Successful EVLT & Sclerotherapy for Right Leg Varicose Veins in 69-Y.O with Diabetes

PACE Hospitals

PACE Hospitals Expert Interventional Radiology Team successfully performed Endovenous Laser Therapy (EVLT) and Sclerotherapy on a 69-year-old female patient with Varicose Veins in the right lower limb who presented with dilated veins, swelling and ulcers in her right leg. These minimally invasive procedures were carried out to relieve symptoms such as swelling, prevent further complications, and improve the patient’s mobility and quality of life.

Chief Complaints

A 69-year-old female with a body mass index (BMI) of 24 presented to the Interventional Radiology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of dilated (enlarged) veins, swelling and an ulcer (open, painful sore) in her right leg.

Past Medical History

The patient had previously undergone Endovenous Laser Therapy (EVLT) for varicose veins in her left leg. She is a known case of diabetes mellitus (DM), which is well-controlled with regular medication.

On Examination

Upon admission to PACE Hospitals, the patient was hemodynamically stable. Cardiovascular and respiratory examinations were normal, with normal heart sounds (S1, S2) and adequate bilateral air entry. Abdominal examination revealed a soft and non-tender abdomen. Examination of the right limb demonstrated enlarged superficial veins, varicose veins, along with swelling and an ulcer.

Diagnosis

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 color Doppler ultrasound was performed to assess venous reflux, valve competence, and the extent of venous dilation.

Imaging studies revealed incompetence of the superficial venous system, with findings more pronounced in the right lower limb. considering the patient's clinical symptoms, physical examination findings, and Doppler ultrasound results, a provisional diagnosis of right lower limb varicose veins with diabetes mellitus 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 her condition.

Medical Decision Making

After consultation with Dr. Lakshmi Kumar Chalamarla, Interventional Radiologist, and cross-consultation with Dr. Mounika Jetti, Diabetologist, a thorough evaluation was undertaken to determine the most suitable diagnostic and therapeutic strategy for the patient's venous condition. Following a detailed assessment, including clinical correlation and imaging findings, it was concluded that conservative management alone would be insufficient.

It was determined that the patient had varicose veins responsible for dilated veins, swelling and an ulcer in the right leg. Varicose vein surgery was identified as the most effective intervention to relieve her swelling and improve her overall condition.

The patient and her family were thoroughly counselled about the severity of the condition, the planned surgical procedure, potential risks, and the necessity for surgery.

Surgical Procedure

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:

The procedure was performed under spinal and tumescent anaesthesia. After ensuring adequate anaesthesia, the following steps were carried out:

Access and Ablation of Right Great Saphenous Vein (GSV): The right GSV was accessed and ablated using a laser radial fibre from just above the ankle to approximately 6 cm proximal to the saphenofemoral junction (SFJ). Proper positioning and fiber tracking were confirmed under ultrasound guidance throughout the procedure.

Access and Ablation of Right Small Saphenous Vein (SSV): Similarly, the right SSV was identified and ablated using the same technique, starting from the apex of the calf up to approximately 4 cm proximal to the popliteal fossa.

Foam Sclerotherapy: Residual varicosities in the right leg were treated using foam sclerotherapy with anionic surfactant. The foam was injected directly into the affected superficial varicosities under ultrasound guidance to ensure accuracy.

Haemostasis and Dressing: Haemostasis (stopping of blood flow) was carefully secured at all access points. The treated limb was then wrapped with a compression dressing using crepe bandages to support post-procedure venous return and reduce the risk of complications. The surgery was completed successfully without intraoperative complications.

Postoperative Care

The postoperative period was uneventful. The patient was monitored in the ICU and remained hemodynamically stable throughout. She received intravenous antibiotics, analgesics, anticoagulants, proton pump inhibitors, and supportive care. Symptomatic improvement was noted with no complications. The patient was discharged in stable condition with post-discharge care instructions and follow-up advice.

Discharge Medications

Upon discharge, the patient was prescribed oral antibiotics to prevent infection and proton pump inhibitors for gastric protection. Analgesics were given for pain relief, and antipyretics were provided to control fever. Anticoagulants were prescribed to lower the risk of blood clots following the vein treatment. Additional supportive care measures were recommended to promote healing and prevent complications. The patient was advised to adhere to the medication plan and attend scheduled follow-up visits.

Advice on Discharge

The patient was advised to avoid crossing the legs and to limit prolonged standing or sitting to no more than 30 minutes at a time. She was also advised to refrain from lifting weights heavier than 5 kilograms for one week. Additionally, she was instructed to wear above-knee Class II compression stockings during the daytime for two months and to continue other medications as advised by other physicians and to maintain a four-layer dressing until the wound heals.

Emergency Care

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

Review and Follow-up Notes

The patient was advised to return for a follow-up visit with the Interventional Radiologist in Hyderabad at PACE Hospitals, after 14 days. During this visit, her recovery would be assessed to evaluate the treatment outcome and determine if any further management was necessary.

Conclusion

This case highlights the effective management of varicose veins, particularly in a patient with diabetes mellitus, using endovenous laser ablation combined with foam sclerotherapy. It emphasizes the importance of accurate diagnosis and individualized treatment planning in achieving optimal outcomes for patients with chronic venous insufficiency.

Advanced vein care with interventional radiology doctor expertise

Advances in varicose vein treatment, such as Endovenous Laser Therapy (EVLT) and sclerotherapy, have revolutionised care compared to traditional surgery, with these minimally invasive procedures often performed by an interventional radiologist / interventional radiology doctor. These techniques use small incisions and local anaesthesia, resulting in less pain and scarring. EVLT utilises targeted laser energy to seal faulty veins, while sclerotherapy involves injecting a solution to close smaller veins. Both methods offer high success rates and lower complication risks. Patients typically experience a much faster recovery and can return to normal activities within a day or two. The likelihood of infection, bleeding, and other complications is greatly reduced compared to conventional surgery. Overall, these modern treatments provide effective symptom relief, improved cosmetic results, and a better quality of life for those with varicose veins.