management of varicose veins by conventional methods

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comparative analysis

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Slide1:

Management of varicose veins conventional versus newer modalities Dr Rohit Shyam (MS) Consultant , Main hospital Durgapur steel plant

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Overview Lack of awareness about the venous disorder Suffering forces individual to compromise in their lives. Non availability Vs non affordability

Introduction:

Introduction Current mordern therapies  less invasive  improved recovery, but long-term outcomes are uncertain ???? * In 90% of cases of reflux at Great saphenous vein and perforator vein reflux  surgery alone resolve the venous hypertension. * Anke AMB, Michael K, George P. Akkersdijk et al. Comparing endovenous laser ablation, foam sclerotherapy , and conventional surgery for great saphenous varicose veins. Journal of vascular surgery Volume 58, Issue 3, Pages 727–734. 2013.

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AIM To evaluate the outcome in patients with varicose veins following conventional methods. Review literature . Develop treatment protocols at our centre.

Objective:

Objective Evaluate all cases with varicose veins Clinical (CEAP) Color Doppler Plan treatment (surgery/ conservative) Follow up

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Clinical classification

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MATERIAL AND METHODS Ongoing prospective non randomized clinical study done at single surgical unit. Inclusion : Reflux of GSV/SSV/Perforators Exclusion Deep vein thrombosis osteoarthritis, spinal disorders, arterial disorders

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TOTAL CASES : 24 follow up /re-assessed after treatment After 1 month After 6 months After 1 year PERIOD OF STUDY 3 years (2010-2014) MATERIAL AND METHODS contd..

CLINICAL PHOTOGRAPHS – CLASS1 :

CLINICAL PHOTOGRAPHS – CLASS1

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CLINICAL PHOTOGRAPHS – CLASS 2

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Healing of active venous ulcer following conservative treatment

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Observation N=24 male : 11 female : 13 Age mean : ( 48-72 )= 60 yrs .

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symptoms Chronic leg pain : 12 Visible varicosities : 8 Skin changes : 22 ( venous ulcer : 2

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Clinical staging Colour Doppler assessment = 11 reflux in sapheno- femoral junction = 7 incompetent sapheno-popliteal jn = 1 perforator incompetence = 3 deep vein thrombosis = 0

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Results Surgery 6 Trendelenburg surgery = 3 Ligation of sapheno-popliteal junction = 1 Ligation of below knee perforators = 2 Conservative management = 18 Graduated compressive stockings Exercise Medicines: Calcium dobesilate daflon

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TRENDELENBERG OPERATION

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Follow-up Completed follow -up =18 /24 (75%) Surgery =6 /6 (100%) Conservative =12/18 (66.67%)

CONTD..:

CONTD .. LENGTH OF HOSPITAL STAY = 4 days WOUND INFECTION = 1 Resolution of skin changes : 14 /22 (63.6%) Leg oedema /Pain : 10 /12 (83.83%) healing ulcer : 2/2 (100%)

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Outcome SATISFACTION LEVEL at one year = (0-10) GOOD (>7) = 15/18 ( 83%) FAIR (4-6) = 1/18(5%) EQUIVOCAL (<4) = 2/18 (10%) Recurrence ( 3 years) : 0

Review of literature:

Review of literature Julie Brittenden , M.D., Seonaidh C. Cotton, Ph.D., Andrew Elders,et al .A Randomized Trial Comparing Treatments for Varicose Veins.N Engl J Med 2014; 371:1218-1227September 25, 2014DOI: 10.1056/NEJMoa1400781 T he mean disease-specific quality of life was slightly worse after treatment with foam than after surgery (P=0.006) but was similar in the laser and surgery groups. the frequency of serious adverse events (approximately 3%) was similar among the groups

Contd..:

Contd.. Nesbitt C1, Eifell RK, Coyne P, et al.Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices.Cochrane Database Syst Rev. 2011 Oct 5;(10):CD005624. doi: 10.1002/14651858.CD005624.pub2 Early recovery and reduced morbidity favor newer modalities Long term treatment outcome is the same for both conventional surgery and with laser ablation of varicose veins

Discussion :

Discussion Surgery for varicose has evolved remarkably advanced modalities are currently available Several studies are further needed to validate the newer modalities. Long term outcome is the fundamental goal for treatment success There fore surgery remains the gold standard.

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DISCUSSION Very few centres in India Newer modalities are also costly since most are available at private institutions The long-term results of laser treatment (3 years) in terms of recurrence rates of the varicose veins are comparable with that for conventional surgery

Bibliography:

Bibliography Anke AMB, Michael K, George P. Akkersdijk et al. Comparing endovenous laser ablation, foam sclerotherapy, and conventional surgery for great saphenous varicose veins. Journal of vascular surgery Volume 58, Issue 3, Pages 727–734. 2013. Nesbitt C1, Eifell RK, Coyne P, et al .Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices.Cochrane Database Syst Rev. 2011 Oct 5;(10):CD005624. doi: 10.1002/14651858.CD005624.pub2 S Subramanian, TA lees. Treatment of varicose veins. Ann r coll surg engl 2007; 89: 96–100 doi 10.1308/003588407x168271 Eleftherios SX, Gabriel B, David JM, et al. Endoluminal thermal ablation versus stripping of the saphenous vein: Meta-analysis of recurrence of reflux .Int J Angiol. 2009 Summer; 18(2): 75–78. PMCID: PMC2780848

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SUCCESS IS NOT ALWAYS WHAT YOU SEE Thank You

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