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VARICOSE VEINS OPEN EVENING Mr Andrew Sandison Consultant Vascular - PowerPoint PPT Presentation

VARICOSE VEINS OPEN EVENING Mr Andrew Sandison Consultant Vascular Surgeon Dr Mo Faris Consultant Interventional Radiologist Aims for the evening What are varicose veins? Treatment Options and the evidence behind them NICE


  1. VARICOSE VEINS OPEN EVENING Mr Andrew Sandison Consultant Vascular Surgeon Dr Mo Faris Consultant Interventional Radiologist

  2. Aims for the evening • What are varicose veins? • Treatment Options and the evidence behind them • NICE guidelines • Commonly asked questions answered • Meet the Team

  3. What are Varicose What are Varicose Veins? Veins?

  4. • Estimated that approximately 1/3 population have visible varicose veins • Women: Men ratio of 2.5:1 • 3-6% of people with VV will progress to venous ulcers

  5. Causes of Varicose Veins • Genetics - 70% of patients with varicose veins have parents with varicose veins • Pregnancy - 80% of women develop varicose veins in the first trimester of pregnancy (progesterone related) • Obesity - strains vein valves • Ambulatory occupations (standing or chair sitting)

  6. • Twisted & swollen veins • Swelling, throbbing, or cramping at night (ACHING) • Difficulty walking • Itching & burning • Restless leg

  7. Modified CEAP CLASSIFICATION • Rated on a 0 – 6 scale – C0 = no visible venous disease – C1 = telangiectatic or reticular veins(Spider/Thread Veins) – C2 = varicose veins +/- aching, throbbing, pain – C3 = oedema / phlebitis / bleeding – C4 = skin changes without ulceration – C5 = skin changes with healed ulceration – C6 = skin changes with active ulceration

  8. Reticular veins

  9. C3 Oedema

  10. C5: Healed Ulcers

  11. C6: Active Ulcer

  12. • Compression stockings – relief of symptoms • Surgical vein stripping • Ultrasound Guided Foam Sclerotherapy • Avulsions / Phlebectomies • Endovenous Laser Ablation

  13. For people with confirmed varicose veins and truncal reflux: Offer Endovenous thermal treatment of the saphenous vein [NICE interventional procedure guidance 52]). If endothermal ablation is unsuitable, offer ultrasound-guided foam sclerotherapy (see Ultrasound- guided foam sclerotherapy for varicose veins [NICE interventional procedure guidance 440]). If ultrasound-guided foam sclerotherapy is unsuitable, offer surgery.

  14. Surgical Vein Stripping • Surgical procedure under general anesthesia • Painful recovery process • Complications = infection, nerve damage, bleeding

  15.  1% serious complications  DVT, neurovascular damage  15% minor complications  infection, seroma, nerve damage, haematoma  General anaesthetic  Fit to drive 7-14 days, work 14-21 days  Recurrence

  16. Sclerosing agent is injected into incompetent segment of vein

  17. Complications: Foam Sclerotherapy  Pigmentation Skin  Skin ulceration  Deep vein thrombosis  Chest pain  Visual disturbance / Stroke

  18. • Several small incisions • Removal of portions of vein with each incision

  19. • Laser fibre is inserted into vein • Laser is activated and pulled back • Blood boils and the vein closes • Laser terminology: – Solid state diode laser console – Power = 10 – 30 Watts – Wavelength = 1470 nanometers

  20. Varicose vein symptoms Endovenous laser therapy

  21. Ultrasound Ultrasound Exam Exam and Leg and Leg Marking Marking

  22. Saphenofemoral Tip of Bright Tip Tip of Sheath Junction Fiber

  23. The anaesthetic acts as insulation and to provide pain management during the procedure.

  24. Laser energy is delivered into blood, not the vessel wall

  25. Recommend the use of over the counter analgesics to manage minor post procedure pain.

  26. Walk Walk Out Out of the of the Clinic Clinic

  27. • Improvements over vein stripping – 45 minute treatment time – Immediate walking – Performed in clinic environment – No general anaesthetic • Clinical results are established – Two, three, and five year follow up success rates at 95% - 98%* – Complications are mild and infrequent

  28. 5 Year Follow Up: Modality Success Rate Surgical Stripping 75.7%- 95% Sclerotherapy 73.5% Radiofrequency 79.9% Endovenous laser ablation 95.4%

  29. Before After

  30. Before After

  31. Before Endovenous 5 weeks after laser therapy Endovenous laser therapy

  32. Before After

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