Varicose veins are veins under the skin of the legs, which have become widened, bulging, and twisted.
A good Treatment Plan is based on
- An accurate diagnosis
- Detailed evaluation of varicose veins.
The diagnostic evaluation can be organized into 3 levels
- Level I – History, clinical examination
- Level II – Duplex color scanning, Plethysmography.
- Level III – 1. Venography,
2. Venous Pressure measurements
3. Computerised tomography
4. Magnetic Resonance Imaging
Treatment Modalities
Self care
Lifestyle Change
- Exercising, ( Read The Need To Move)
- Losing weight,
- Not wearing tight clothes,
- Elevating your legs (Read more: Varicose Veins)
- Avoiding long periods of standing or sitting
A. Non- Surgical Options
- Compression Therapy
They can effectively reduce Edema and Pain
But, their tolerance is questionable.
Recommended Pressure
15 – 20 mmHg – minor varicosities
20 – 30 mmHg – Moderate to severe varicosities
30 – 40 mmHg- Severe varicosities and Chronic Insufficiency
i. Inelastic Compression Therapy (Unna Boots)
High working pressure during ambulation
No resting Pressure
ii. Elastic Compression Therapy(Stocking)
Sustain compression during both Rest and Activity
Exert graded pressure, Max at ankle decreasing upwards.
Patients should remove them at night
Change to a new one every month
iii. Intermittent Pneumatic Compression
Generally reserved for bedridden patients.
- Leg Elevation
Along with Compression Therapy is – the standard of care
It Mainly
Reduces Edema
Improves Circulation
Hastens Ulcer healing
30 minutes, 3-4 times a day is recommended
B. MEDICINES
Calcium Dobesilate
Pentoxifylline
Aspirin
Micronised Purified Flavonoid Fraction
C. SURGERY
Stripping/Ligation
Echo-Sclerotherapy
EVLTS
– Radiofrequency Ablation
– Steam Vein Sclerosis
Miniflebectomy
TIPP
D. Treatment For Perforator Incompetence
Open Surgery
SEPS (Subfascial Endoscopic Perforator Vein Surgery)
ENDO VENOUS THERMAL ABLATION
LASER ABLATION (EVLT)
One of the most popular Treatment Modalitiy for Suprficial Venous Incompetence.
It uses Thermal energy to ablate the Great Saphenous Vein(GSV)
Usually, Doppler scan Guided procedure.
Advantages
- Minimal Invasive Procedure
- Minimal Discomfort
- Least disruption of daily activity
- Performed as a day care procedure
- Excellent safety profile
Recurrence after EVLTS is usually due to
Perforator Veins
Recanalised Great Saphenous Vein.
New Anterior Accessory Great Saphenous Veins
RECURRENT VARICOSE VEINS
Varicose veins are associated with high recurrence rates.
Many factors are responsible for this
Inaccurate Diagnosis
Inadequate Surgery (Early Recurrence)
Neovascularisation (Late Recurrence)
Increased disease severity (Progression)
Prolonged Standing
Deep Venous Thrombosis(DVT)
