stripping. Patients were put to sleep and their varicose veins were literally yanked out of their legs. As an alternative, VNUS Medical Technologies developed RFA almost a decade ago, and EVLT was developed five years later as another alternative.
If RFA is used to treat symptoms and not used for cosmetic reasons, all consultations and procedures are covered by insurance.
“The reason for doing this is to improve quality of life,” said Dagher. “The pain of varicose veins is just a symptom of high pressure due to malfunctioning veins.”
Varicose veins are bad valves in the superficial veins of the leg that fail over time. Blood deep within the leg backflows into these faulty veins and causes pressure that results in pain.
“Instead of blood flowing from the foot to the heart, the blood flows back down, creates pressure and dilates the veins until they become varicose,” said Dagher.
When Dagher began treating varicose veins two years ago, he had a choice between offering EVLT or RFA. At the time, 75 percent of physicians used RFA and 25 percent used EVLT.
Dagher chose RFA because it had been around longer, because data suggested that it works better and because it is minimally evasive.
Of the patients who underwent the old procedure of ligation and stripping, 45 to 60 percent could expect their varicose veins to recur after treatment. Almost ten years of data on RFA, however, shows a recurrence rate of between 2 and 10 percent. Five years of data on EVLT indicates a recurrence rate of between 2 and 30 percent, but Dagher said that five years is not enough time to definitively determine the recurrence rate.
Around 85 percent of RFA patients are able to return to work the next day. Dagher’s staff also polls patients the day after the procedure and asks them to rate their pain on a scale of 1 to 10. The highest rating reported in two years is 3 out of 10. The procedure takes roughly 45 minutes per leg and can be done in the office.
“In about 24 hours, [RFA] leads to the alleviation of the majority of patients’ symptoms,” said Dagher.
After the procedure, 50 percent of patients have resolution of varicose veins altogether and 92 percent have resolution of symptoms, according to Dagher.
For more information, call the Watauga Surgical Group at 828-264-2340 or click to www.wataugasurgicalgroup.com.