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The answer Of ur Question Dr_rd is --->
** 1ry VV...:
1) Conservative ttt..By reassurance & elastic stockings ( Self-care measures such as wearing compression stockings, elevating your legs, and exercising regularly may relieve symptoms and keep varicose veins from getting worse.)
2) Injection Sclerotherapy:
Sclerotherapy, endovenous laser or radiofrequency treatment (which uses heat to close off varicose veins), or surgery to treat varicose veins may be considered when symptoms persist. These procedures may also be used if you are concerned about the appearance of varicose veins.
* Sclerotherapy uses an injection of a special chemical (sclerosant) like 5% ethanolamine oleate or 3% sodium tetradecyl sulphate into a varicose vein which has to be empty (- if the vein full of blood, thrombosis will occur which later recanalizes with recurrence of varicosities - ) to induce unjury of the endothelial layer of intima, to damage and scar the inside lining of the vein. This causes the vein to close, as the twp walls of the vein will adhere together without any interveingg blodd clot thus permenant occlusion of the vein occurs.
During this procedure, the affected leg is elevated to drain blood, and the sclerosant is injected into the varicose vein. The procedure is done in a doctor's office or clinic and takes 5 to 30 minutes, depending on how many varicose veins are treated and how big they are.
After the injection of sclerosant is given, pressure is applied over the veins to prevent blood return when you stand up. You may need to wear compression stockings or elastic bandages for several days or weeks to maintain the pressure.
Immedicately after the application of the bandage , the patient is instructed to walk for a long distance inorder to flush any amount of sclerosant that might have reached the deep veins.
The sclerotherapy injection may be painful, and the chemical (sclerosant) that is injected can cause a feeling of burning or cramping for a few minutes in the area where the shot was given. You may need repeated sessions and many injections per session depending on the extent of the varicose veins and type of sclerosant used.
- Pateints with clear evidence of long or short saphenous incompetence or a combination of the two should be treated by sapheno-femoral or saphenopopliteal disconnection combined with stripping.
Ligation of the sapheno femoral junction is called " Trendlenburg's Operation" .The saphenous vein should ve disconnected flush with the femoral or popliteal vein and all tributaries near their termination must be ligated and divided to prevent recurrence. Then the long saphenous is stripped from the medial malleolus to the groin.The short saphenous is stripped from the lateral malleolus to the popliteal region.
** 2ry VV---->
1-Post phlebitic ( followind DVT),The majority of cases are treated conservatively by elastic stockings,rarely the varicosistes are large enough to require active ttt.In these cases verify that the deep system is recanalized clinically and by duplex,then treat as 1ry vv.
2- VV complicating AV fistula, Surgical ttt of the fistula is usually followed by marked regression of varicosisties,If residual veins remain,treat as 1ry vv.
3- VV occuring during pregnancy, A complete elastic stocking from the toes up to the groin is applied through the period of pregnancy, After Labour any residual veins are treated as 1ry vv.
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