PROF S.R.SUBRAMMANIYAN INSTITUTE OF VASCULAR SURGERY MADRAS MEDICAL COLLEGE
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1 PROF S.R.SUBRAMMANIYAN INSTITUTE OF VASCULAR SURGERY MADRAS MEDICAL COLLEGE
2 VARICOSE VEINS OF SUPERFICIAL VENOUS SYSTEM OF LOWER LIMBS
3 A SYMPTOM NOT A DISEASE
4 INITIAL,MILD CASES and severe cases with contraindication for surgery CAN BE TREATED CONSERVATIVELY LEG ELEVATION REGULAR EXERCISES GRADUATED COMPRESSION STOCKINGS WITH VARIABLE PRESSURE (CLASS2/3) DECREASE SWELLING INCREASE NUTRIENT EXCHANGE IMPROVES MICROCIRCULATION SHOULD NOT BE USED IN CONCOMITANT ART.DIS.
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8 phlebotonic drugs have a modest effect on the symptoms of chronic venous disease including edema. These become less apparent or disappear when compression is used as a comparator treatment.
9 Venous ulceration is conventionally managed by compression treatment, which may be combined with surgery to varicose veins, perforating veins and much less frequently with deep vein reconstruction. Compression treatments have been found to lead to acceleration of healing with a greater proportion of healed ulcers. A significant problem remains the rate of recurrence of ulcers after healing with compression
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11 Venous ulceration is conventionally managed by compression treatment, which may be combined with surgery to varicose veins, perforating veins and much less frequently with deep vein reconstruction. Compression treatments have been found to lead to acceleration of healing with a greater proportion of healed ulcers. A significant problem remains the rate of recurrence of ulcers after healing with compression
12 ZINC AND VITAMINS Greaves and Skillen reported complete healing in 13 of 18 patients with previously intractable ulceration after a 4- month course of 220 mg zinc sulfate three times daily
13 FIBRINOLYTIC THERAPY The concept of an oxygen diffusion barrier causing skin hypoxia was first proposed by Browse and Burnand in Stanozolol tissue plasminogen activator has been added as a topical treatment to leg ulcers as an ointment Sulodexide, a highly purified glycosaminoglycan with profibrinolytic properties
14 Pentoxifylline potent effect on inhibition of cytokine-mediated neutrophil activation pentoxifylline may be useful in the management of leg ulcers, especially when combined with compression.
15 The use of topical antibiotics in leg ulcers may lead to the emergence of resistant organisms and risk sensitizing the patient to the antibiotic Impair wound epithelialization clinical infection of an ulcer must be treated, but this is best done by local ulcer toilet, unless cellulitis or septicemia are present. In these circumstances, intravenous antibiotics are usually indicated
16 Prostaglandin E1 reduction of white cell activation, platelet aggregation inhibition, small vessel vasodilatation and reduction of vessel wall cholesterol levels. reducing the healing time of venous ulcers.
17 Prostacyclin analogs Iloprost increased fibrinolytic activity, reducing leukocyte aggregation, and adhesion to endothelium
18 Diosmin hesperidin Micronized purified flavonoid fraction (MPFF; Daflon 500 mg, ), which consists of 90% diosmin and 10% flavonoids expressed as hesperidin, protect the microcirculation from damage secondary to raised ambulatory venous pressure. It decreases the interaction between leukocytes and endothelial cells by inhibiting expression of endothelial intercellular adhesion molecule 1 and vascular cell adhesion molecule, as well as the surface expression of some leukocyte adhesion molecules (monocyte or neutrophil CD62L, CD11B)
19 venous ulcer healing is accelerated by MPFF treatment. MPFF might be a useful adjunct to conventional therapy in large and longstanding ulcers which might otherwise be expected to heal slowly.
20 PLATELET INHIBITORS Aspirin Ifetroban oral thromboxane A2 receptor antagonist ifetroban (250 mg daily) on healing of chronic lower extremity venous stasis ulcers
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22 WHO GETS SCLEROTHERAPY? SMALL NON SAPHENOUS VARICES<5mm TELANGIECTASIA RETICULAR VEINS PERFORATOR VEINS RESIDUAL/RECURRENT FRAIL WITH RESISTANT/HEALED ULC
23 SCLEROSING AGENTS SODIUM TETRADECYL SULPHATE SOD.MORRHUATE HYPERTONIC SALINE SOL. POLYDOCANOL,SOTRADECOL ETHANOLAMINE OLEATE GLUCOSE COMBINATIONS
24 PRINCIPLE DAMAGES ENDOTHELIUM LEADING TO FORMATION OF FIBROUS CORD REABSORPTION OF ALL VASCULAR TISSUE LAYERS SCLEROSANT IS GIVEN INTO AN EMPTY VEIN & COMPRESSED IMMEDIATELY TO AVOID THROMBUS FORMATION TECHNIQUE
25 COMPLICATIONS PHLEBITIS SKIN STAINING FAILURE RESIDUAL LUMPS MATTING EMBOLUS (CVA) DVT,PULMONARY EMBOLISM ULCERATION(RARE) ANAPHYLAXIS(VERY RARE) SKIN SLOUGHING DUE TO EXTRAVASATION
26 30 G BUTTERFLY NEEDLE 0.2%STS& POLIDOCANOL SEVERAL COURSESARE REQUIRED FOR THREAD/RETICULAR VEINS COMPRESSION BANDAGE FOR 1-5 DAYS
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28 SCLEROSANT & AIR ARE IN 4:1 RATIO 1%/3% SCLEROSANT IS USED INDUCES SPASM DISPERSES WELL ENHANCED SCLEROSIS
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