Successful EVLT & Sclerotherapy for Chronic Right Lower Limb Varicose Veins

Chief Complaints

A 51-year-old male with a body mass index (BMI) of 24 presented to the Interventional Radiology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of dilated veins, swelling, and skin pigmentation in the right lower limb.

The patient had a history of varicose veins involving the left lower limb and had previously undergone laser ablation for the same.

On examination, the patient was conscious, coherent, afebrile, and hemodynamically stable with stable vital signs. Local examination of the right lower limb revealed prominent dilated varicose veins with associated swelling and skin pigmentation changes.

Following the clinical examination, the Interventional Radiology team conducted a comprehensive assessment, which included a detailed review of the patient’s medical history and a focused clinical evaluation. A Colour Doppler ultrasound was performed to assess venous reflux, valve competence, and the extent of venous dilation in the right lower limb.

Imaging studies revealed varicosities of the right lower limb veins with incompetent perforator veins. Considering the patient’s clinical symptoms, physical examination findings, and Colour Doppler ultrasound results, a diagnosis of varicose veins of the right lower limb was established.

Based on the confirmed diagnosis, the patient was advised to undergo Varicose Veins Treatment in Hyderabad, India, under the care of the Interventional Radiology Department, to ensure comprehensive management of his condition.

After consultation with Dr. Lakshmi Kumar Chalamarla, Senior Interventional Radiologist, a thorough evaluation was undertaken to determine the most appropriate diagnostic and therapeutic approach for the patient’s venous condition. This included a detailed clinical assessment along with correlation of Colour Doppler findings.

Following evaluation, it was concluded that conservative management alone would not be sufficient due to the extent of venous reflux and symptomatic varicosities in the right lower limb. It was determined that the patient had varicose veins, causing dilated veins, swelling, and skin pigmentation changes.

It was determined that Endovenous Laser Therapy (EVLT), along with foam sclerotherapy, was the most suitable intervention to ablate the incompetent veins, alleviate symptoms, and improve venous circulation.

The patient and his family members were counselled in detail regarding the nature of the disease, the planned endovenous procedure, associated risks and benefits, and the importance of intervention for definitive management of the condition.

Following the decision, the patient was scheduled to undergo Endovenous laser therapy (EVLT) and Sclerotherapy surgery in Hyderabad at PACE Hospitals under the supervision of the expert Interventional Radiology Department.

The following steps were carried out during the procedure:

• Anaesthesia and Patient Preparation: The procedure was performed under spinal anaesthesia with tumescent anaesthesia to ensure adequate analgesia and perivenous tumescence. The patient was positioned appropriately, and the right lower limb was prepared and draped under strict aseptic precautions.

• Venous Access and Mapping: Under ultrasound guidance, the great saphenous vein (GSV), anterior accessory saphenous vein (AASV), and small saphenous vein (SSV) of the right lower limb were identified and mapped. Venous access was obtained at appropriate entry points to facilitate catheter and laser fibre insertion.

• Laser Fiber Placement and Positioning: A radial laser fibre was advanced into the targeted venous segments, including the GSV (from above ankle to 5 cm proximal to saphenofemoral junction), AASV (upper thigh), and SSV (from apex of calf to 6 cm proximal to popliteal fossa). Correct positioning was confirmed prior to energy delivery.

• Laser Ablation and Sclerotherapy: Endovenous laser ablation was performed along the diseased venous segments to achieve vein closure. Additionally, residual superficial varicosities in the right lower limb were treated with ultrasound-guided foam sclerotherapy using 1% sodium tetradecyl sulfate (STS).

• Hemostasis and Compression Dressing: Following completion of the procedure, hemostasis was achieved. A compression dressing was applied using crepe bandages to support venous closure and reduce postoperative complications. The procedure was completed uneventfully.
  

Postoperatively, the patient was managed with medications to prevent infection, control pain, reduce gastric protectant, and prevent thromboembolic complications. Compression therapy was continued to support venous closure and reduce edema. The patient was advised to elevate the limb, ambulate early, and avoid prolonged standing or sitting to promote optimal venous return and recovery. Regular monitoring was performed for signs of bleeding, infection, or thrombotic complications. The postoperative course remained uneventful.

Upon discharge, the patient was prescribed medications for the prevention of post-procedural infection, gastric protection, prevention of thromboembolic complications, and control of post-procedural pain.

The patient was instructed to avoid prolonged standing or sitting, avoid cross-legged sitting, and refrain from lifting heavy weights for 1 week to reduce venous pressure and promote healing. He was also advised to wear above-knee class II compression stockings during the daytime for two months to support venous return and optimize treatment outcomes.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, swelling of the operated limb, severe leg pain, chest pain, or breathlessness.

The patient was advised to return for a follow-up visit with the Interventional Radiologist in Hyderabad at PACE Hospitals, after 14 days. 

This case highlights the successful management of symptomatic varicose veins of the right lower limb using Endovenous Laser Therapy (EVLT) with foam sclerotherapy. The procedure effectively ablated the incompetent venous segments, resulting in symptom relief and improved venous drainage. The intervention was uneventful, and the patient recovered well. He was discharged in stable condition with appropriate advice and follow-up care.

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