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Vascular Surgery

Non-invasive technique uses light as guide to effectively treat varicose veins

08/01/2008

Light-assisted stab phlebectomy (LASP) is a non-invasive procedure to remove branch varicose veins from the thighs, calves and ankles. In this innovative procedure, surgeons insert a light source beneath the branch varicose veins to illuminate them before gently excising them through tiny incisions.

Treating varicose veins - UCLA Gonda Venous CenterVaricose veins

Varicose veins are enlarged veins – commonly found on the backs of calves or on the inside of the leg – that are swollen and raised above the surface of the skin. Varicose veins can occur in the saphenous vein or in the branch-like tributary veins. They can be dark purple or blue, and look twisted and bulging. Varicosities develop when valves in the veins that allow blood to flow toward the heart stop working properly. As a result, blood pools in the veins and causes them to enlarge. According to the National Institutes of Health, varicose veins affect half the population over age 50 and are more common in women than men. Varicose veins are not life-threatening, but can cause discomfort and leg swelling and, on occasion, leg ulcers.

Treating varicose veins

Conservative treatment for varicose veins includes exercise, weight loss and elevating the legs when resting. Support stockings may help relieve the mild discomfort associated with varicose veins. Procedures such as closure of the vein by heat - using radiofrequency energy or a laser - are used in the larger saphenous vein, while sclerotherapy and phlebectomy (removal of veins through small incisions) are used for the smaller branch tributaries. The tiny spider veins are treated with either injection sclerotherapy or lasers. All of these treatments require surgeons to map out the varicose veins on the patient beforehand, when the patient is standing. The veins collapse and disappear from view once the patient is lying down on the operating table and as a result some varicose veins are missed.

Light-assisted stab phlebectomy (LASP)

The LASP procedure begins with a tiny incision near the varicose veins. The surgeon threads a slender tube with a light at its tip underneath the vein cluster, and an injection of saline and lidocaine (like novocaine) is used to make the veins visible. The lights in the operating room are turned off, allowing the surgeon to see the varicose veins illuminated under the skin. This technique allows maximum visibility - and helps ensure that all the varicose veins are identified and removed.

Next, the surgeon uses a crochet hook to grab the vein and pull it through the tiny nick in the skin. Using a gentle circular motion, the surgeon pulls the vein from the skin, gradually working the entire vein free. Further tiny incisions are used as needed to remove any remaining veins. The surgeon then flushes out any blood that remains in the channel that held the vein. The procedure is done under mild sedation. No sutures are used; instead, a tight dressing is applied, and the patient may go home within one hour after the procedure. Patients are instructed to elevate the leg for 48 hours. The incisions from surgery appear as small freckles when they are healed.

Patients who have undergone the LASP procedure often report a new level of comfort in their legs following the procedure. LASP is often used to treat branch tributary veins in the calf in conjunction with either laser or radiofrequency procedures, which are used to close the main saphenous vein that runs from the bottom of the foot to the thigh. By combining therapies, all vein problems can be resolved in most patients with a single procedure.

Better cosmetic results using a combination of surgical techniques

With traditional varicose vein surgeries, it is difficult for the physician to locate and remove all of the varicose veins. This is partially due to the fact that, with the patient lying down on the operating table, the veins collapse and disappear from view. 

Light-assisted stab phlebctomy is technique that illuminates the veins from below , making them even easier to see than when the patient is standing. “The main advantage of this technique is that is reduces the likelihood of missing varicose veins — including varicose veins that are not visible now, but that will become visible in the near future,” explains Peter F. Lawrence, M.D., chief of the Division of Vascular Surgery.

“The use of tiny instruments and tiny incisions makes the cosmetic result as good as it can possibly be,” Dr. Lawrence continues. “LASP puts together the best aspects of several minimally invasive procedures that have been successfully performed for many years.”

Participating Physicians

Peter F. Lawrence, M.D.
Professor
Chief, Department of Vascular Surgery
Director, Gonda (Goldschmied) Vascular Center
David Geffen School of Medicine at UCLA

Hugh Gelabert, M.D.
Professor
Department of Vascular Surgery
David Geffen School of Medicine at UCLA

Juan Carlos Jimenez, M.D.
Assistant Professor
Department of Vascular Surgery
David Geffen School of Medicine at UCLA

David A. Rigberg, M.D.
Assistant Professor
Department of Vascular Surgery
David Geffen School of Medicine at UCLA

Brian DeRubertis, M.D.
Assistant Professor
Department of Vascular Surgery
David Geffen School of Medicine at UCLA

Contact Information

For further information on the LASP procedure or to schedule an appointment, please contact the Gonda Venous Center at (310) 825-4357.

 





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