One of the best of mine.......

1. Treatment
By…..
Muhammad Abdullah

2. CONSERVATIVE MANAGEMENT….
 Elastic crepe bandage
 30-40mm Hg
 Elevation of limbs
 Above the level of heart
 Graded compression
 Stockings.

3. CONTINUE…..
 Unna Boot…
 Nonelastic compression.
 Dressing changed once in a week.
 Infection should not be there.

4. MEDICATIONS ....
 Calcium dobesilate
 Improves lymph flow, reduce edema
 Diosmin…
 Protects venous valves / anti inflammatory

5. SCLEROTHERAPY…
 Complete sclerosis (hardening) of the venous wall
 Indications
 Uncomplicated perforator incompetence
 Smaller varices
 Recurrent varices
 Isolated varices
 Aged/unfit patients

6. CONTD…
 Sclerosants used are
 Sodium tetradecyl sulphate
 Sodium morrhuate
 Ethanolamine oleate
 Polidocanol

7. TECHNIQUE
23 gauge needle in to
vein and emptied.
(ultrasound guided)
0.5 -1 ml of
sclerosant
Immediate
compressio
n bandage
Proper
endothelial
apposition
May have
to be
repeated
after 2-4
weeks later

8. SURGICAL MANAGEMENT…
 Saphenofemoral ligation and
long saphenous Stripping.
 An oblique groin incision is made at the level
of and lateral to the pubic tubercle.
 The long saphenous vein is identified and
dissected to the SFJ.
 Six tributaries are normally encountered close
to the SFJ.

9. • Superficial inferior epigastric vein
• Superficial circumflex iliac vein laterally
• The deep and superficial external
pudendal veins medially
• Distally the anterolateral
• Posteriomedial thigh veins.
• A flush SFJ ligation is then peformed and
the LSV retrogradely stripped to the
knee.

10.  Saphenopopliteal junction
ligation and lesser saphenous
stripping
 Perforator ligation
Complications
 Saphenous nerve injury
 Hematoma
 Infection

11. SEPS…
 Subfascial endoscopic perforator surgery
 Minimally invasive method

12. ENDOVENOUS LASER ABLATION - EVLA
 US guidance LSV canulated above knee jt
 Guide wire passed beyond SFJ
 Tip is placed 1cm distal to SF junction
 Laser fibre inserted upto the catheter
 Diode laser used for firing

13. CONTD…
 Thermal damage of endothelium – occlusion of vein
 Laser energy acts on blood – in turn heats the vein wall.
 Radio Frequency (VNUS Procedure)
Uses radio frequency to heat the vein
 Complications
 Pain / ecchymosis
 Hematoma
 Skin burns
 DVT

14. THANK YOU