We are at the stage of the procedure now where the vein is cannulated and we are about to
introduce the laser fibre.
Now we at this clinic The VeinCare Centre at the Melbury Clinic we use the Biolitec
system.
It’s the “state of the art” system which has a 1470 nanometre wavelength.
This has a number of advantages.
It’s specific for water which is the main constituent of the vein walls so it’s energy
is selectively absorbed by the vein which means that it is much more comfortable and
the recovery is very very straight forward with very little discomfort.
The particular system that we use has a so-called “aiming beam” and that helps us position
the laser fibre very accurately and together with ultrasound we can be absolutely sure
that the laser is in the correct place.
It has various marking points on it which allow us to ensure that we deliver the correct
amount of laser energy to the vein for a given length to ensure the complete success of the
procedure.
I am going to turn down the light a little bit and we will be able to see the laser fibre
with its aiming beam flashing being introduced into the vein and being positioned at the
top of the leg where the great saphenous vein joins the femoral vein.
What I am going to do next is introduce the catheter into the cannula, the cannula has
been placed inside the vein.
The aiming beam allows us to follow the advancement of the catheter up the leg.
Remember, the catheter is inside the vein and it’s following the course of the great
saphenous vein up the inside of the thigh underneath the skin and we are watching it
advance up the leg to where the great saphenous vein joins the femoral vein.
So we’ve got the flashing light in the thigh we are advancing the catheter right up and
that’s where I think the catheter is probably very close to the junction.
For the last few centimetres we positon the catheter with ultrasound.
Now as you can see on the screen we’ve got the superficial vein there – it’s compressible
when I apply light pressure.
As I advance it up the leg (the ultrasound) we can see it (the superficial vein) joining
the deep vein just there.
Here we see the confluence of the great saphenous vein on the top left with the femoral vein
in the middle.
Some people say that that image there in the middle looks a little bit like “Micky Mouse”.
You can see his face in the middle and you can see his two ears!
Micky Mouse’s left ear – i.e. the right one on the screen – is pulsating and that
is the artery.
His face is the femoral vein and his ear on the left is the great saphenous vein.
And we can see as we advance the catheter – in a moment – we are going to see a
little white dot appear in Micky Mouse’s right ear (on the left of the screen).
There it is!
You just see a little white dot appearing in Micky Mouse’s right ear – i.e. the
left of the screen - and that indicates that we are very close to the junction.
Now this is one of the few places where I do image the vein in transverse and longitudinal.
I am turning the probe 90 degrees and I am looking at the junction in longitudinal.
I can see now that the tip of the catheter is positioned right at the correct place at
the inferior epigastric vein and that IS the correct place.
The catheter is now in position: we have cannulated the vein advanced the laser and now we are
at the right (correct) place.
We are now going to apply tumescent local anaesthetic.