Saturday, 9 October 2010

Varicose Veins

Varicose Veins Treated by 'Slow-Acting Sclerosants'

Superficial Veins and their tributaries (branches) that usually give rise to Varicose Veins.
Varicose Veins Treated by 'Slow-Acting Sclerosants'.

Varicose Veins, compared to normal side (leg).

Varicose Veins involving the tributaries that drain into the Long Saphenous Vein.

Before treatment.

Immediately after the injection of Slow-Acting Sclerosants & application of plaster.

Varicose Veins are abnormally, dilated Superficial Veins of the lower limbs (legs). In the lower limbs there are 3 kinds of Veins:
1. Superficial Veins (situated just under the skin)

2. Communicating Veins (connects Superficial to Deep Veins)

3. Deep Veins (situated below the leg muscles)

All Superficial Vein tributaries drain into the Short Saphenous Vein (Popliteal area or behind the knee) and the Long Saphenous Vein (groin area or inner aspect of the thigh)

Communicating Veins drain from the Superficial Veins into the Deep Veins. Deep Veins are situated below the leg muscles. Muscle contraction aids in pushing the blood towards the heart.

Superficial Veins rely mainly on Valves, to ensure a one way flow of blood, against gravity, towards the heart. Defects within this Valves may cause backflow and pooling of blood, within the Superficial Vein tributaries (branches), causing them to dilate (Varicose Veins).

The usual treatment is Surgical Stripping (surgically pulling out the veins through several skin incisions) of the involved veins. Other nearby, competent veins, may eventually take over the function of drainning the blood. However, the main complications are bleeding, bruising and pain. Despite this agressive surgery and the associated agonies, there may be recurrence.

Nowadays, substances that destroy the veins (irritants or sclerosants) are injected into the veins or laser ablation is carried out through a tiny skin incision. However, there is a risk of thrombo-embolism (clot/thrombus formation and dislodging to the lungs) resulting in life threatening complications. Other newer techniques use heat, to seal-up the veins. However, heat is associated with alot of pain & swelling after the procedure. In large varicose veins, large quantities of sclerosants may be used for injection. The commonly used sclerosant is Foam Polidocanol (mixed with air to cause bubble formation, to increase the surface area of contact between the endothelium & the sclerosant/polidocanol). However, it has a risk of systemic absorption leading to cardiac arrest as well as air embolism. Some surgeons attempt surgeries on these incompetent vein valves. However, the surgery is meticulous, time consuming & the outcome may not be good. There is also a risk of thrombo-embolism because of disturbed (turbulant) flow through these repaired valves.

'Slow-Acting Sclerosants' do not destroy the veins immediately but induces a slow (chronic) inflammatory process/response that allows the body's own defence system to destroy the veins, over a long period of time (several weeks to months). This method is associated with very minimal complications. It is almost painless and the patient may go home the same day (day surgery procedure). Furthermore, 'Slow-Acting Sclerosants' do not cause thrombo-embolism and has only a local effect (chronic inflammation), without any other systemic complications.

The procedure requires the application of a topical anaesthetic cream an hour prior to the injection, therefore, it is almost painless upon injection. A light plaster is applied around the area of injection for 3 days. With this plaster on the leg, the patient is adviced not to engage in strenuous activities (exercise and/or sports etc.) for at least 3 days. After removal of the plaster, the patient can return to his/her normal activities.

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