About Venous Vascular Disorders
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What is venous vascular disorder?
Vascular disease that results from damage to the vein valves or abnormal venous pressure is called as venous vascular disorder. It includes venous insufficiency like varicose veins and venous ulcers or deep vein thrombosis etc.
What are the treatment options for venous vascular disorder?
Treatment options for venous vascular disorder includes compression stockings, surgery or endovenous therapy. Compression stockings are the cornerstone of the treatment of venous insufficiency. Other options are:
Sclerotherapy: A sclerosing substance is injected directly into the varicose veins that make them collapse.
Endovenous laser therapy (EVLT): It uses high-frequency radio waves or laser that produces local heat in the affected vein and destroy it.
Radiofrequency ablation (RFA): In this technique a special radiofrequency catheter is passed from the knee to the groin which carry out controlled thermal injury to the targeted vein resulting in its shrinkage.
Surgical option is required in less than 10% of the patients. It is commonly in those with discomfort or ulcers refractory to medical management. It includes ligation and stripping, vein bypasss, phlebectomy or Subfascial endoscopic perforator surgery (SEPS) in which endoscopic techniques are used to find and ligate perforating veins. In case of congenital absence of functional valve valvuloplasty is done.
What is the success rate of vascular surgery for venous vascular disorders treatment?
Subfascial endoscopic perforator surgery (SEPS) has a recurrence rate of 3% in ulcer cases with lesser morbidity than that of traditional surgical techniques.
RFA has very good recovery rate. Valvuloplasty may be associated with postoperative deep venous thrombosis. When associated with perforating vein ligation it has a good outcome. EVLT has excellent long term results with low associated complications.
Duration of procedure/surgery : Duration depends on the technique used. Sclerotherapy may take 5 to 30 minutes. Surgical techniques take longer from 1 to 2 hours.
Days admitted : 1 to 2 days stay is required for most procedures. Surgical techniques may require longer stay.
Anesthesia : Local or general anaesthesia, depending on the technique used
Risks : Risks are associated with different techniques. Cutaneous necrosis, allergic reactions or arterial injection may occur with sclerotherapy. Nerve injury, arterial injury or infection may occurs in surgical ablation techniques. Skin burns, arterial injury or thermal injury may occur in cases of RFA and EVLT
After care : Careful monitoring of vital signs and cardiac status is required following SEPS. Also, periodic monitoring of haemoglobin and haematocrit is essential. Wound care is important following surgery. In cases following valvuloplasty postoperative anticoagulation is required.
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