Scott Webb (Host): Chronic venous disease affects tens of millions of Americans, and my guest is here today to tell us about venous ablation, which is a minimally invasive procedure that has proven to be incredibly effective in helping folks with chronic venous disease. And I'm joined today by Dr. Chanaka Wickramasinghe. He's a Cardiologist with Eisenhower Health.

 This is Living Well with Eisenhower Health. I'm Scott Webb.

Doctor, it's so nice to have you here today. We're going to talk about venous ablation. And I feel like I've heard that before, venous ablation, but I don't know what that is. So let's start there. What is venous ablation?

Chanaka Wickramasinghe, MD: So venous ablation is a procedure, a minimally invasive procedure we use to treat people with a condition called chronic venous disease. Chronic venous disease is a condition that's pretty common in the USA. You know, the estimates based on the data we have available suggest approximately 150 million people have some form of chronic venous disease.

 So you may ask, what is chronic venous disease? So chronic venous disease is a condition when the superficial veins in your legs do not drain the blood and the fluid back to the heart as they should. So you know, your heart sits in the center of your chest and it supplies blood and nutrients to the rest of the body. That blood, nutrients and fluid has to recirculate back to your heart and then be sent back down. So, the blood flow and the nutrient flow from your legs back up to your heart occurs through these conduits or vessels called veins and in your legs there are two types of veins. There's a type called a superficial vein that's right under your skin and there's a deep vein that's more deeper to the muscle.

All of us, over time, have dysfunction in the superficial veins. So, these veins start either wearing out or leaking blood and fluid back downwards, as opposed to up towards the heart. There are some risk factors which make that progression or the dysfunction move faster. So, people with family history or genetics where it runs in families, there's a familial component of varicose veins or venous disease.

People whose occupation involves prolonged standing, you know, if you've been on your feet most of your life during work, you have a higher pressure in the veins in your leg, so over time those veins give up faster. Certain conditions like blood clots in your legs can damage the veins. And then women and pregnancy increase the pressure in the legs that predisposes to venous disease. And finally, one of the other main risk factors, as with most medical conditions we see is smoking. Smoking damages the veins. That essentially is chronic venous disease when the veins in your legs don't circulate the blood and fluid back to your heart as expected and there's a leaking of blood and fluid back towards your legs.

Host: Right. Yeah. And as you say, it could be something like 150 million people with some form of venous disease. So you kind of understand why we need folks like yourself, why we need this procedure. Let's talk a little bit about the circumstances under which this procedure is done.

Chanaka Wickramasinghe, MD: So this is a minimally invasive procedure. So, you know, once you've been diagnosed with this condition and you have symptoms, the procedure is done in the outpatient office setting. It's a minimally invasive procedure. The patient is not sedated. The patient doesn't have to be in a fasted state. They can eat and drink, drive to their appointment. We lay them on a bed in a procedural room in our office. We then, under ultrasound guidance, identify the leaking vein in their leg. And then we numb the skin using lidocaine and then with a needle I am able to access that leaking vein and send a wire or a catheter up all the way into that vein and then treat it with something called radiofrequency ablation.

That's why it's called a venous ablation because we use thermal or heat energy to burn that vein that's leaking. And in doing so, we collapse that vein and close that leaking vein. Then what happens is, if you collapse or close the leaking vein, the fluid and blood can then diverge into your healthy veins and go back to your heart in a more efficient way.

Host: Yeah, I see what you mean. And I'm trying to think about maybe like, what are the symptoms do folks experience? Is it pain in their legs? Is it sort of leg tiredness?

Chanaka Wickramasinghe, MD: Correct. So some of the things we tell folks to watch out for, because as I mentioned, this is a very common and there are different stages to it. So, in the early stages of this condition, you may notice just a bit of swelling, and most people will say, you know, in the morning, they get out of bed, their legs look fine, and then after a long day of standing or being seated, towards the end of the evening, that they notice their feet, their shoes feel a bit tighter because of swelling, or they see an indentation around where their socks were, and that is because of the accumulation of fluid, and that's called edema or swelling.

As the disease progresses, that's when they get more symptoms, such as pain is a common symptom. Some people say their legs feel heavy or tight. They feel like they're walking on sand. And then more advanced symptoms are people start getting really bad cramps. And, eventually, from the pressure in the skin, from the swelling, the skin can start breaking down. And people can get really bad wounds in the legs and that can put them at risk of developing something called venous ulcers. And those are very painful and they're very hard to treat.

Host: Yeah, so it definitely seems like this is the kind of thing that affects people's quality of life and you know, early diagnosis would be really helpful. So let's talk about the procedure a little bit. How long does it take? How effective is it? What's the success rate? All that good stuff.

Chanaka Wickramasinghe, MD: Right. So, the procedure takes about 15 to 20 minutes. We typically treat one leg at a time. Okay. The procedure, if done in the right patient, once we confirm they have a leaking vein, the success rates for the procedure is about 97% for improvement of symptoms. One of the key things we advise all of our patients pre and post procedure are some lifestyle or supportive measures such as making sure if they're going to be seated at home for a while keeping their feet elevated So you help gravity drain that fluid and blood back to your heart, Using something called compression stockings, which you can buy online any pharmacy, to improve the circulation back to your heart, especially if you're going to be traveling for prolonged hours.

If you're flying on a long flight, or you're going to be out standing or playing golf or pickleball for several hours, we'd like you to put compression on to prevent the accumulation of fluid. You know, the procedure combined with those supportive measures has about a 97 percent success rate for resolution of symptoms and then for long term prevention of recurrence of symptoms.

Host: Yeah, you mentioned pickleball there. We know that's quite popular, of course. Wondering if there's any side effects to venous ablation.

Chanaka Wickramasinghe, MD: So the main side effects to the procedure as with any, you know, cardiac or invasive procedure we do, is we are entering your skin with a needle and entering a blood vessel. So when we go through the skin there's a risk of infection. We minimize that risk to less than 1 percent because it's done in a sterile setting.

We clean your leg with sterile solution and we have you in a sterile dressing. The second risk is when we are entering a blood vessel and sending a wire up that blood vessel; there's a potential risk of damaging that blood vessel. Again, that risk is less than 1 percent because the procedure is not done blindly. It's done using ultrasound guidance. So, I see the tip of my needle entering the blood vessel. And I also see the size of the blood vessel, which is why patient selection is very important because the blood vessel that's leaking has to be a certain size to do it safely. And then the final, I would say the most, procedural specific risk is when we ablate or burn that superficial blood vessel;

sometimes people can get small superficial clots in their blood vessel. Clots in superficial blood vessels we don't worry about. So after the procedure, everybody gets an ultrasound scan done within 7 days to look for that. If the clot is in a superficial blood vessel, you leave it alone, it goes away. If that clot migrates though and goes up towards the deep vessel in your leg, then we treat those patients with a full dose aspirin or a blood thinner such as Eliquis for two weeks. Again, that risk is less than 3%.

Host: Right. Right. So, uh, lots of folks have this. Lots of folks would benefit from venous ablation. You know, highly successful, low risk of side effects. It all sounds like a winner, Doctor. I just want to finish up here. You know, you as a Cardiologist, why is venous health, the health of our veins, especially in our legs, so important to cardiac health?

Chanaka Wickramasinghe, MD: So because, you know, when we think of your heart, it's involved in pumping blood and draining blood. So your heart pumps oxygenated good blood through vessels called arteries to the rest of your body. And the return of blood is just as important. So the veins play a crucial role in returning that blood to your heart.

And then the other thing is, with this condition, if you leave it alone and it keeps progressing, venous ulcers are a very difficult condition to treat. And when they get infected, you risk infecting your valves in your heart and any other complication of a venous infection, such as clots in your leg, just pain and prolonged healing.

So, you know, it ties into basically better heart health, making sure your legs are looked after as well.

Host: Yeah, that's perfect. It's always great to have experts on and kind of lay this out for us. And as you say, like early diagnosis of this, not ignoring the symptoms, being treated, considering venous ablation, all good stuff. Thank you so much.

Chanaka Wickramasinghe, MD: Thank you Scott.

Host: And for more information, go to eisenhowerhealth.org/cardiology. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest. I'm Scott Webb. And this has been Living Well with Eisenhower Health. Thanks for listening.