What is it about?
Varicose veins are traditionally pulled out, a process called "stripping". Unfortunately this causes them to grow back. In 1999, we introduced radiofrequency or laser to burn the veins. By putting devices inside the vein and heating them, we showed that we could permanently destroy them. This has become the standard treatment for varicose veins. However, a new revolutionary way of treating veins is from outside of the body. Ultrasound is focused from outside of the body, concentrating onto the vein itself. This can destroy the varicose vein, just as effectively as laser, but without having to pass anything inside the vein itself.
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Why is it important?
Moving from stripping veins to burning them was a revolutionary as it made a painful operation much less painful. It reduced the size of scars, reduce the pain of the procedure and our long-term studies have shown it reduces the risk of veins coming back again. As such, endovenous surgery was regarded as a "disruptive" change. 20 years on, HIFU (Sonovein) appears to be the next disruptive change. Because veins can be treated from outside of the body, there is no risk of infection or bleeding. Nothing is passed into the vein itself, and so, therefore, there can be no risk of anything getting into the circulation during treatment. It also opens up the possibility in the future of totally automated vein treatments. As such, HIFU (Sonovein) may well turn out to be a truly disruptive technology.
Perspectives
Although there have been one or two publications in the past suggesting or reporting High Intensity Focused Ultrasound (HIFU) as a method to treat varicose veins, this is the first report of a commercially available device to do so. The Sonovein device uses linear ultrasound to image the vein and then HIFU to focus energy exactly onto the vein to be treated. As this is the first commercially available machine, it is slow compared to modern techniques of endovenous surgery. However, endovenous surgery was slow in 1999 when we introduced it as an alternative to stripping. Just as endovenous surgery has progressed, Sonovein (HIFU) will develop and progress. As it is an imaging-based treatment, there seems no reason that it has to be performed by a doctor. As such, it is not only revolutionary and disruptive as a technology, but also as a way future varicose vein services might be constructed. I suspect that this will herald vascular technologists or ultrasonographers performing the treatments under the guidance and insurance of an overseeing doctor in the short-term. However, with improvements in artificial intelligence, there is no reason this should not become a semiautomated or even automated treatment for routine varicose veins in the future. HIFU (Sonovein) is one of the most exciting developments in venous surgery in the last two decades.
Professor Mark S Whiteley
The Whiteley Clinic
Read the Original
This page is a summary of: High Intensity Focused Ultrasound (HIFU) for the treatment of varicose veins and venous leg ulcers – a new non-invasive procedure and a potentially disruptive technology, Current Medical Research and Opinion, November 2019, Taylor & Francis,
DOI: 10.1080/03007995.2019.1699518.
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