Sasikumar Sheethal

MODERN
METHODS OF
PREVENTION
z
AND
TREATMENT
OF VARICOSE By,
VEINS OF THE SASIKUMAR SHEETHAL
GROUP 8649
PREVENTION
z OF VARICOSE VEINS
 Pregnant patients and those with a strong family

history of varicose disease may prevent, delay, or
ameliorate the problem by wearing 30-40 mm Hg
gradient compression hose whenever standing.
 Constant use of compression hose can prevent the

worsening of existing varicose disease that cannot
be treated immediately.
 Prophylaxis with 0-(beta-hydroxyethyl)-rutosides

(HR) (Venoruton) is effective for controlling flight
microangiopathy associated with edema.
 Manage weight. Shedding excess pounds
takes unnecessary pressure off the veins.
 Exercise. Get moving. Walking is a great

way to encourage blood flow in the legs.
 Avoid salt. Follow a low-salt diet to

prevent swelling caused from water
retention.
 Choose proper footwear. Avoid high

heels. Low-heeled shoes work calf
muscles more, which is better for your
veins.
 Raise the legs. To improve the blood flow in the
legs, take several short breaks daily to raise the
legs above the level of the heart. For example,
lie down with the legs resting on three or four
pillows.
 Avoid tight clothing. Don’t wear tight clothes
around your waist, legs or groin because these
garments can reduce blood flow.
 Avoid long periods of sitting or standing.
Change your position frequently to encourage
blood flow.
TREATMENT OF THE
VARICOSE VEINS
Superficial varicosities are the result of high-
pressure flow into a normally low-pressure
system. Varicosities carrying retrograde flow are
hemodynamically harmful because they cause
recirculation of oxygen-poor, lactate-laden venous
blood back into an already congested extremity..
The primary goal of treatment is the ablation of
these reflux pathways with resulting improvement
of venous circulation.
The following are the modern techniques used to ablate varicosities:
 Sclerotherapy – The most widely used medical procedure for varicose veins
and spider veins.
 Laser and intense-pulsed-light therapy
 Radiofrequency (RF) or laser ablation
 Ambulatory phlebectomy
Common surgical approaches to large-vein varicose disease include the

following:
Ligation of the saphenofemoral junction with vein stripping
 Phlebectomy performed through microincisions

Endovenous RF thermal ablation
• Endovenous laser thermal ablation
The principal surgical approach to small-vein disease is by

microincisional phlebectomy followed by sclerotherapy.
Sclerotherapy
♦Chemical sclerosis or endovenous chemoablation

(sclerotherapy) is the most widely used medical
procedure for ablation of varicose veins.
♦ In this procedure, a sclerosing substance

(polidocanol and sodium tetradecyl sulfate) is
injected into the abnormal vessels to produce
endothelial destruction that is followed by formation
of a fibrotic cord and eventually by reabsorption of
all vascular tissue layers.
Laser Therapy
♦Transcutaneous pulsed dye laser and intense-

pulsed-light (IPL) therapy has proven effective
for the tiniest surface vessels.
♦Because of the physics of light absorption,

delivering an ablative dose of thermal energy to
the vessel without damaging the overlying skin is
difficult.
♦ For most patients, the laser pulses are

significantly more painful than the 30-gauge
needles used for microsclerotherapy.
Endovenous Laser Therapy
♦ Endovenous laser therapy is a thermal ablation
technique that uses a laser fiber placed inside the vein.
♦ Seldinger over-the-wire technique is used to place a

long catheter along the entire length of the truncal varix
to be ablated. A bare laser fiber is passed through the
catheter until the end protrudes from the tip of the
catheter by about 2 cm and the laser fiber tip is
positioned at the saphenofemoral junction just distal to
the subterminal valve.
♦ The position is confirmed by ultrasonography and by

Ambulatory Phlebectomy
The stab-avulsion technique (ambulatory phlebectomy) allows removal of
short segments of varicose and reticular veins through tiny incisions, using
special hooks developed for the purpose. This procedure is extremely useful
for treatment of residual clusters after saphenectomy and for removal of
nontruncal tributaries when the saphenous vein is competent.
Radiofrequency Ablation
Radiofrequency ablation is a thermal ablation technique that uses a specially
developed proprietary RF catheter placed inside the vein. A special RF
ablation catheter is passed through the sheath and along the vein until the
active tip is at the saphenofemoral junction just distal to the subterminal valve.
Position of the tip is confirmed by ultrasonography.
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MODERN

 Pregnant patients and those with a strong family

 Constant use of compression hose can prevent the

 Prophylaxis with 0-(beta-hydroxyethyl)-rutosides

 Exercise. Get moving. Walking is a great

 Avoid salt. Follow a low-salt diet to

 Choose proper footwear. Avoid high

 Laser and intense-pulsed-light therapy

 Radiofrequency (RF) or laser ablation

Common surgical approaches to large-vein varicose disease include the

Ligation of the saphenofemoral junction with vein stripping

 Phlebectomy performed through microincisions

The principal surgical approach to small-vein disease is by

♦Chemical sclerosis or endovenous chemoablation

♦ In this procedure, a sclerosing substance

♦Transcutaneous pulsed dye laser and intense-

♦Because of the physics of light absorption,

♦ For most patients, the laser pulses are

♦ Seldinger over-the-wire technique is used to place a

♦ The position is confirmed by ultrasonography and by

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