High-Intensity Focused Ultrasound (HIFU)
may prove to be the next disruptive technology in the treatment of varicose veins and venous reflux disease. It is totally non-invasive, with ultrasound energy being beamed from a transducer applied to the skin above the vein. The gentle pressure of the device on the skin above the vein closes the vein, removing any blood that might thrombose or remove heat during treatment.
HIFU heats the target vein to temperatures proven to cause permanent closure of a leaking varicose vein by fibrosis. It does not require cannulation of the vein, and indeed nothing is inserted into the target vein at all. There is no need for an operating theatre and, as nothing is introduced into the vein itself, this procedure can be performed in a clean clinical room.
The treatment is totally non-invasive, except in those patients who may need small volumes of a local anesthetic to be injected around the target vein. However, even if local anesthetic is used, the volumes for this are substantially less than the amount of tumescence pumped around truncal veins during catheter-based endovenous thermo-ablation. As the vein is not cannulated, infection and bleeding risk are minimal. Of course, as with any new technology, the current device is large, cumbersome, expensive and treatment is slow in long truncal veins.
The HIFU machine, Sonovein, automatically detects the depth of the vein from the skin surface, and adjusts the maximum energy that can be delivered, in order to protect the skin. This, combined with a skin cooling delay which is computed within the device, prevents any thermal skin damage. This appears to work as no skin burns or skin complications have been seen in few cases which have been performed to date. However, this is a new technology, and a lot of work yet needs to be done before it is introduced as part of the regular treatment offered to our patients.
It is important that the procedure is performed by an expert, who has thoroughly evaluated the patient and is very well experienced in the technique. It is also important to note that every patient of Varicose veins is different, and no one procedure can be used to successfully and adequately all patients. The type of procedure performed is at the discretion of the treating doctor, who may even use one or more techniques to give the best result.
Dr. Shoaib Padaria has over 30 years of experience in treating Vascular Diseases, and over 17 years in treating veins by Endovenous methods. The first documented case of the Endovenous Laser for varicose veins was performed by Dr. Padaria at Jaslok Hospital on 6th January 2003. Since then he has performed more than 16000 treatment procedures. Dr. Padaria is well versed in all modern techniques of Varicose Veins treatment and is part of many teaching courses and workshops, both Nationally and Internationally.
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