Diagnosis and Treatment of Varicose Veins The most frequently used exam and the gold standard for the diagnosis of varicose veins is venous duplex ultrasound, which identifies any blood reflux or obstruction that is possibly causing a blood flow alteration as well as what is the anatomical or functional cause of it. Other exams might be conducted such a venous plethysmography, magnetic resonance, conventional venography or computed tomography, but they are all less frequently done, depending on each individual patient and their current illness. Always remember that the swollen legs is a very common symptom of heart and kidney disease, as well as from other diseases from the legs, which should be ruled out as well during the diagnostic process, especially when there is an unclear diagnosis.
Based on the results of all of the above and if the most likely diagnosis is varicose veins, doctors use different classifications for the disease, the most common one called CEAP with is the acronym for: • Clinical: Based on the medical examination findings. • Etiology: Whether is congenital, primary or secondary. • Anatomic: Depending on which part of the venous system is affected (superficial, deep or perforating veins). • Pathophysiologic: If the disease is being cause by reflux, obstruction or both.
Which is the treatment for varicose veins? The treatment is divided in two groups: Conservative treatment and Invasive treatment. Conservative treatment The main goal of this treatment is decreasing of the symptoms, stopping the progression of the disease and reducing the risk and incidence of complications. This type of treatment is usually temporary and especially for patients with contraindications for the invasive procedures. The treatment requires the use of compression stockings, which come in various tension degrees (20 – 30, 30 – 40 y 40 – 50 mm Hg) and will be chosen depending on each individual patient and how advance the disease is.
The compression stockings should be ensured for every patient who choses conservative treatment over the invasive one. Additional to this, there are some therapies that should be complementary to the stockings, that include the below ones: • Moisturizing of the ski • Use of topical steroids, hydrocolloids or absorbent dressings • Lifestyle changes • Weight decrease • Drugs that favor the normal venous blood flow • Ulcer treatment • Antibiotic treatment, if needed • Leg elevation above the heart level at least twice a day (more if possible)
Some of the life style changes involve modifiable risk factors such as exercise, specially on the muscles of the calf with adequate recovery periods, active pauses at work, avoiding long standing periods, weight reduction, healthy diet, smoking cessation and doctor’s visit in order to determine the risk-benefit of using a hormone replacement therapy. Invasive treatment One of the most frequently used therapies is the endovenous laser ablation. This is an ambulatory 60 minutes treatment. An ultrasound is made and some routine questions are asked to the patient in order to identify the vein to treat. Then, the patient is taken to the operating room, where a small catheter is inserted into the vein and heat is delivered in order to collapse the diseased vein. This takes about 20 minutes. The main advantage of this procedure is that it gives a definitive treatment for the disease with a fast recovery and no need of work absence.
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