Sclerosing treatment

Sclerosing Treatment of Varicose Veins

Varicose veins are veins, some shallow, others deep, protracted and tortuous appearance, formed by a malfunction of the valves of the veins or venous hypertension.

Primary varicose veins are due to defects in the architecture and secondary venous stem from damage to the venous system.

To prevent both the appearance of varicose veins as the recurrence of these is important to understand that the process of varicose veins in the legs due to multiple factors: genetic, posture, obesity, hypertension, etc.

Therefore, the exercise, especially walking, stockings with gradients of pressure and weight reduction are some of the measures that can alleviate the situation.

Sclerotherapy involves injecting into the lumen of the vein sclerosant that causes a controlled local inflammation with subsequent fibrosis and closure of the varicosity.

Sclerotherapy of varicose veins

It is called injection sclerotherapy to them of various chemicals that can trigger an inflammatory response in the endothelium of the vein, which first lead to thrombosis and ultimately to fibrous organization and cancellation of the varicose vein.

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It can be performed on an outpatient basis, the patient can return to his home and does not need rest or medication.

Not all varicose veins can be sclerotic. Sclerotherapy in no case should be applied to all types of varicose veins. If this were done, would be a high failure rate and complications.

MECHANISM OF ACTION OF THE SCLEROSIS

It causes a chemical phlebitis that eventually leads to the production of scar tissue.


CLASSIFICATION sclerosing agents

MAJOR SCLEROSING

* Iodine

It is used in the form of sodium iodine (Association of iodine and sodium iodide). It is found in concentrations of 1% and 3%. It is the oldest and probably the most effective sclerosant. Little allergenicity. Painful injection. In cases of overdose can occur with febrile iodism passenger.

* Sodium tetradecyl:

Powerful. It occurs in concentrations of 0.2% to 5%. Very easy aplicación.Problemas: necrosis, perivenitis, pigmentation, telangiectasias postesclerosis relatively common, many allergic reactions. Intraarterial injection pain is delayed.

* Polidocanol:

We present in concentrations of 0,5,1,2 and 3%. Transparent, non-staining. Your injection is painless and easy to use. It has good power and allergies are sclerosing raras.La paravenous injection may cause scarring.

MINOR SCLEROSING

* Sodium salicylate:

Concentrations of 20 and 60%. Paravenous injection is immediately painful. There are no pigmentation or telangiectasia practically, unless excessive concentrations. His power sclerosing is reduced, making it ineffective in the venous trunks of medium and large caliber, and points of reflux. The injection is painful, so it is used frequently associated with lidocaine.

* Glycerol chrome:

Sclerosing very weak, reserved for telangiectasias and small veins. Rarely produces sores.

THE IDEAL SCLEROSING

Features sclerosing perfect:

- Purified substance and high chemical stability

- Ease of use

- Minimum effective dose

- Low viscosity

- Not to be painful or cause local injection cramps or discomfort following the same

- Do not induce inflammatory reactions in surrounding tissues

- Produce a sound and lasting fibrosis

- Not require rest after injection

- Require short-term treatments

- Not toxic

- Not allergizing.

TECHNICAL AND TREATMENT PLAN

You use a syringe of 3 to 5 ml. The choice of the caliber of the needle depends on the desired sclerosed vessel and viscosity of the product used, very fine needles are reserved for the treatment of telangiectasias.

During the first session, a low concentration is used to assess your tolerance.

The patient is positioned sitting at the site of vessel to be monitored and venous blood is not blood. The injection will be slow to foster maximum contact with the wall of sclerosing leg venosa.La can and must lift to empty the vein and encourage contact with the wall and prevent dilution of the sclerosant. In the case of sclerosis of veins or telangiectasias less important, where accuracy is critical of the maneuver, the patient will lie.

Immediately after injection, compression is applied selectively puncture the venous pathway and treated, complete with an elastic bandage member. This compression is essential.

The technique can be refined by sclerosing injecting a small air bubble (air-block) to promote the micronization of the sclerosant and better emptying of the vein, as well as a safety mechanism.

The interval between treatment sessions is at least two weeks, and should observe the possible signs of intolerance or complications.

It paravenous injection avoided, given the risk of periflebitis and necrosis. The injection has to be without strength and without pain. Any discomfort you feel during the injection immediately require the stopping of it.

Decreasing the concentration and depending more than bandage, diminish the effects Doppler negativos.Por through veins-arteries prevents errors.

On the back is not practiced foot sclerotherapy.

The technique called Sigg tries to minimize the risk of multiple sclerosis by security mechanisms, which are:

* Using a needle, 1.2 mm thick, so if we accidentally located an artery instead of a vein, the force and volume of blood enter the syringe would indicate such a situation, avoiding the error .

* Using a glass syringe plunger also run to allow notice any resistance to the injection of sclerosant.

* Use of "air-block."

Sclerotherapy should be planned in advance. They're classic four schemes:

Technique "bottom-up" first sclerose varicose veins distally and treatment ends with the obliteration of the feeder trunks. It is a slow and cautious approach that requires numerous sessions.

Stage technique: try to eradicate in a single session all the varicose veins. This technique is difficult and not without risk.

Technique "top down" is to paralyze the logs first feeder, the crooks and perforators. In the first phase paths are ignored and only injecting varicose veins if they persist during treatment. Technical difficult.

Sclerosis Association and surgery: complementary sclerosis less aggressive surgery (ligation of arch, segmental stripping, etc.) Deleting the points of reflux. Varicose recurrences are less frequent.

INDICATIONS SCLEROTHERAPY

Varicose veins can be treated effectively by reticular sclerosis.

The nurturing of an ulcer varicose veins can also be treated by sclerosis.

Sclerosis of venules and telangiectasias, not associated with a systematic varicose syndrome produces good and lasting results.

Angiomatosis.

Varices side: good indication (SIGG technique).

Recurrent varices after surgery (good indication)

Klippel-Trenaunay syndrome.

When there is reflux in V. Internal Saphenous, relapse to sclerotherapy is above 30%, so that surgery is indicated.

CONTRAINDICATIONS OF SCLEROSIS

Patients who need prolonged bed rest and that, therefore, have a high risk of deep vein thrombosis (DVT).

Patients with a history of venous thromboembolism (VTE).

Patients with uncontrolled hypertension.

Pregnancy.

Nephrotoxicity and liver disease.

Bronchial asthma.

Decompensated diabetes.

Known hypersensitivity to the sclerosing agent.

INCIDENTS AND ACCIDENTS IN THE SCLEROSIS

Local events

* Phlebitis and periflebitis.

It usually comes from an overdose of the drug.

Treatment consists in the application of NSAIDs, and avoidance of elastic containment rest that may favor the development of deep vein thrombosis.

Later intravaricoso can evacuate the hematoma through a small thrombectomy.

Pigmentation *

The melanin pigments are made up and, above all, for hemosiderin, the inflammatory reaction involves extravasation of red cells that give rise to tattoo the skin. The spots come out telangiectasia: excessive dose, concentration, or lack of dressing.

It is advisable to avoid compression of the puncture and the passage of sclerotic and drainage of intravenous thrombus occurred. Once the pigment is difficult to treat successfully, it may be helpful to use hydroquinone associated with a corticosteroid. You can try the cream Klingman, who used wisely gives good results in a high number of cases. At times, this pigment disappears with time, and at other end to be a major aesthetic alteration, so its appearance should be avoided.

Klingman Cream:

- Hydroquinone 3 gr.

- Retinoic acid 0.1 gr.

- Dexamethasone 0.2 gr.

The Desferín, used in mesotherapy, with one meeting each 2O days and for at least 6 months (to see the results) can also be used, either alone or in combination with the cream of Klingman.

* Variculas

Telangiectasias are generally maintained by an underlying vein, since it has eliminated the drainage path sclerosis, but not the contribution. Treatment consists of power to paralyze road or telangiectasia.

* Edema

To avoid this is to make a good containment elastic.

Accidents locoregional

* Extravascular injection

It can cause an inflammatory reaction from more or less important to necrosis. The importance of this complication will depend on the concentration and depth of injection.

* Intraarterial injection

It can result in extensive loss of limb or even be required amputation of the same. Luckily it is a rare complication, but obviously very serious. To prevent this, one must be very careful especially in inguinal folds, popliteal, internal malleolar region or dorsum of the foot, making sure it is in vein. Treatment consists of hospitalization of the patient and intra-arterial administration of corticosteroids and, by general, intravenous heparin, antibiotics and symptomatic treatment.

* Deep vein thrombosis (DVT)

Rare.

GENERAL ACCIDENT

Minor accidents

* Vagal reaction

It is relatively common particularly in patients who are very emotional.

Major Accidents

* Allergy

The treatment is any allergic reaction, are useful steroids, antihistamines, may be necessary to administer atropine or epinephrine and the general principles of resuscitation.

 

 
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