Physicians develop
a new way to help
al varicose patients.

Varicose veins
are diminished
through the new
procedure.

Before

After

r. Eric Seiger thinks hu-
man beings weren't de-
signed as two-legged
creatures.
"We were made to be
on four legs — at least
our veins were," he
says.
This bi-legged con-
struction has resulted
in some problems. Mil-
lions of Americans suf-
fer from varicose veins,
a condition for concern,
medically as well as cos-
metically.
The disorder occurs when
vein valves get leaky. Healthy
valves pump blood upward to
the heart, but diseased valves
allow blood to slip. "What hap-
pens is, like a water balloon,
the pressure increases and di-
lates these veins," Dr. Seiger
says.
The result: pain, achiness, fa-
tigue, rashes and ulcerations.
There's no known reason
for the problem. Doctors say
heredity counts for a lot, and
the common myth — that the
obese run a greater risk — isn't
true.
"Some people are just born
with stronger veins," Dr. Seiger
says.
The physician and his part-
ner, Dr. Sandy Goldman, oper-
ate on varicose and spider veins
in their five "Skin and Vein Cen-
ters" throughout southern
Michigan.
Spider veins are less serious,
stringy red marks considered a
beauty nuisance but not a med-
ical dilemma. (Insurance gen-
erally covers help for varicose
veins only.)
In treating varicose veins,
Drs. Seiger and Goldman use

traditional techniques, such as
sclerotherapy, and a new pro-
cedure they've developed on
their own.
Sclerotherapy, administered
for about a decade by many clin-
ics worldwide, consists of in-
jecting an FDA-approved
solution into the vein through a
tiny needle. The solution irri-
tates the vein and prompts the
growth of scar tissue, which
shuts the vein down.
Blood, which would otherwise
flow through weakened veins
near the skin's surface, is
diverted to vessels deeper in
the body. The deep veins are
supported by muscle tissue,
which eases the journey upward
to the heart and enhances cir-
culation.
After sclerotherapy, patients'
legs are wrapped in bandages
for one to three days. This com-
presses the veins while scar tis-
sue forms. If patients want to
shower, they must wrap their
bandages in plastic. Five to 10
percent of sclerotherapy pa-
tients sustain a mild recurrence
and must be treated again.
'We're not reversing or elim-
inating the disease," Dr. Seiger
says. 'We suggest our patients
come in once or twice a year for
a little tune-up."
Before the development of
sclerotherapy, vascular sur-
geons prescribed surgical stock-
ings or support hose to reroute
blood through deep veins. For
more serious cases, they relied
on stripping to totally eliminate
the veins. Most stripping in-
volves an anesthetic and sever-
al one-inch incisions. Unlike
sclerotherapy, which closes
down the vein, stripping re-
moves it entirely.

I

Vascular stripping is still
common. Dr. Elie Aboulafia, a
vascular surgeon at Botsford
General and Sinai hospitals, be-
lieves the procedure is appro-
priate when the veins' main
trunks have seriously deterio-
rated and the veins themselves
cannot be used for bypass
surgery.
Unlike sclerotherapy, strip-
ping precludes recurring prob-
lems in the same diseased veins.
Traditional stripping, however,
can be painful and often re-
quires a two-week recovery pe-
riod. Plus, it leaves scars.

The procedure
applies
fat-removing
liposuction
technology to vein
extraction.

Not long ago, Drs. Seiger and
Goldman wanted to find a way
to lessen the pain of vein treat-
ment and decrease the scarring
and recovery time. They came
up with a procedure called "Am-
bulatory Phlebectomy Using the
Tumescent Technique For Lo-
cal Anesthesia." Their study (by
the same name) will be pub-
lished in the Journal of Derma-
tologic Surgery next month.
The procedure applies fat-re-
moving liposuction technology
to vein extraction. It begins with
a clinical consultation. The
doctors use a special stethoscope
to determine if the patient's
valves are diseased. If so, they

RUTH LITTMANN

STAFF WRITER

recommend sclerotherapy or
ambulatory phlebectomy. For
patients with recurring prob-
lems, they generally recommend
the latter.
Ambulatory phlebectomy pa-
tients then receive anesthesia
through the tumescent tech-
nique. A tube-like probe is in-
serted into the leg. As the probe
makes its way upward, anes-
thesia sprinkles out and numbs
the whole appendage.
The doctors make small prick
marks along the leg. These
serve as points where the veins
are pulled out with a hook-like
device.
Drs. Seiger and Goldman say
the 1 1/2 hour procedure is near-
ly painless. The patients' legs
are wrapped up and they are
sent home where they should
rest with their legs elevated.
The small incision marks heal
like pimples and fade away.
"It's better than stripping
because it's less traumatic,"
Dr. Goldman says. "The next
day, most people are back to
work."
The doctors say they conduct
12 to 20 ambulatory phlebec-
tomies a week. Sclerotherapy
still accounts for 40 percent of
their practice.
Dr. Patrick Lillis is the der-
matologist in Loveland, Colo.,
who first published a study on
the tumescent technique of
anesthesia for use on liposuc-
tion patients. He says Drs.
Seiger and Goldman had him
"really blown away" by their ap-
plication of the technique to
varicose veins.
"This is really going to be a
breakthrough," he says. "There's
going to be tremendous demand
for this." ❑

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