Varicose Veins Nonsur

7/30/2019 Varicose Veins Nonsur

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Non Surgical Management OfVaricose Veins

Dr.Soumen Das


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Management

Varicose Vein

Complications


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Complications

1. Bleeding.

2. Thrombophlebitis- superficial red painfull lump

3. Brown pigmentation- haemosiderin deposition

4. Venous Eczema

5. Venous Ulcers- over medial ankle orgaiter area

6. Lipodermatosclerosis-progressive sclerosis of cutaneous fat- anklebecomes thin and hard- area above becomes oedematous


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Treatment Options

Conservative

Drug Therapy Compression Therapy

Sclerotherapy [Microsclerotherapy]

Laser Therapy Cryoablation

Surgery


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Conservative

Leg elevation

Rest


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Drug Therapy

Controversial


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Compression Therapy- Role

Decreases Edema

Increases Venous Velocity Decrease in Venous Volume

Decrease in Venous Reflux

Decreases Recurrence


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Compression Methods

Bandage

Stockings


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Compression Bandage

Graduated elastic compression

Heal upto 93% of venous ulcers ( Mayberry1991)

wool, crepe, elastic bandages, coban

ankle pressure 40mmHg graduated to

18mmHg at knee


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Compression Bandage


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Compression Stockings

Class 1 < 25 mm of Hg Mild VV, DVT

prophylaxis

Class 2

25-35

Marked VV

Edema

C V I

Class 335-45

Healed venousulcer

Class 4 45-60

[Ankle Pressure]

Severe

lymphodema


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Compression Stocking
http://images.google.co.in/imgres?imgurl=http://www.makemeheal.com/images/products/estore/10008/141C.jpg&imgrefurl=http://www.makemeheal.com/mmh/product/compression_stocking/support_sock/index.vm%3Fprocid%3D28%26catid%3D380&usg=__IB1_SCcKN5IEZ_uLIFGIIDXcsoY=&h=425&w=360&sz=190&hl=en&start=18&tbnid=YRgIZkGpqgiD3M:&tbnh=126&tbnw=107&prev=/images%3Fq%3Dcompression%2Bstocking%2Bfor%2Bvaricose%2Bvein%26gbv%3D2%26hl%3Den%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://content.revolutionhealth.com/contentimages/images-image_popup-ww5rl32.jpg&imgrefurl=http://www.revolutionhealth.com/conditions/skin/varicose-veins/varicose-veins%3Fsection%3Dsection_09&usg=__6OZbzDRNE8oiW6Oc4foPFTlEwAI=&h=280&w=400&sz=11&hl=en&start=7&tbnid=pnKpYlrs7Fu4pM:&tbnh=87&tbnw=124&prev=/images%3Fq%3Dcompression%2Bstocking%2Bfor%2Bvaricose%2Bvein%26gbv%3D2%26hl%3Den%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://www.milfordvascular.com/images/varicose_veins/Varicose_veins_compession_stockings.jpg&imgrefurl=http://www.milfordvascular.com/varicose_veins.htm&usg=__NIvqQeSFl7uuDPg81KK1803HAhs=&h=213&w=171&sz=16&hl=en&start=9&tbnid=V8ddhsdvOHT0WM:&tbnh=106&tbnw=85&prev=/images%3Fq%3Dcompression%2Bstocking%2Bfor%2Bvaricose%2Bvein%26gbv%3D2%26hl%3Den%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://www.milfordvascular.com/images/stockings/compression_stocking.jpg&imgrefurl=http://www.milfordvascular.com/stockings.htm&usg=__6KqeMgt40BwUfMxL3ZY8wY2pF2M=&h=231&w=283&sz=39&hl=en&start=6&tbnid=0Gt8T7XAWzZD0M:&tbnh=93&tbnw=114&prev=/images%3Fq%3Dcompression%2Bstocking%2Bfor%2Bvaricose%2Bvein%26gbv%3D2%26hl%3Den%26sa%3DGhttp://images.google.co.in/imgres?imgurl=http://www.veindirectory.org/Blog/Graduated%2520stocking.jpg&imgrefurl=http://www.veindirectory.org/Blog/2008/08/compression_stockings_for_low.html&usg=__YlKJk3apXQ9KIe8S73J8HwwRHhc=&h=442&w=376&sz=62&hl=en&start=2&tbnid=ubxwHcuBHsgd6M:&tbnh=127&tbnw=108&prev=/images%3Fq%3Dcompression%2Bstocking%2Bfor%2Bvaricose%2Bvein%26gbv%3D2%26hl%3Den%26sa%3DG


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Compression Stocking - Problems

Compliance

Allergy Poor grip

Cost


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Sclerotherapy

Injecting sclerosant agent into vein Inviting endothelial inflammation

Apposition of Venous walls


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Sclerotherapy

Open

Duplex Guided

Foam Sclerotherapy

Microsclerotherapy


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Schlerotherapy - Indications

Leg varicosity without large vein involvement

Thread Veins Reticular veins

Left over varicosity after Sx

? All cases


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Sclerotherapy- Agents

STD

Polydocanol


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Sclerotherapy- Procedure

Empty the vein

Site

Injection

Post Tx Compression


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Foam Sclerotherapy

Developed by Tessari

Large Volume solution- same sclerosant

Procedure:

STD drawn into 1 syringe >

Passed forwards & backwards into another

syringe through a t-piece containing air> Inj into vein >Air is absorbed >

vein collapses


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Microsclerotherapy

For Thread Veins

32 gauge needle Diluted sclerosant

Slow push

Results ?


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Sclerotherapy- Complication

Deep Ulcer

Haematoma- Pigmentation Phlebitis

DVT

Anaphylactic Reaction Intra arterial inj

Nerve Damage


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Sclerotherapy- Complication

Polydocanol Cardiotoxicity

Reference: Pol idocanol in duced c ardiotoxic i ty : A case report

and review of the l i terature.Sylvoz N, Vil l ier C, Blaise S, Seinturier C, Mallaret M

J Mal Vasc. 2008 Dec;33(4-5):234-8. Epub 2008 Nov 18.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Sylvoz%20N%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Villier%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Blaise%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Seinturier%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mallaret%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mallaret%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Seinturier%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Blaise%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Villier%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Sylvoz%20N%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


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Sclerotherapy- Results

Best for -Below knee reticular veins

-Distal varicosities left after Sx

Repeated ScleroTx = Surgery

Ref: Foam s clerotherapy of the great saphenous vein with sapheno-femor al l igat ion

com pared to standard and inv aginat ion str ipp ing: a prospect ive cl in ical ser ies.Abela R, Liamis A , Pr ionidis I, Mathai J, Gorton L , Browne T, Panayiotopoulos Y. Eur J Vasc Endovasc Surg. 2008

Oct;36(4):485-90. Epub 2008 Aug 20. Links
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Abela%20R%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Liamis%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Prionidis%20I%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mathai%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Gorton%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Browne%20T%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Panayiotopoulos%20Y%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3048&itool=AbstractPlus-def&uid=18718769&db=pubmed&url=http://linkinghub.elsevier.com/retrieve/pii/S1078-5884(08)00367-5http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3048&itool=AbstractPlus-def&uid=18718769&db=pubmed&url=http://linkinghub.elsevier.com/retrieve/pii/S1078-5884(08)00367-5http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Panayiotopoulos%20Y%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Browne%20T%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Gorton%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Mathai%20J%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Prionidis%20I%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Liamis%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlushttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Abela%20R%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus


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Chronic Venous Ulcer -Rx

Elevation of legs at rest above the level of

heart - reduce oedema, exudate accelerateregression of skin changes.

Bed rest - in severe case reduce venous pressure

12-15mmHg at ankle


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Graduated elastic compression

Four layer compression bandage


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Mechanical devices

Sequential pneumatic compression Flowtron boots

Foot pumps


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Dressings

Wide range of topical dressings available.

Lack of evidence whats best dressing.

Role of occlusive dressings

a. reduction of infection

b. autolytic debridement

c. reduction of wound pain

d. stimulation of granulation tissue

Types

films, hydrocolloids, foams, alginates, hydrogels


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Summary

Proper delineation of defect- must before Rx

Drugs dont have proved role Compression Stockings best initial modality

Sclerotherapy should be individualised

Repeated Sclerotherapy = Surgery CVU Treated conservatively- heals after

varicose vein cure


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Thank you

Documents

Varicose Veins Nonsur