DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon1VenousVenousDisea...
DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon2VenousVenous
DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon3What is it ?Venou...
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DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonLOWER LIMBLOWER LI...
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Webinar on Varicose Veins - Venous Disease : Hinduja Hospital

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Varicose Veins is dilatation of superficial veins due to high pressure in the vein i.e. because standing and walking upright increases the pressure in the veins of lower body. It affects as many as 10% of the population.

For many people, varicose veins could be a cosmetic concern. For others, it causes unsightly bulges in the legs, present with swelling of the leg, pain, Eczema, heaviness and fatigue. These veins do not perform any effective function and their removal or closure only helps the blood to flow through the normal deeper veins.

Varicose veins may also signal a higher risk of other circulatory problems. Treatment may involve self-care measures or procedures by your doctor to close or remove veins. These varicose veins should be treated before they produce complications, which are often irreversible.

To know more, read on Varicose Veins by our Consultant Cardiothoracic and Vascular Surgeon, Dr. C. Anand Somaya.

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Webinar on Varicose Veins - Venous Disease : Hinduja Hospital

  1. 1. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon1VenousVenousDiseaseDiseaseA Medical, CosmeticA Medical, Cosmeticand sometimes a Life-threatening Conditionand sometimes a Life-threatening ConditionDr. Anand SomayaDr. Anand SomayaConsultant – Cardiothoracic and Vascular SurgeonConsultant – Cardiothoracic and Vascular SurgeonMS FICA, FACP, FIACSMS FICA, FACP, FIACSHinduja Hospital, Mahim, MumbaiHinduja Hospital, Mahim, Mumbaihttp://www.hindujahospital.com/dr-c-anand-somaya/http://www.hindujahospital.com/dr-c-anand-somaya/
  2. 2. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon2VenousVenous
  3. 3. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon3What is it ?Venous disease is defined as the impairmentof blood flow towards your heart.VenousVenousDiseaseDisease legs are comprised of a network ofveins of varying sizes. Healthy veins have valves which openand close to assist the return of bloodto the heart. If valves in the veins become damagedthey allow backward flow of blood inthe legs. gravity works on the legs more than onother parts of the body, these veinwalls are under tremendous pressure.Over time, this increased pressure can causeadditional valves to fail. If left untreated, it can leadto leg pain, swelling, ulcers, and other healthproblems. When blood cannot be properlyreturned through the vein, it can pool,leading to a feeling of heaviness andfatigue, causing varicose veins andother skin changes.DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  4. 4. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon4VenousVenousDiseaseDiseaseTREATMENT OF SPIDER VEIN OR VARICOSEVEINS HAS OFTEN BEEN CONSIDEREDCOSMETICTODAY, WE KNOW LEAVINGVENOUS ISSUES UNTREATED CAN LEAD TOLARGER HEALTH PROBLEMS,EVERYTHING IN THE BODY IS CONNECTED.Common Types Varicose veins Spider veins Telangiectases Venous ulcers Deep vein thrombosis(economy class syndrome) Pulmonary embolism Venous gangreneDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  5. 5. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veins VARICOSE derived from theLatin root ‘varix’ meaningTWISTED. Defined as:An enlarged, gnarled bloodvessel carrying impure bloodfrom the extremities of the bodyto the heart lying close to theskin. Can affect any vein butcommonly those of leg and feet. Approximately 30% of thepopulation suffer from it.When valve in veinmalfunctions, vein wallbecomes less elastic, dilateslike a balloon.Backward bloodflow causeseczema and ulceration.Pregnancy also a cause asuterus pressing on veinscausing pressure increase.DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  6. 6. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsRisk FactorsRisk Factors Age – usually appears between30 to 70 years and progressivelygets worse. Sex – women are more proneprobably due to pregnancy, HRTor birth control pills, whichrelaxes the vein wall. Genetic – if other family members have it. Standing for long periods – thisalso increases the pressure on the venoussystem. Obesity – this adds pressure on the veinsSymptomsSymptomsAching legs – burning, throbbing andcrampingSwelling of the legsEnlarged veins seen under the skinBrownish black discolouration of the anklesItching around one or more veinsUlcers near the ankle – severe diseaserequiring immediate attentionSevere bleedingDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  7. 7. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsCVICVICHRONICCHRONICVEINVEININSUFFICIENCYINSUFFICIENCYCVICVI is a distinctis a distinctclinical syndrome of the lower limbclinical syndrome of the lower limbSymptomsSymptomsSwellingSwellingPainPainHeavinessHeavinessCrampsCramps +/-+/- SignsSignsOedemaOedemaVaricoseVaricoseveinsveinsSkinSkinchangeschangesUlcerUlcerThere may be no signs, only symptomsThere may be no signs, only symptomsDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  8. 8. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsPathogenesis of CVIPathogenesis of CVI – early stages– early stagesCHRONICCHRONICVEINVEININSUFFICIENCYINSUFFICIENCYMacro vascularMacro vascularbasisbasisInfectionInfectionSurgerySurgeryTraumaTraumaOral pillsOral pillsPregnancyPregnancyImmobilityImmobilityGenetic cause ?Genetic cause ?Loss of venous toneLoss of venous toneDeep vein thrombosis ofDeep vein thrombosis oflower limblower limbValvular incompetenceValvular incompetenceVenous stasis of blood in lower limbVenous stasis of blood in lower limbDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  9. 9. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonLOWER LIMBLOWER LIMBnormal venous returnnormal venous returnNormal veinsStanding at restSuperficial venoushypertensionpresentNormal veinsLeg exercisingNo superficialvenoushypertensionLeg: posteriorlateral viewShortSaphenousveinMid calfperforatorLateral thighperforatorSolealperforatorSapheno femoraljunctionThigh perforatorsBoyd’s perforatorAnkle perforatorsPRIMARYPRIMARYSECONDARYSECONDARYVaricose veinsCVI typesCVI typesDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  10. 10. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsCVI clinical evolution in IndiaCVI clinical evolution in IndiaMeanage-yearsEarly stageSymptoms alone / oedema417 yrs for7 yrs forprogressionprogression48Eczema7 year interval in progressionfrom early to severe CVIImplies ample opportunity totreat early CVI and preventserious complications such aseczema and leg ulcerationDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  11. 11. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsThe Ugly TruthThe Ugly Truth Patient with large tortuousvaricose veins, high-volumevenous reflux, and early stasischanges of the medial ankle. Typical chronic medial legulceration associated with long-standing venous insufficiency. The ulcer had been present for12 years and was refractory toevery treatment approach untilsurgical extirpation of therefluxing superficial varices wasDiagnosisDiagnosis Usually made by clinical examination byvascular surgeon or in mild cases adermatologist. Confirmed by duplex ultrasound test withcolour Doppler, which shows the damagedvalves and enlarged veins. Could also be confirmed by venography –now outdated due to improvement incolour Doppler.DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  12. 12. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsTreatmentTreatmentCVI with varicose veins121Laser therapy Sclerotherapy Drug treatment Compression SurgeryCVI without varicose veinsTreatment ofTreatment ofMildMildVaricosities Lifestyle change – exercise,losing weight, wearing loseclothing, avoiding all periodsof standing or sitting. Pregnancy associatedvaricosities healsspontaneously within threemonths of delivery. Class I & Class II stockingsshould be worn during periodsof standing or prolong sitting.DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  13. 13. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsTreatmentTreatmentOedema  Is there varicose veins or superficialvenous reflux? Yes No  1stChoice Alternative Flavonoids +compression Surgery/SclerotherapyLaser therapyFlavonoids +compressionDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  14. 14. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsTreatmentTreatmentCVI with varicose veins121Laser therapy Sclerotherapy Drug treatment Compression SurgeryCVI without varicose veinsVenoactive drugsVenoactive drugsflavonoid compoundsflavonoid compounds  Venous toneVenous tone  WBC activation &  release ofWBC activation &  release ofinflammatory mediatorsinflammatory mediators  Capillary hyper permeability andCapillary hyper permeability andfragilityfragility  Lymphatic drainageLymphatic drainage Effective in suppressing symptoms,Effective in suppressing symptoms,reducing oedema and facilitatingreducing oedema and facilitatingulcer healingulcer healing Well toleratedWell toleratedCombined withCombined with Topical dressingsTopical dressings for ulcersfor ulcersPreferably non adherent and which provide hydrationPreferably non adherent and which provide hydrationas well as gas exchangeas well as gas exchangeDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  15. 15. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsTreatmentTreatmentCVI with varicose veins121Laser therapy Sclerotherapy Drug treatment Compression SurgeryCVI without varicose veinsCompressionCompressionBandages and MaterialsBandages and Materials Compression bandages: Mode of actionCompression bandages: Mode of action  Ambulatory venousAmbulatory venoushypertensionhypertension Improve microcirculation flow,Improve microcirculation flow,filtration and exchange dynamicsfiltration and exchange dynamics Compression materialsCompression materials Inelastic - for continuous use inInelastic - for continuous use insevere CVIsevere CVI Elastic - self applied for day timeElastic - self applied for day timeuseuse Short stretch (< 70%)Short stretch (< 70%) Medium stretch (70-140%)Medium stretch (70-140%) Long stretch (>140%)Long stretch (>140%)Application pressure is correct when:Application pressure is correct when:it isit is uncomfortableuncomfortable to sit for >20 minutesto sit for >20 minutesDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  16. 16. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsTreatmentTreatmentCVI with varicose veins121Laser therapy Sclerotherapy Drug treatment Compression SurgeryCVI without varicose veinsSclerotherapySclerotherapy Sclerotherapy is a minor procedurein the doctor’s office – injectingsmall and medium veins with aspecial solution that thromboses thevein instantly. Does not require generalanaesthesia, is effective andcomplication free in experiencedhands. Now microsclerotherapy, animproved injection technique undermagnification increases successrate and reduces complications..DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  17. 17. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsTreatmentTreatmentCVI with varicose veins121Laser therapy Sclerotherapy Drug treatment Compression SurgeryCVI without varicose veinsSurgerySurgery Vein stripping – removing underGA the entire length of the diseasedvein and its branches. This is theage old method Requires hospital stay of two tothree days with multiple scars andnormal activities in two weeks orless. Vein removal does not affectcirculation as the deep veins in theleg takes over.DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  18. 18. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsTreatmentTreatmentCVI with varicose veins121Laser therapy Sclerotherapy Drug treatment Compression SurgeryCVI without varicose veinsLASER SURGERYLASER SURGERY Most modern and effectivemethod of treatment of varicoseveins. Day-care hospital procedure Cost effective Immediate return to normalactivities Minimal scarringDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  19. 19. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsTreatmentTreatmentLASER SURGERYLASER SURGERYELVeSELVeSEndo-LaserEndo-LaserVeinVeinSystemSystemFollowing percutaneous entry into thegreater saphenous vein, a fine ELVeS laserfiber is inserted into an introducer sheathand advanced towards the sapheno-femoraljunction.Once in position (confirmed by ultrasoundand the laser aiming beam), the near infraredlaser energy is delivered in short pulses,causing thermal damage and contraction ofthe vein wall. Due to the application oftumescent local anaesthesia damage ofsurrounding structures is inhibited.The laser treatment is performed along theThe laser treatment is performed along theentire vessel length. The irreversible thermalentire vessel length. The irreversible thermaldamage induced by the laser energy thendamage induced by the laser energy thenleads to a complete occlusion of the vein.leads to a complete occlusion of the vein.Fiber position at SFJPerivenous anaesthesiaand laser energy deliveryTreatment using fineELVeS laser fiberDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  20. 20. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsTreatmentTreatmentLASER SURGERYLASER SURGERYELVeSELVeSEndo-LaserEndo-LaserVeinVeinSystemSystemUnaesthetic TelangiectasiaUnaesthetic Telangiectasia andand Spider VeinsSpider Veins are frequentlyare frequentlyobserved in patients presenting varicose veins. These tiny veinsobserved in patients presenting varicose veins. These tiny veinscan becan be treated with the ELVeS focusing hand-piecetreated with the ELVeS focusing hand-piece..The near infrared laser energy is well absorbed by haemoglobin.The near infrared laser energy is well absorbed by haemoglobin.The surface tissue is unaffected by the laser energy.The surface tissue is unaffected by the laser energy.DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  21. 21. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsPreventionPreventionRegular exerciseRegular exercise helps to pump blood up the legshelps to pump blood up the legsand back to the heart against gravityand back to the heart against gravityGetting enoughGetting enough restrestEating aEating a healthy diethealthy dietKeeping yourKeeping your weight downweight down..Support stockings and herbal supplementsSupport stockings and herbal supplements havehavebeen shown to improve pain and swelling frombeen shown to improve pain and swelling fromvaricose veins but have never been proven to healvaricose veins but have never been proven to healbad veins or prevent healthy ones frombad veins or prevent healthy ones fromdeteriorating.deteriorating.Unfortunately, time and gravitycause veins in susceptible peopleto wear out over time.Once a vein has become varicoseit will never function properly andshould be eliminated.DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  22. 22. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsCVICVI…… as with any chronic diseaseas with any chronic diseaseCHRONICCHRONICVEINVEININSUFFICIENCYINSUFFICIENCYIt causes significant impairment of quality of life.Patients demand relief from symptoms.Correct diagnosis and treatment does: relieve symptoms and delay progression....the physician is the first contactand can make the maximum impact on itscontrol in the population.DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  23. 23. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonVaricose veinsVenous Ulcer – wound healingVenous Ulcer – wound healingLASER SURGERYLASER SURGERYELVeSELVeSEndo-LaserEndo-LaserVeinVeinSystemSystemELVeS hasELVeS has beneficial effectsbeneficial effectson healing woundson healing wounds. The. Thetreatment of woundstreatment of woundsencourages the wound healingencourages the wound healingprocess, significantly reducingprocess, significantly reducingthe healing time.the healing time.TheThe laser treatment induces a positive effect:laser treatment induces a positive effect: in conditions of reduced microcirculation, andin conditions of reduced microcirculation, and results in the stimulation and proliferation of theresults in the stimulation and proliferation of thepatient’s own cells.patient’s own cells.DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  24. 24. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonFromFrommedicalmedicaland cosmeticand cosmeticTOTOa life-threateninga life-threateningcondition…condition…DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  25. 25. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisDeep vein thrombosis -DVTDeep vein thrombosis -DVT ThromboThrombo means "means "clotclot."." PhlebitisPhlebitis isis inflammation of a veininflammation of a vein.. ThrombophlebitisThrombophlebitis (throm-bo-fluh-BI-tis) occurs when(throm-bo-fluh-BI-tis) occurs whenaa blood clot and inflammation develop in one or more ofblood clot and inflammation develop in one or more ofyour veinsyour veins, typically in your legs. On rare occasions,, typically in your legs. On rare occasions,thrombophlebitis (often shortened tothrombophlebitis (often shortened to phlebitisphlebitis) can affect) can affectveins in your arms.veins in your arms. The affected vein may be near theThe affected vein may be near the surface of your skinsurface of your skin(superficial thrombophlebitis) or(superficial thrombophlebitis) or deep within a muscledeep within a muscle(deep vein thrombosis).(deep vein thrombosis).DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  26. 26. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisSEVERE Deep vein thrombosisSEVERE Deep vein thrombosisThe incidence of post operative DVT inIndian patients undergoing major lowerlimb surgery is as high as seen in thewestern worldThe most common distribution of DVT inIndian patients appears to be distal, similarto their Asian counter parts.DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  27. 27. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPathophysiology ofPathophysiology ofDVTDVTIn 1856, Rudolf Virchows proposed threerisk factors for thrombosis which weresubsequently termed Virchow’s TriadVirchow’s triadHypercoagulabilityEndothelialinjuryStasisThe strong relationThe strong relationbetween DVT and PEbetween DVT and PEApproximately 50% of patients with proximalDVT of the leg have asymptomatic PEDVT (mainly asymptomatic) is found in around80% of patients with PEThrombusMigrationEmbolusDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  28. 28. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisDVTDVTOften goes undetectedOften goes undetectedtill its too late…till its too late…The strong relationThe strong relationbetween DVT and PEbetween DVT and PEApproximately 50% of patients with proximalDVT of the leg have asymptomatic PEDVT (mainly asymptomatic) is found in around80% of patients with PEThrombusMigrationEmbolusLess than half of all cases of fatal PE aredetected prior to deathApproximately 80% ofDVT are clinicallysilentDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  29. 29. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisDeep vein thrombosis -DVTDeep vein thrombosis -DVTYourYour RISKRISK of DVTof DVT increasesincreases if you:if you:AreAre inactiveinactive for a long period of time, such as sitting in a car or anfor a long period of time, such as sitting in a car or anairplane (economy class syndrome).airplane (economy class syndrome).AreAre confined to bedconfined to bed for a prolonged time, such as after surgery, a heartfor a prolonged time, such as after surgery, a heartattack or a leg fracture.attack or a leg fracture.Have certain types ofHave certain types of cancercancer, such as pancreatic cancer, which may, such as pancreatic cancer, which mayresult in an increase in your blood of procoagulants, substancesresult in an increase in your blood of procoagulants, substancesnecessary for blood clotting (coagulation).necessary for blood clotting (coagulation).Have had aHave had a stroke resulting in paralysisstroke resulting in paralysis of your arms or legs.of your arms or legs.AreAre pregnantpregnant or haveor have just given birthjust given birth, which may mean you have, which may mean you haveincreased pressure in the veins of your pelvis and legs.increased pressure in the veins of your pelvis and legs.UseUse oral contraceptives or hormone replacement therapyoral contraceptives or hormone replacement therapy, which may, which mayincrease the clotting factors in your blood.increase the clotting factors in your blood.Have aHave a family historyfamily history of a tendency of blood clots.of a tendency of blood clots.HaveHave varicose veinsvaricose veins. Clots may develop in dilated superficial veins. Clots may develop in dilated superficial veins(varicose veins), causing superficial thrombophlebitis and DVT(varicose veins), causing superficial thrombophlebitis and DVT..DVTDVTVery large population at riskVery large population at riskPrevalence of DVT risk in a typical hospital population:Percentage of patients with at least 3 DVT risk factors20% of hospital patients have atleast three risk factorsPatients with at least three risk factors (%)0 10 20304050607080AllhospitalizedAll majorsurgeryAbdominalsurgeryVascular surgeryNeurosurgeryUrologyCardiacsurgeryUp to 70%in some wardsDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  30. 30. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisDeep vein thrombosis -DVTDeep vein thrombosis -DVTDVTDVTDr. Rajagopalan’s DataDr. Rajagopalan’s DataPatients with recent surgery hasa 22-fold increased risk of DVTIn the absence of prophylaxis,about 50% of hip replacementpatients and over 60% of kneereplacement patients develop DVTRisk ClassificationRisk ClassificationLow RiskLow Risk Minor surgery, Age <40 yrs,Minor surgery, Age <40 yrs,No other risk factorsNo other risk factorsModerate RiskModerate Risk Major surgery, Age >40 yrs, No otherMajor surgery, Age >40 yrs, No otherrisk factorsrisk factorsHigh RiskHigh Risk Major surgery, Age >40 yrs, MI,Major surgery, Age >40 yrs, MI,Additional risk factorsAdditional risk factorsVery high RiskVery high Risk Major surgery, Age >40 yrs, HistoryMajor surgery, Age >40 yrs, Historyof VTE, Hip or total joint procedure,of VTE, Hip or total joint procedure,Stroke, Spinal cord injury, Trauma,Stroke, Spinal cord injury, Trauma,MalignancyMalignancyDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  31. 31. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPulmonary Embolism - PEPulmonary Embolism - PEClinical FeaturesClinical Features Dyspnoea Tachypnoea Pleuritic pain Rt sided heart failure Cardiovascular collapsePulmonary embolismPulmonary embolismoccurs when aoccurs when a bloodbloodclot becomes lodged inclot becomes lodged ina lung artery, blockinga lung artery, blockingblood flow to lungblood flow to lungtissue.tissue. Blood clotsBlood clotsoften originate in theoften originate in thelegs.legs.DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  32. 32. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPulmonary Embolism - PEPulmonary Embolism - PEPREVENTIONPREVENTION‘‘umbrella’umbrella’DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  33. 33. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPulmonary Embolism - PEPulmonary Embolism - PECase 1Case 1 A 33 year old male C/o severe headache andvomiting for two days Vital signs – normal MRI - sup sagittal sinusthrombosisDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  34. 34. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPulmonary Embolism - PEPulmonary Embolism - PECase 1Case 1Clinical ProgressionClinical Progression 10th day 7am – acute left sidedchest pain Rushed to cath lab – complete cutoff LPA Wheeled into O R Crashed on induction Emergent CPB PA opened and thrombusextracted Weaned off CPB with minimalCulprit ThrombusCulprit ThrombusDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  35. 35. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPulmonary Embolism - PEPulmonary Embolism - PECase 1Case 1Post-operative CarePost-operative Care Doppler showed multiple floatingthrombi – both legs Emergency laparotomy secondpost op day Plication of IVC done Sodium nitroprusside test +ve-diagnostic of homocysteineuria Post op – Vitamin B and oralanticoags for six monthsAlive and well –twenty years later!Homocysteineuria -ve
  36. 36. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPulmonary Embolism - PEPulmonary Embolism - PECase 2Case 2 A 33 year old man Acute dyspnoea on exertionthree days XX: ray chest: severeoligemia both lungs 2D echo: large myxoma inRA Large mass in MPA with totalobliteration of LPARAMyxomaonCPBRAMyxomaonCPBSurgerySurgeryTumourMassinMPATumourMassinMPADR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  37. 37. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPulmonary Embolism - PEPulmonary Embolism - PECase 2Case 2 A 33 year old man Acute dyspnoea on exertionthree days XX: ray chest: severeoligemia both lungs 2D echo: large myxoma inRA Large mass in MPA with totalobliteration of LPACulprit ThrombiCulprit ThrombiAndAndMyxomaMyxomaDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  38. 38. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPulmonary Embolism - PEPulmonary Embolism - PECase 3Case 3 48 year old male Chronic rheumatoid arthritis 10th day post operative totalhip replacement Nil Risk factors Mobilised day 3 postoperative No DVT prophylaxisCase of Acute PECase of Acute PEDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  39. 39. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPulmonary Embolism - PEPulmonary Embolism - PECase 3Case 3Clinical ProgressionClinical Progression AM - tense calf PM - Sudden onset dyspnoea Cold clammy peripheries Seen by physician Immediate HRCT scan Diagnosed within 30 minutes Resuscitated with fluids,inotropesCardiopulmonaryBypassCardiopulmonaryBypass……first glimpse of thrombusfirst glimpse of thrombusDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  40. 40. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPulmonary Embolism - PEPulmonary Embolism - PECase 3Case 3Clinical ProgressionClinical Progression AM - tense calf PM - Sudden onset dyspnoea Cold clammy peripheries Seen by physician Immediate HRCT scan Diagnosed within 30 minutes Resuscitated with fluids,inotropesand it kept coming…and it kept coming…CardiopulmonaryBypassCardiopulmonaryBypassThe culprit! – world’s largest!The culprit! – world’s largest!DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  41. 41. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonThrombophlebitisPulmonary Embolism - PEPulmonary Embolism - PECase 3Case 3Clinical ProgressionClinical Progression AM - tense calf PM - Sudden onset dyspnoea Cold clammy peripheries Seen by physician Immediate HRCT scan Diagnosed within 30 minutes Resuscitated with fluids,inotropesDR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon
  42. 42. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular Surgeon42DVT prophylaxis!!DVT prophylaxis!!Role of surgicalRole of surgicalmanagementmanagementAs good?As good?Maybe better!Maybe better!
  43. 43. DR. ANAND SOMAYADR. ANAND SOMAYAConsultant – Cardio Vascular SurgeonConsultant – Cardio Vascular SurgeonDr. Anand SomayaDr. Anand SomayaConsultant Cardiothoracic and Vascular SurgeryConsultant Cardiothoracic and Vascular SurgeryOPD Schedule:OPD Schedule: Wednesday, 12:00 to 01:30 pmWednesday, 12:00 to 01:30 pmAppointment Helpline:Appointment Helpline: 022-39818181/67668181/24451515022-39818181/67668181/24451515For any Queries, please write us on:For any Queries, please write us on:info@hindujahospital.cominfo@hindujahospital.comThank YouThank You

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