VARICOSE VEINS OPEN EVENING€¦ · •Improvements over vein stripping –45 minute treatment time...
Transcript of VARICOSE VEINS OPEN EVENING€¦ · •Improvements over vein stripping –45 minute treatment time...
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VARICOSE VEINSOPEN EVENING
Mr Andrew SandisonConsultant Vascular Surgeon
Dr Mo FarisConsultant Interventional Radiologist
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Aims for the evening
• What are varicose veins?
• Treatment Options and the evidence
behind them
• NICE guidelines
• Commonly asked questions answered
• Meet the Team
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What are Varicose Veins?
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• Estimated that approximately 1/3 population have visible varicose veins
• Women: Men ratio of 2.5:1
• 3-6% of people with VV will progress to venous ulcers
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Causes of Varicose Veins
• Genetics - 70% of patients with varicose veins haveparents with varicose veins
• Pregnancy - 80% of women develop varicose veinsin the first trimester of pregnancy (progesterone related)
• Obesity - strains vein valves
• Ambulatory occupations (standing or chair sitting)
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• Twisted & swollen veins
• Swelling, throbbing, or cramping at night (ACHING)
• Difficulty walking
• Itching & burning
• Restless leg
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Modified CEAP CLASSIFICATION
• Rated on a 0 – 6 scale
– C0 = no visible venous disease
– C1 = telangiectatic or reticular veins(Spider/Thread Veins)
– C2 = varicose veins +/- aching, throbbing, pain
– C3 = oedema / phlebitis / bleeding
– C4 = skin changes without ulceration
– C5 = skin changes with healed ulceration
– C6 = skin changes with active ulceration
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Reticular veins
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C3 Oedema
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C5: Healed Ulcers
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C6: Active Ulcer
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• Compression stockings – relief of symptoms
• Surgical vein stripping
• Ultrasound Guided Foam Sclerotherapy
• Avulsions / Phlebectomies
• Endovenous Laser Ablation
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For people with confirmed varicose veins and truncal reflux:
Offer Endovenous thermal treatment of the saphenous vein[NICE interventional procedure guidance 52]).
If endothermal ablation is unsuitable, offer ultrasound-guided foam sclerotherapy (see Ultrasound-guided foam sclerotherapy for varicose veins [NICE interventional procedure guidance 440]).
If ultrasound-guided foam sclerotherapy is unsuitable, offer surgery.
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Surgical Vein Stripping
• Surgical procedure under general anesthesia
• Painful recovery process
• Complications = infection, nerve damage, bleeding
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1% serious complications
DVT, neurovascular damage
15% minor complications
infection, seroma, nerve damage, haematoma
General anaesthetic
Fit to drive 7-14 days, work 14-21 days
Recurrence
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Sclerosing agent is injected into incompetent segment
of vein
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Pigmentation Skin
Skin ulceration
Deep vein thrombosis
Chest pain
Visual disturbance / Stroke
Complications: Foam Sclerotherapy
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• Several small incisions
• Removal of portions ofvein with each incision
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• Laser fibre is inserted into vein
• Laser is activated and pulled back
• Blood boils and the vein closes
• Laser terminology:
– Solid state diode laser console
– Power = 10 – 30 Watts
– Wavelength = 1470 nanometers
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Varicose vein symptoms
Endovenous laser therapy
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Ultrasound Exam and Leg
Marking
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Tip of Bright Tip Fiber
Tip of SheathSaphenofemoralJunction
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The anaesthetic acts as insulation and to provide pain management during the procedure.
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Laser energy is delivered into blood, not the vessel wall
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Recommend the use of over the counter analgesics to manage minor post procedure pain.
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Walk Out of the Clinic
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• Improvements over vein stripping
– 45 minute treatment time
– Immediate walking
– Performed in clinic environment
– No general anaesthetic
• Clinical results are established
– Two, three, and five year follow up success rates at 95% - 98%*
– Complications are mild and infrequent
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5 Year Follow Up: Modality Success Rate
Surgical Stripping 75.7%- 95%
Sclerotherapy 73.5%
Radiofrequency 79.9%
Endovenous laser ablation 95.4%
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Before After
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Before After
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BeforeEndovenous laser therapy
5 weeks afterEndovenous laser therapy
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Before After
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