Chronic venous disease is the most common vascular disorder. It imposes huge economic burden on the nation and the families of the patients. It also results in loss of millions of work days, according to Dr Prakash Ramamoorthy, Consultant Vascular Surgeon of KG Hospital.

In his lecture on the topic “Update on chronic venous disease treatment,” delivered at KG Hospital Auditorium recently, Dr Prakash Ramamoorthy said that prolonged standing or sitting would intensify the symptoms of chronic venous disease.

The people at risk are those who have to stand for long hours, such as grocers, police personnel, coffee shop owners and barbers. However, genetic factor is the prime cause for the onset of the disease.

Its symptoms are: achy or heavy feeling, burning, throbbing, muscle cramping and swelling, Pruritis (itchy skin), discolouration and painful skin ulcer.

When the disease progresses it would lead to the following complications:

  • Extremely painful ulcers may form on the skin near varicose veins, particularly near the ankles.
  • Brownish pigmentation usually precedes the development of ulcer
  • Occasionally, veins deep become enlarged
  • Bleeding
  • Superficial thrombophlebitis

However, those afflicted with the disease are hesitant to get timely treatment as they have apprehensions that the disease might recur and it would involve huge cost.

Treatment methodologies

Dr Prakash Ramamurthy says that some patients would go for local remedy or to a skin doctor to get the treatment and get some ointments for external application. Such an approach would hardly provide the cure.

Many patients seek medical intervention only after they develop complications or when the skin colour changes or when ulcers begin to appear or when they are about to get married. The poor people shy away from treatment for economic reasons.

The management of the disease could be done in any of the following ways depending upon its severity: exercises, wearing compression stockings, laser therapy, radiofrequency ablation, foam sclerotherapy and surgery.

Laser therapy is applied for small varicose veins of <5 mm size and not for larger varicose veins. Thermal ablation techniques are limited by an upper limit (>1.5 cm).

Surgical procedures such as Cryostripping, High saphenous ligation, Ambulatory phlebectomy, Stab/avulsion phlebectomy, Transilluminated phlebectomy, Perforator ligation and Subfacial endoscopic perforator vein ligation.

Revolutionary management

Dr Prakash Ramamoorthy says that venous ulcer could be managed by any of the following procedures: limb elevation, elastic compression, inelastic containment, passive and active calf movements, growth factors or surgery.

He says that ultrasound-guided foam sclerotherapy is a revolution in the management of varicose vein. In trained hands it is simple, affordable, safe, efficient and easily repeatable.

However, foam sclerotherapy has certain complications like Phlebitis, skin staining, residual lumps, matting and so on. It is advisable to get treatment for varicose vein problem from the specialists

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