New procedures provide hope to chronic venous disease patients

Long-term solution now available for swollen legs and varicose veins

Thursday, 26 October 2017, Diseased or abnormal veins in the legs not only results in considerable discomfort for thousands of South Africans who suffer debilitating symptoms but can ultimately manifest in swollen and painful limbs, varicose and spider veins or in persistent ulcer wounds that heal only with difficulty.

“While it is not commonly known, a range of effective new treatment options are available to South African patients suffering from severe symptoms as a result of chronic venous disease [CVD],” says Dr Ariel Eyal, a vascular surgeon who practises at Netcare Sunward Park Hospital in Boksburg and Netcare Waterfall City Hospital in Midrand.

“These treatment options include a range of minimally invasive interventions undertaken by vascular surgeons through small puncture holes in the skin, and they are showing encouraging results both locally and internationally in resolving symptoms and facilitating wound healing in cases where ulcers have developed as a result of the disease.”

Dr Eyal, who has trained in Switzerland and Italy in the treatment of conditions associated with chronic venous disease, and runs a treatment centre at Netcare Sunward Park Hospital, explains that CVD is a common condition that affects the venous system or the system of veins of the lower extremities.
“As many as 30% of adults may suffer from this condition, which commonly develops later in life, although most do not have serious side effects and it is often considered to be little more than a cosmetic problem,” he says.

“Some individuals, however, suffer quite debilitating symptoms including pain, rashes and swelling in the lower legs and feet resulting in severely reduced mobility. In more serious cases, ulcer wounds may develop as a result of impaired blood flow returning from the legs to the heart. If left untreated, these ulcers, which are often difficult to treat, may become infected and require intensive and repeated wound care.

Dr Eyal explains that the veins in the leg contain one-way valves which enable blood to be pumped back to the heart and prevent it from flowing back down into the leg. When these valves become diseased or damaged a condition known as chronic venous insufficiency may develop. The valves no longer prevent the blood from leaking backwards and the blood may pool in the leg causing severe swelling.

“Venous disease may have a variety of causes and is common among patients who have suffered a deep vein thrombosis, or blood clot, in the legs, and may be associated with obesity and pregnancy. It may also develop in individuals who have a family history of the condition, who have suffered an injury to a leg, or who have had previous surgery,” notes Dr Eyal.

“Damage to the valves in the leg resulting in chronic venous insufficiency may be caused by extended periods of sitting or standing, reduced mobility or it may simply occur as part of the ageing process,” he elaborates.

“There are a number of medicines available for the treatment of CVD, but their effectiveness is often limited. Using compression socks or stockings do not offer a long-term solution for most patients, and may be difficult to use, especially in the elderly. However, the range of highly specialised minimally invasive procedures that are increasingly being used internationally, and now also locally, offers a low-risk and highly effective long-term treatment solution.”

“We are, for example, able to perform deep vein reconstruction interventions, which are undertaken to improve the outflow of blood from the leg. This typically entails angioplasty, which is a procedure using catheters and balloons to open blocked or narrowed veins and restore blood flow. We also place stents, which are small metallic tubes, inside the iliac veins to relieve obstructions and ensure the vessels remain widely open.

“After this procedure, the majority of patients experience pain relief and approximately half report complete pain relief. Some 30% of patients have complete resolution of the swelling or oedema while a significant 90% of patients are free of ulcer wound recurrence at five years.”

“Interventional therapy is, in addition, available for treating diseased and leaking valves. We may also use sclerotherapy, a medical procedure involving the injection of a solution to eliminate varicose and spider veins while laser ablation may be used to remove larger varicose veins, depending on the individual’s condition. Patients with ulcers now also become excellent candidates for standard wound therapy or vacuum-assisted therapy.

“These highly specialised interventions offer CVD sufferers new hope and truly meaningful long-term symptom relief, as well as greatly improved prospects of wound healing, with the restoration of healthy blood flow seemingly enabling the recovery of the vascular system. Furthermore, the minimally invasive interventions do away with the need for traditional surgical procedures that may have previously been used to treat, for example, varicose veins,” explains Dr Eyal.

According to Dr Eyal, patients are first examined clinically and with duplex, Doppler technology to assess the flow of blood in the veins. Most patients go home the same day after the procedure and most will no longer need to use compression socks or stockings.

The general manager of Netcare Sunward Park Hospital, Dr Annamarie Richter, says that Dr Eyal and his team are to be congratulated for establishing a world-class CVD treatment centre at the facility and which has few equals anywhere else in the country.

“Dr Eyal is one of the very few vascular surgeons in South Africa to have developed such a high level of expertise in this field. The hospital is most gratified to be able to work with him and his team to offer this service to our patients,” concludes Dr Richter.