Explaining how varicose veins treated

Explaining how varicose veins treated

Varicose veins treatment depend on many factors such as its either associated with complications or problems or no its symptomatic such as there is pain skin pigmentation skin venous ulcer or no is the patient complaining from it or no and also depend on the age of the patient and patient is fit for operation or patient refuse the operation or no most varicose veins usually not required treatment other reason may for cosmetic
Treatment of varicose veins can be divided into the following items
 
Conservative treatment
This type of treatment considered the main line of treatment which consists of
 Change the life style of the patient in the form of
  • Regular leg exercises to restore muscle tone and the blood passing through the veins
  • Avoid prolonged standing or sitting for long time and during sitting avoid crossing your legs because this lead to more venous congestion keep your legs raised above when your are sitting by putting them on chair  this relieved pain and edema and help blood return to the heart through the veins
  • Periodic leg elevation lead to prevent venous stasis and congestion and sleeping with the foot of the bed raised or put your legs above pillow
  • Avoid wearing tight clothes especially around your waist groin or your thigh to avoid venous compression pathway and avoid venous stasis
  • Avoid wearing of high heels for a long time because its interfere with the tone of muscle calf which is responsible for moving the blood through the veins
  • Body wight reduction in obese patient to improve blood flow and decreased the pressure on the veins
Elastic compression stocking
Elastic compression stocking acts by supporting the superficial leg veins and to prevent reflux from deep veins into superficial veins which help leg muscle pump and to prevent edema
 
How elastic compression stocking used
  • It has different sizes and pressure such as light compression  or medium compression or strong compression which may required in patient feel aching leg pain or fatigue
  • It has different lengths as below knee elastic compression or above knee elastic compression
  • It has different foot styles either cover the whole foot or stopped before your toes
  • It should dressed in the morning as soon as you get up how you can do it first it should be dressed and you are sleeping on your back then elevated your legs above and the dressed all the day and take off during go to sleep
  • It may need to change it every three to six months
  • It is bought in the medical supply stores and in pharmcies
  • If you feel its not comfort for you so you need to change it by another one fit for you
  • It may only line of treatment in some condition such as pregnant woman patient unfit or refuse the surgical operation or the patient don not need any more treatment or in case associated deep venous thrombosis
  • Most of the patient can be treated by these methods without need additional therapy
Injection - compression sclerotherapy
This type of treatment are indicated in case of small varicose veins less than 3 mm in diameter and in spider varicosities or telangiectatic vessels or residual varicose after operation
  
These sclerosing agents are include hypertonic saline sodium tetradecyl sulfate polidocanol and 5% ethanolamine oleate
 
Aims of treatment with sclerotherapy
 They acts by inducing irritation and damage or destroying the wall of the vein from inside leading to fibrosis and occlusion of the lumen of the vein
How sclerotherapy used
Used by injection it into empty vein so that wall adheres to wall
The needle inserted into the vein with the patient sitting down with the leg horizontal the maximum dose at any time is 1 ml
After injection a pressure or elastic bandage are applied for or wrapped around the leg and worn continously for 3 to 5 days to produce apposition of the inflamed vein walls and prevent thrombus formation
 Then the elastic bandage removed and the elastic compression stocking applied instead it and it should be worn from 3 to 6 weeks this allow rapid healing and decreased swelling
After the injection the patient should be instructed to walk for a long distance in order to flush any amount of sclerosant that might reached the deep veins
what are the complications of sclerotherapy
These may including the following
Extravastion of the material into surrounding tissue causes  inflammation around the vein periphlebitis cellulitis and skin necrosis
Allergic reaction skin pigmentation thrombophlebitis and deep venous thrombosis headache and lower back pain

Surgical operation

Indicated in severe cases large varicose veins symptomatic greater or longer saphenous vein reflux saphena varix blow out varicose
Contraindication for operation acute septic inflammation of the veins thrombophlebitis secondary varicose veins due deep venous thrombosis  pregnancy and pelvic tumors 

Aim of the operation
Ligation and division of those veins

Operations used

It is done by two small incision are placed one medially or inner side in the groin at the top of varicose veins and others incision is placed just below the knee at the bottom of the varicose veins
Then the vein at the top (greater saphenous vein) is tied up and sealed removal of vein called phlebectomy
Then a thin flexible wire is passed through the bottom of the vein and the gently pulled out and removed
After the operation the patient need to apply elastic stocking for at least one week
  
Stab -avulsion technique
Indicated in case of large varicose veins
 This technique is performed by making 2 mm incision directly over the branch of varicose veins and then the varicosity is dissected from the surrounding subcutaneous tissue as far proximally above and distally below as possible through the small incision in most cases the vein is simply avulsed with no attempt at ligation  and the bleeding easy to control with leg elevation and manual pressure
Complications of surgical operation
skin ecchymosis lymphocele formation transient numbness in the saphenous verve distribution
 
Indicated in cases of small varicose veins
This method applied light energy from laser to the varicose veins which make the veins fade away
This technique can be done by using laser or radio frequency energy  in this case the greater saphenous vein is left in situ or in place and destroyed with catheter based technique by creating heat to close off the varicose veins
In these cases a small incision is made just above or below the knee then a small catheter tube passes through the vein guided by ultrasound scanning and a small probe is inserted through this catheter to send radio frequency energy to the wall of the vein which lead to heating collapsing closing and sealing of the venous wall and become obliterated this procedure can be done under local anesthesia and the patient should be applied elastic stocking for at least one week after this procedure
For causes types symptoms and signs and complications of varicose veins see here
  

1 comment:

Bonnie Forbez said...

Will laser Treatment for Varicose Veins in the worsen state helps? What are the ways to avoid it?

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