Varicose veins treatment:

Treatment for varicose veins is of two types: surgical and non-surgical. The non-surgical treatments include exercise, weight loss in overweight/ obese patients, leg elevation and most importantly compression stockings and compression garments along with pneumatic compression pumps.

Medical compression stockings:

Medical compression stockings remain the mainstay of treatment for varicose veins. There are hundreds of clinical studies proving the efficacy of graduated medical compression stockings.

How do medical compression stockings work? 

Medical compression stockings help provide external compression on the leg and thereby on the veins. The compression should be tight enough to compress the veins, but not too tight to compress the arteries and stop blood flow to the feet. This delicate balance is achieved by determining the pressure level given by the stockings at the ankle level according to compression classes determined by expert clinicians and scientists. These medical compression stockings have to be graduated which means, they’ve to be tighter at the ankle level and reducing as you go up the leg. This follows the basic physics principal that blood will flow from high pressure to lower pressure.

How to choose scientific medical compression stockings?

• Stockings have to be RAL/GZG certified
• Ask for colour options, if that is important for you. In India, colour stockings may not be readily available but can be imported upon your order
• Many times, we find legs thinner at the ankle and broader at calf and thigh. For this, regular sizes are not the right choice. Ask the company if they have PLUS sizes or custom made stockings
• It is best to get proper measurements taken by an expert
• Initially, wearing and removing may be difficult, but after wearing the stockings they’ve to feel comfortable
• Buy from a reputed and experienced dealer near you who’ll train you how to wear and remove stockings. And how to wash stockings

Remember, proper measurements, training / demonstration and comfort after wearing are most important steps in choosing where to buy medical compression stockings from. Your comfort and clinical result will be the indicator if you’ll be able to wear these stockings everyday. When you feel this difference, money will be the last priority in choosing your stockings

 

Surgical Options:

There is a fleet of surgical interventions available for treatment of varicose veins. Appropriate intervention is selected based on patient-related factors such as age, gender and weight; and the disease-related factors like presence or absence of symptoms, severity, and chronicity of the disease, etc.

The different modalities offered are as under:

Vein stripping:

This method involves removal of the entire damaged vein surgically. This method is still widely practiced by many general surgeons. The 1-year and long-term success rate are very high. However, the surgical technique requires a hospital stay. The patient may have a bruised or sore feeling, ecchymosis, discomfort for some days after the surgery. This technique is performed at a fraction of a cost compared to the newer pin-hole surgical techniques. Post stripping compression therapy with Class 2 graduated medical compression stockings is highly recommended.

When vein stripping is not opted for, other interventions called ‘closure procedures’ are used. In all these methods, the abnormal vein is closed using thermal energy produced by various methods along with its entire length such that it loses its function. The other surrounding veins take up the function of the sealed vein.

Foam sclerotherapy:

This method is similar to the conventional sclerotherapy, except that the sclerosant used is in the form of the foam. This ensures that the sclerosant reaches larger, underlying abnormal veins, which could not have been reached by a conventional method. This technique is commonly practiced for smaller veins. This procedure does not require a hospital stay, it can be performed on very small veins on OPD basis also. It can be painful occasionally. Results are very good and if performed well, gives immediate cosmetic results.

 

Glue therapy:

This is a novel closure procedure, which uses a special medical grade glue to seal the abnormal vein. The glue is injected through a catheter under ultrasound visualization. This procedure is almost painless.

Ablation therapy:

Ablation therapy is also a ‘closure procedure’. The word ablation means ‘destruction of’.

Endovenous thermal ablation (EVTA):

This is a method of ablation performed from inside the vein using heat energy. Heat energy can be radiofrequency heat (RF) or laser energy, or steam energy.

• Endovenous thermal ablation (EVTA) with RF: This is a method of ablation using radiofrequency (RF) energy. It is proven to be very effective as well as nearly painless technique*. (compared to Laser 980nm). Much faster and controlled energy delivery than Laser.
• Endovenous laser ablation (EVLA):  This is a method of ablation using LASER energy. It is proven to be highly effective in closing varicose veins. Newer 1470nm Lasers are shown to be less painful than their predecessors.
• Steam ablation: A relatively novel method that uses steam for ablation.

MOCA (Mechanical Occlusion with Chemical Assistance) procedure:

This novel procedure is an ablation procedure performed using a sclerosant. This procedure is a mechano-chemical procedure which includes a mechanical aspect (a 360° rotating tip of specialized ablation instrument) along with chemical, a sclerosant infusion used together in a system.

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