Give Those Veins the Slip (Stitch)

A Stitch in Time

Redefining size seven crochet hooks, Dr. Peter Lawrence, UCLA's chief of vascular surgery uses the sweater-making tools as his instrument of choice in the newest technique for treating varicose veins: light-assisted stab-phlebectomy, or LASP. Lawrence developed the outpatient procedure which does the trick for the removal of branch varicose veins from ankles, calves, and thighs.

LASP is a combination of two methods of vein-removal: the powered phlebectomy and the stab phlebectomy. These techniques allow surgeons to remove veins while working through small incisions in the skin. Dr. Lawrence's added improvements involve the use of a light that is beamed beneath the skin to help locate the veins during the procedure as well as the development of new surgical instruments modified from size seven crochet hooks. The crochet hooks, now surgical instruments, have been found to be minimally invasive for the removal of veins.

Lawrence, a professor at the David Geffen School of Medicine at UCLA, and author of the study said that, "This new, sutureless technique allows complete and rapid varicose branch vein removal with few missed varicose veins, little bruising and an excellent cosmetic result."

Groundbreaking Procedure

Patients undergoing the LASP procedure are sedated but remain conscious. Dr. Lawrence passes a thin tube with a lighted tip through a small incision close to the varicose veins and then brings the tip beneath the venous area. A special mix of saline, lidocaine, and epinephrine is pumped into the area, helping to numb the area as well as pump up and fatten the veins so they can be seen. The operating room is darkened, so that Lawrence can see the veins which are now illuminated by the lighted tubes threaded beneath the patient's skin.

This use of transillumination is a groundbreaking procedure insofar as it offers the surgeon the best possible view of the work he needs to do. "Usually the veins are mapped before the procedure, which is not as effective," says Lawrence.

Lawrence makes a tiny incision just next to a varicose vein, and using the filed down crochet hook, reaches into the incision, hooks a vein, and pulls it out. The lights in the operating room are turned back on; Lawrence evaluates the vein, clamps its base, then separates the vein from the skin with a circular motion. Each vein will require its own tiny incision.

The veins are then washed with more solution that helps flatten them so as to prevent bruising and bleeding under the skin. The areas of incision are left unstitched to allow for drainage, should it be necessary. The doctors apply a compression dressing and the patient is ready to leave for home within an hour. At home, the patient elevates his leg for 48 hours. The tiny incisions are so small that when healed they look like freckles.