For the first time in Houston, a new, in-office procedure for removing the source of painful varicose veins has been performed at the Greater Houston Vein Clinic by Dr. William B. Berry, F.A.C.S.

For several years, laser technology has been available for the removal of varicose veins and unsightly spider veins. Only now has laser technology advanced to the level of allowing doctors to safely remove the actual source of these painful varicosities through the obliteration of the greater, or long saphenous vein without hospitalization. The success rate for this procedure currently ranges nationally around 97%, and provides a new option to patients who would otherwise be hospitalized and subjected to general anesthesia, as well as all of the discomforts associated with hospitalization.

The long saphenous vein, which is also called the greater or superficial saphenous vein, is the same vein that is harvested for use as a coronary artery by-pass graft. It connects to the deep femoral vein at the groin where there is a constant valve present to prevent blood from backing up into the superficial system. ( See Attachment).

The long saphenous vein is not the actual varicose vein, however, if it receives high pressure through retrograde blood flow, because of an incompetent valve at the sapheno-femorall junction, then it does become the source of the varicosity, and during the act of taking a deep breath, for instance, blood will reflux back into the long saphenous vein instead of moving through the deep femoral vein back to the heart. This causes a situation of high pressure in that vein.

Over a period of time, left unattended, blood will seek an escape path from that high-pressure zone causing enlargement of other small veins coming off the saphenous vein. These veins are called reticular veins, and once their enlargement falls in the range of 4-6 millimeters, they begin to move toward the surface of the skin and become the actual varicosities or varicose veins.

If the long saphenous vein is removed, assuming that the above-mentioned condition exists, then by definition there will no longer be a high-pressure system affecting the varicose vein, and the varicose vein will collapse. Although the long saphenous vein is not actually removed in this laser procedure, the same effect is achieved through laser energy destruction of the vein wall.

To take out a varicose vein and leave a high-pressure system present in an existing long saphenous vein, expectedly, other varicosities will arise within a period of time, depending on the genetic make-up of the individual. Therefore, it is not recommended just to remove varicosities and leave a high-pressure system working in the saphenous vein expecting to get an 80-90% success rate.

The recommended procedure is to image the sapheno-femoral junction with the ultra-sound technology, find out if and where the incompetence exists, and, if it is affecting the long saphenous system, then remove the long saphenous system. This theory is true whether you remove it in an earlier traditional way in a hospital with general surgery, with a pin stripping device on an out patient basis, with a radio frequency probe or whether you remove it with a laser filament. The end result is all the same -- the vein is gone, the high-pressure mechanics are gone, and the varicose vein will collapse in approximately 95% of cases.

Dr. Berry, a senior cardiovascular surgeon in Houston, who has performed thousands of heart by-pass procedures, is deploying the new laser technology at the Greater Houston Vein Clinic, and, with the assistance of ultra-sound technology for diagnosis, is now performing the in-office procedure virtually pain free without general anesthesia or hospitalization, and patients can return to work with little or no recovery period.

Dr. Berry’s deployment of the ultra-sound technology partnered with the laser technology not only allows for a more accurate diagnosis, but also for a safer procedure with constant monitoring throughout the entire process. This technology confirms whether or not the valvular mechanism between the superficial system and the deep system is adequate, and allows him to see clearly whether the deep system is open. If there are clots in the deep system, or if there is any existing pathology in the deep femoral vein, the patient is not a candidate for this procedure, because that might be the only mechanism the patient has to drain blood from the leg back to the heart.

Once the ultra-sound determines that the deep system is open, Dr. Berry says, “we know that we can remove the superficial system, because blood will still be able to return to the heart from the deep system. “ In addition,” he says, “since we certainly know that over 450,000 coronary by-pass procedures are successfully being performed in this country every year, and that the veins are being utilized in these patients as by-pass conduits in the heart with no problem experienced in lower extremity function, then the deep system by itself is quite competent to return all blood out of the legs back to the heart.”

Importantly, patients’ vein health is dependant upon an accurate diagnosis, and Dr. Berry deliberately provides patients with all the information they require to feel confident about their decision to eliminate this painful inhibitor to normal activity in a brief procedure without hospitalization and risky surgery.

Dr. Berry recently performed the first procedure of this type in Houston on a man with an active lifestyle, who suffered from varicose veins, which had become unsightly, uncomfortable, and occasionally disabling during exercise. He examined the patient and determined with the use of a portable doppler system that the patient had reflux of blood from the deep system into his superficial saphenous vein and into the varicosities at various points in his leg.

After the patient’s options were discussed with him, he agreed to continue with the diagnostic procedure, which determined that the valve at the sapheno-femoral junction was incompetent, and that he was indeed a candidate for this procedure with a competent deep system.

He reappeared in the office on the scheduled day and again his saphenous vein, the superficial system, was mapped out and marked for the laser fiber or filament to be inserted. The filament was inserted at the knee and positioned just below the sapheno-femerol junction using ultra-sound. Once the laser fiber was in place, a local numbing agent allowed the patient to be completely pain free along the course of the long saphenous vein, at which point the laser was then activated and an intermittent light pulse was delivered to the vein as the filament was withdrawn. At the completion of the withdrawal procedure, the vein had been completely destroyed by light energy delivered by the laser.

A compressive dressing was applied to the patient’s leg followed by application of a custom fitted compression stocking, and the patient then left the office with an anti-inflammatory prescription to be taken twice daily. He was out of the office in less than 1 1/2 hours and drove himself back home. He has been seen in follow-up and continues to show complete obliteration of the saphenous vein. This obliteration technique removes all increased pressure delivered to the varicosities, and any remaining varicosities in the lower extremities will most probably not require treatment, since there is no longer any increased blood flow into them.

Research has revealed that the 940nm wavelength is the most accurate level to target red blood cells for energy absorption. The laser system deployed by Dr. Berry at the Greater Houston Vein Clinic utilizes this wavelength, and is the most advanced system in the industry, overcoming shortfalls of other light systems. This method is considered to be the most recommended for the obliteration of the greater saphenous vein with the least amount of risk and/or distress to the patient.

Dr. Berry also utilizes the latest technology to remove reticular veins, which are targeted with a VeinLite for more accurate removal. At the Greater Houston Vein Clinic patients can be assured that, whether they are being treated for vein problems, such as the destruction of the long saphenous vein, or for a more minor procedure, such as the removal of reticular or spider veins, they are receiving accurate diagnoses and procedures utilizing the most advanced technology available.