CR - Venous disease - Varicose Veins (ii) Tx
goals
improve symptoms + appearance
heal + prevent ulcers
reduce oedema
endovenous surgery
min invasive
complications
infection (rare)
skin burn
DVT/PE
neuropraxia
temporary loss in PNS (paraesthesia - but sometimes can persist 😒
sometimes with hyperaethesia (increased sensitivity to pain)
incidence = 9%
recurrence of 30% (no way to predict)
thermal
US-guided puncture of vein @ level of knee with a needle
1st line
pass up a wire + heat it to 120 degrees via laser or radio frequency ablation (RFA)
vein scalded closed
use tumescent local anaesthesia
bicarb + adrenaline + xylocaine
envelope of cold fluid prevents heat damage to Ns + muscles
complication = endovenous heat-induced thrombosis (EHIT)
thrombus can propagate up so keep catheter @ least 2 cm away from SFJ
don't do both legs @ once - increases DVT risk
non-thermal
same method as thermal but no heat used
no cold fluid envelope needed
less needle pricks
can do 2 legs @ once
2 types
Carivein
blade destroys vein's intima, then foam to occlude
lower success (occlusion rate)
Venaseal
glue that solidifies on contact with blood
used when patient unsuitable for compression as not needed
Open surgery
becoming obsolete
longer return to work
multiple large incisions
post-op pain
more costly
general anaesthetic needed
cosmetic
laser/injection scleropathy
give polidocanol (local anaesthetic)
conservative management = compression
level 1 = socks available in chemist
level 2 = prescription needed - assess ABI - indicated for varicosities
level 3 = bandages
level 4 = full compression - indicated for ulcers
neovascularistion can occur post-op