Varicose Veins Nonsur
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Transcript of 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