Varied Choice for Varicose Veins

Vaired Choice for Varicose Veins

Diagnosing a case of varicose veins is easy enough: the swollen and tortuous blood vessels stand out in bold relief on the victim's legs. Deciding on treatment is something else, and the choice is most likely to depend on the doctor's nationality. In U.S. hospitals, the preferred approach is to "extinguish" the offending veins by stripping them out in tedious operations that take up to twelve hours and leave the footsore surgeon himself a candidate for varicose veins. In Europe, doctors reach for hypodermics, hoping to harden the veins and cure the trouble quickly with simple injections.

While the international argument continues, the biggest excitement in phlebology (the study of veins) is now being generated in England and Ireland, where inventive surgeons are perfecting their injection treatments. Ironically enough, they are improving on techniques developed by Americans.

Purple Ropes. Behind the widely varied treatment for varicosity lies the basic fact that no one knows what causes the trouble in the first place. Doctors agree only that the condition tends to run in families, to strike people who spend most of their time sitting or standing, and to appear often during pregnancy. About 10% of the U.S. population are affected--men and women almost equally.

It is also certain that man's upright posture puts an unnatural burden on the veins of the feet, legs and thighs, which have to work against gravity when blood is returning toward the heart. Normally, most of the blood travels through deep, internal veins, which are tightly enclosed in muscle and other tissues. The rest of the blood goes through thin-walled surface veins. Connecting the internal and external veins, like the rungs of a ladder, are horizontal communicating veins. All these veins are fitted by nature with internal cuplike valves, which open rhythmically to let a certain amount of blood flow up, then close to make sure that none flows back.

When these valves fail, usually for unknown reasons, blood pools in the legs, especially in the fragile, surface veins, distending them until they look like ugly purplish ropes, all knotted and snarled. As bad as the appearance are the possible complications: the veins often develop inflammation (phlebitis) and sometimes become infected; they may also become ulcerated, or break at a touch and bleed copiously.

These risks are virtually abolished if the surface veins are extinguished, leaving all the blood to return through the deep internal veins, which can easily carry the added load in most cases. The same result, say European phlebologists, can be attained for most patients by injections that sclerose (harden) the veins, and close them.

From Cod-Liver Oil. A pioneer injector, Manhattan's Dr. Hyman I. Biegeleisen, started with cod-liver oil extracts and worked up through a series of progressively more sophisticated chemicals that hardened and shrank varicose veins. One trouble with his treatment was that it required a series of injections spread over several weeks, and the chemical he used most often, sodium tetradecyl sulfate (trade-named Sotradecol), sometimes caused allergic or other reactions. New York Hospital's Dr. William T. Foley got around such reactions by using a mixture of salt solution and heparin; he also worked out a method for preventing dilution of the sclerosing chemical by draining the blood from the veins before making injections.

Before Dr. Foley's description of his work was published last year, Surgeon William George Fegan began using a similar technique at Sir Patrick Dun's Hospital in Dublin. Fegan injected a few selected veins, and stuck to Sotradecol as the sclerosing chemical. Surgeon John Thomas Hobbs at St. Mary's Hospital in London also uses Sotradecol, but maps and injects many more up-and-down as well as connecting veins. For the vital points in all of these veins must be closed, to reduce the likelihood that any of the sclerosed channels may later reopen.

Surgeons Fegan and Hobbs both drain the blood from the veins with the leg held slightly above the horizontal; Fegan begins injections at the foot, while Hobbs works downward from the groin, with the leg restored to a vertical position. The British patients have suffered no significant adverse reactions--largely, Dr. Hobbs suggests, because when the injections are given all at once the patient's system has no time to develop sensitivity to the sclerosing chemical. And most important, even though the Hobbs method may require as many as 15 to 25 injections in each leg, it takes less than an hour after preliminary marking.

A Smoother Leg. Elastic bandages are applied at once over pressure pads at the injection sites, and patients can quickly resume activities; many have gone back to strenuous work within 24 hours. Of more than 1,000 patients treated so far, only 20 have later needed minor surgery. With thousands of Britons waiting months for nonemergency surgery, 75% of them for varicose veins, it is estimated that the doctor's office injection system could free 4,000 hospital beds.

Most U.S. surgeons remain unimpressed. Toledo's Dr. Bert Seligman, however, went to Dublin as an investigative unbeliever and came away substantially converted. In two months he has used the method on twelve Ohio patients. Dr. Seligman still feels sure that generally U.S. women who can afford the time and money will continue to choose surgery because it will leave them with a smoother, less lined leg. But the improved injection method, he is convinced, will be a boon in properly selected cases where a businessman or housewife cannot afford much time off the job.

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