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1. When dealing with lower extremity varicose veins, a prsctioner should first exclude or tre... Page 1 of 6
TransLite Application Note Number 1
Using the Veinlite for Varicose Veins Treatment
Asad R. Shamma, M.D. Nizar A. Mullani B.S.
Introduction
Veinlite is a relatively new device for transilluminating superficial veins and assist in the
treatment of these veins. Transillumination, i.e. shining light through an object to make the
tissue transluscent, has been used for many years to aid in the visualization of superficial
veins. However, this classical transillumination method is achieved by shining light through the
body and is of limited use for imaging thick areas of the body. Light is absorbed by body tissue
within a few mm and can not pass through thicker body parts. Therefore, classical
transillumination has not been used very much in many medical applications.
Side-Transillumination
A new patented transillumination method (3), called Side-Transillumination, removes the need
to transmit light through an object. Unlike classical transillumination, side-transillumination or
oblique angle transillumination, shines light into the skin at an angle from outside the area of
interest. A circular array of bright fiberoptic light is directed to the circle’s center at an oblique
angle, so that the light is focused a few millimeters below the skin surface. The focused light
creates a conical volume of illumination, with the central focus point being very bright and
acting as a virtual light source under the skin. This technique achieves uniform
transillumination of a small region of percutaneous tissue, anywhere on the body. The light
transmitted through the skin is orange to red in color and is very sensitive to absorption by
deoxygenated hemoglobin. The result is that percuteneous blood vessels are seen with great
contrast up to a depth of 5 mm or more depending on the size of the blood vessels.
Veinlite Design
The Veinlite is designed as a circular array of light source with an opening in one end to
provide access to the vein during visualization as shown in Figure 2. It uses a very bright ring
of cold fiber optic light that is directed at an angle towards the center of the ring, to form a
virtual light source at a depth of approximately 1 cm. The virtual light source under the skin
makes the circular area within the ring to become translucent. Blood vessels are seen with
great clarity. Varicose and feeder veins are easily identified and can be accessed through the
opening in the ring. The concept of side-transillumination is shown in Figure 2 below.
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viewer
bright light source bright light source
skin surface
deeper veins
are visualized
virtual light
source
Figure 1. Side-Transillumination Method Showing the Direction of the Light Towards the
Center of the Ring to Form a Virtual Light Source a Few Milimeters Below the Skin Surface.
This Makes the Skin Area Within the Ring Translucent.
Using the Veinlite for Varicose Veins Treatments
Varicose veins are enlarged venous blood vessels that that can range in size from a fraction of
a millimeter to several millimeters in diameter. These enlarged blood vessels are characterized
by poor blood flow and often have retrograde blood flow, which can cause bulging or blood
clots. Superficial varicose veins such as spider veins, reticular or feeder veins that feed these
spider veins, or the larger superficial veins can be easily seen using the Veinlite
transilluminator.
The Veinlite can be used in several ways to aid the physician in treating varicose veins. These
are
1. Treatment of superficial spider veins and reticular or feeder veins with sclerotherapy
2. Mapping of the venous network of large superficial varicose veins for mini ambulatory
phlebectomy to assist with surgical planning
3. Aiding in visualization and evacuation of trapped blood in bulging veins
4. Determining reflux of blood flow in superficial veins
5. Education of the patient of the extent of the disease
Veinlite Assisted Sclerotherapy of Reticular and Spider Veins
Reticular veins, or feeder veins as they are often referred to, are often associated with
superficial spider veins and feed a network of tiny superficial veins that are varicosed.
Depending on skin color and extent of adipose tissue, reticular veins may be difficult to see
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with the naked eye. Unlike larger varicosities, they are difficult to palpate as they do not bulge.
The Veinlite is an excellent device that can help visualize these reticular veins and assist in
accessing these deeper veins for the treatment of superficial varicosities.
When dealing with lower extremity varicose veins, the physician should first exclude truncal
saphenous reflux, or treat it if present. Following this, the patient is typically left with a
combination of bulging varicosities, reticular veins, and spider vein complexes. These are
mostly of cosmetic concern but need to be treated to avoid future complications from
developing.
While bulging varicosities may be treated by phlebectomy or sclerotherapy, it is universally
agreed that reticular veins are best treated by sclerotherapy. These subdermal reticular veins,
which appear blue, are often referred to as ‘feeder veins’, as they supply the more visible
spider vein complexes. By treating them, the spider vein complexes are weakened and often
disappear after a single injection of sclerosant.
Technique for Treating Reticular Veins with the Veinlite
The Veinlite is much more than a visualizing aid for superficial veins. Its C shaped ring with an
access port is designed to
(a) sequester the vein,
(b) isolate the area being treated, and
(c) help stretch the skin while inserting the needle in the vein.
The best way to achieve successful treatment of a varicose vein is to first visualize the vein to
be treated using the Veinlite. Following that press lightly on the skin with the Veinlite ring and
pull it back, stretching the skin in the direction opposing the opening in the ring. This action is
the key to successful sclerotherapy as with the Veinlite as it achieves two vital objectives. First,
it stabilizes the vein and facilitates accurate entry of the needle into the stabilized vein that
does not ‘run away’ from the needle. Second, it tightens the overlying skin and permits an
almost painless entry through the skin into the vein, which would be difficult otherwise,
especially if the skin is loose and or redundant. This is particularly useful when treating older
patients, with sagging skin, and is vital when doing sclerotherapy on reticular breast veins. See
Figure 2.
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Figure 2, Vein Stabilization and Injection Technique
After securing entry into the vein, confirmed by blood return, gradually release some of the
pressure applied to the skin by pressing on the Veinlite ring. Then, using a 3cc luer lock
syringe with a 30 gauge needle, and with minimal force on the plunger, gently inject sclerosing
agent. As soon as you see the vein segment within the ring blanch, re-exert pressure on the
skin by pressing on the Veinlite ring and keep your thumb firmly on the plunger for around 10
seconds. This minimizes the rapid refilling of the vein with blood and allows the sclerosing
agent to stay in contact with the intima for longer interaction time.
In treating the whole leg with the Veinlite assisted scleroptherapy, start with the patient in the
supine position and work on the anterior limb, from just above the ankle up to the groin. Then,
ask the patient to roll (one quarter turn) laterally and do the same procedure on the outside of
the limb. The patient rolls again to lie prone and treat the posterior limb. Finally, after the
patient rolls again, perform the procedure on the inside of the limb.
Compression stocking is used after the treatment, applying a light, thigh high liner under it. The
liner allows for easier application of the stocking and keeps it clean.
To help the Veinlite ring slide easily over the skin, advise the patient not to apply any lotion to
their legs on the day of treatment. Prior to starting the procedure spray the skin with 70%
alcohol. Between patients, the ring is cleaned using lint free gauze and 70% alcohol.
Limitations of the Veinlite for Sclreotherapy
For the technique to be most effective, a tight seal is needed between the ring and the skin.
This is difficult when treating over bony prominences such as the ankle, anterior shin or knee
cap. This limitation may be overcome by using a smaller ring on these difficult areas. However,
the smaller ring is more difficult to use, owing to its smaller opening.
The second limitation is that the phlebologist is obliged to perform the aspiration of blood and
the injection of sclerosing agent, with a one hand technique, as the other hand is holding the
ring. While this is easy for some of us, others find it more difficult. Fortunately, there are new
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devices that facilitate the one hand injection technique.
Mapping of Veins Prior to Ambulatory Phlebectomy
A preferred method for treating bulging varicosities is mini-phlebectomy. This procedure
minimizes the trapping of blood in the bulging veins that often accompanies sclerotherapy.
To best achieve this procedure, the sites of puncture must be accurately marked on the skin.
Most of physicians do this with the patient standing. However, when the patient lies down to
undergo the phlebectomy, the skin marks applied when standing become inaccurate as the
skin moves with respect to the vein. This is demonstrated in Figure 3, which shows the
position of the mark applied when standing and the vein position in the operating position.
So use the Veinlite to accurately mark the stab sites with the patient in the operating position
and the leg positioned exactly as it will be after the skin is prepped and the leg draped. This
will result in accurate positioning of stab positions for the excision of the vein.
Figure 3, Marking the locations of stab punctures during phlebectomy with the patient in the
operating position rather than standing up.
Aiding in Evacuation of Trapped Blood
Occasionally, blood becomes trapped in a treated vein. This can be painful and or annoying to
the patient and may cause skin discoloration. The recommend procedure for this is to
evacuate the trapped blood by performing a stab with an 18 or 20 gauge needle. While this is
often easy to do, because the vein is hard and palpable, you can achieve a more exact and
less painful stab if you use Veinlite to guide your way. The trapped blood in the bulging veins is
viewed as much darker in color than normal vein due to the lower level of oxygen in the blood.
Patient Education
The Veinlite is an excellent tool to educate the patient on the extent of the disease in the
patient. By transillumating the skin, the physician can show the patient the network of veins
and the feeder veins responsible for the overlying spider vein complex. Once the patient can
see the feeder vein it makes it easier to explain the logic behind treating the reticular veins.
The Veinlite is also excellent for showing the patient the larger varicosed veins and discussing
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the impact of these on venous circulation in the leg.
Conclusions
The Veinlite device has changed the way we examine and treat varicose veins. Its ability to
transilluminate the superficial veins so that they are easily seen by the physician and the
patient has made it an extremely important diagnostic too. However, the use of the Veinlite for
identifying and assisting in the treatment of reticular veins has clearly changed the way we
treat spider veins.
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