Precision-Guided EVLT and Sclerotherapy for Varicose Veins in a 72 Y.O. Male Patient
The Radiology team at PACE Hospitals successfully performed Endovenous Laser Therapy and Sclerotherapy on the varicose veins of the right lower limb in a 72-year-old male patient, who had been suffering from varicose veins in both lower limbs (right larger than left), providing significant pain relief.
Chief Complaints
A 72-year-old male patient presented to the Interventional Radiology Department at
PACE Hospitals, Hitech City, Hyderabad, with complaints of dilated veins and visible swelling in his right leg, symptoms suggestive of varicose veins.
Diagnosis
Upon admission to PACE Hospitals, the patient's vital signs were stable. A thorough physical examination revealed dilated veins and noticeable swelling in the right leg. Diagnostic tests, including ultrasound scans, confirmed the diagnosis of varicose veins in both lower limbs, with the right leg being more affected than the left, as indicated by the Color Doppler scan.
Varicose veins are enlarged, twisted veins in the legs, often caused by damaged valves. The condition is characterized by visible bulging veins, swelling and discomfort.
Surgical Procedure
After consulting with Dr. Lakshmi Kumar Chalamarla, the consultant radiologist, it was determined that Endovenous laser therapy (EVLT) and sclerotherapy for the varicose veins in the right lower limb, to be performed under spinal and tumescent anaesthesia, would be the most suitable treatment plan for the patient.
After being admitted with the symptoms mentioned above, the patient underwent further evaluation and was subsequently scheduled for surgery. An Endovenous laser therapy (EVLT) and sclerotherapy were successfully performed under spinal and tumescent anaesthesia to ensure patient comfort and effective pain management.
During the procedure, the right great saphenous vein (GSV), from above the ankle to 6 cm proximal to the saphenofemoral junction (SFJ), and the right small saphenous vein (SSV), from the apex of the calf to 4 cm proximal to the popliteal fossa, were successfully ablated using a laser radial fiber. In addition, some varicosities in the right leg were treated with foam sclerotherapy using a 1% sodium tetradecyl sulfate (STS) solution.
Findings
The Color Doppler examination revealed varicosities in both legs, with the right leg being more severely affected. Incompetent perforators, veins that fail to direct blood from the superficial to the deep venous system, worsen varicose veins by allowing backward flow, increasing venous pressure, and forming enlarged, twisted veins. Targeted treatment is needed to alleviate symptoms and prevent further complications.
Postoperative Care
The procedure was smooth and without complications. Haemostasis was achieved, and a compression dressing was applied using crepe bandages to support the healing process. The postoperative period was uneventful.
Discharge Medications
Upon discharge, the patient was prescribed antibiotics, analgesics, proton pump inhibitors (PPIs), and anticoagulants.
Medications Advised at the stay
During the hospital stay, the patient was advised of medications including antibiotics, analgesics, proton pump inhibitors (PPIs), and anticoagulants.
Advice on Discharge
The patient was advised to avoid cross-legging and prolonged standing or sitting for more than 30 minutes. Weightlifting should be limited to not more than 5 kg for the next week. Above-knee class II compression stockings should be worn during the daytime for the next two months to support healing and reduce swelling. Additionally, the patient should continue taking prescribed medications as prescribed by other physicians.
Emergency Care
The patient’s guardians were informed to seek admission for the patient in the Emergency Ward of PACE Hospitals, Hyderabad, if they observe symptoms such as fever, leg swelling, severe leg pain, chest pain, or breathlessness.
Review and follow-up notes
The patient was advised to schedule a follow-up appointment with Dr. Lakshmi Kumar Chalamarla in the OPD after 14 days.
Utilizing Colour Doppler for Precision in Endovenous Laser Therapy and Sclerotherapy of Varicose Veins
Color Doppler is essential for the accurate treatment of varicose veins, offering real-time imaging of blood flow and venous structures to assess vein size, location, and severity before, during, and after treatment. In EVLT, it guides catheter placement for precise laser direction and improved vein closure, while in sclerotherapy, it monitors the spread of the sclerosing agent without damaging healthy tissue. Post-treatment, it evaluates vein closure and restores normal blood flow, enhancing the precision, safety, and outcomes of both procedures.
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