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DISEASES OF VEINS

The function of the veins is to take the de-oxygenated blood from the periphery/ various organs of the body and take it back to the heart/ lung for oxygen on. Veins are thin walled tubes that we commonly see on the back of our hands or on feet.

Veins are present all over the body. The veins in the just below the skin are called Superficial veins. There is another set of larger veins that runs deep between the muscles of the legs, abdomen, arms, neck etc. these veins are called Deep Veins.


All of these veins have valves that permit
unidirectional flow of blood from the periphery to the heart.

The most common diseases of the veins
involve either a failure of these valves or
clotting of blood in these veins. Varicose veins is a condition that arises from failure of valves that can happen due to a variety of reasons.

Varicose veins is probably the most common venous disease. Similarly, clotting of blood in the veins is known as Venous Thrombosis. This clotting or thrombosis can happen in any of the veins, but is frequently seen after i.v. injections. Occasionally though, this clotting can happen in the deep venous segments of the leg, known as Deep Vein Thrombosis (DVT)

DVT is a potentially lethal disease as these
clots can migrate to the lungs and can be life threatening in the acute stage and lifestylethreatening in the chronic stage.

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Arterio-Venous FISTULA [AVF]

A vascular surgeon performs arteriovenous (AV) fistula surgery. A vascular surgeon specializes in surgery of the blood vessels.

The goal is to allow high blood flow so that the largest amount of blood can pass through the dialyzer. The AV fistula is a blood vessel made wider and stronger by a vascular surgeon to handle the needles that allow blood to flow out to and return from a dialysis machine. Most people can go home after outpatient surgery.

An A-V fistula usually takes 4 to 6 weeks to be ready before it can be used for haemodialysis. The fistula can be used for many years. A graft (also called an arteriovenous graft or A-V graft) is made by joining an artery and vein in your arm with a plastic tube.

As with all surgeries, arteriovenous (AV) fistula surgery involves risks and potential complications. An AV fistula generally lasts longer and has fewer complications than other dialysis access options, such as a venous catheter or AV graft. Complications are still possible and may become serious or life threatening in some cases.

Complications can occur during surgery, throughout your recovery, or later after the AV fistula has been used for years of dialysis.

Stenosis and thrombosis are the most common complications of AV fistulas. Central vein stenosis occurs in 19-41% of HD [Haemodialysis] patients. Patients presenting to the ED [Emergency Department] with fistula stenosis may report distress secondary to upper extremity and chest wall oedema [swelling].

A vascular surgeon usually performs the procedure in the operating room. You receive a local anaesthetic (numbing medicine) at the proposed site  sometimes along with IV sedation to relax you]. Discomfort is minimal and you may even fall asleep during the 1 to 2 hour-long
procedure.

The creation of an arteriovenous fistula (AVF) for haemodialysis access is a low-risk procedure. It is often time sensitive, as one can avoid use of central venous catheters (CVCs) and their complications.

An AV graft is a looped, plastic tube that connects an artery to a vein. A vascular surgeon
performs AV graft surgery, much like AV fistula surgery, in an outpatient center or a hospital.
The patient may need to stay overnight in the hospital, although many patients can go home after the procedure. A health care provider uses local anaesthesia to numb the area where the surgeon creates the AV graft.
A patient can usually use an AV graft 2 to 3 weeks after the surgery. An AV graft is more likely than an AV fistula to have problems with infection and clotting. Repeated blood clots can block the flow of blood through the graft. However, a well-cared-for graft can last several years.

All types of vascular access—AV fistula and AV graft - can cause problems that require further treatment or surgery. The most common problems include access infection and low blood flow due to blood clotting in the access.
Infection and low blood flow happen less frequently in properly formed AV fistulas than in AV grafts. Still, having an AV fistula does not guarantee the access will be problem-free.

AV grafts more often develop low blood flow, an indication of clotting or narrowing of the access. The AV graft may then require angioplasty, a procedure to widen the narrow part.  Another option involves surgery on the AV graft to replace the narrow part.

A patient can care for and protect a vascular access by:
• Ensuring that the health care provider checks the access for signs of infection or problems with blood flow before each haemodialysis treatment.
• Keeping the access clean at all times.
• Using the access site only for dialysis.
• Being careful not to bump or cut the access.
• Checking the thrill in the access every day. The thrill is the rhythmic vibration a person can feel over the vascular access.
• Watching for and reporting signs of infection, including redness, tenderness, or pus.
• Not letting anyone put a blood pressure cuff on the access arm.
• Not wearing jewellery or tight clothes over the access site.
• Not sleeping with the access arm under the head or body.
• Not lifting heavy objects or putting pressure on the access arm.

AV fistula surgery can improve the comfort and quality of life for people who need long-term dialysis. An AV fistula is the preferred method of vascular access for long-term dialysis. It generally lasts longer and has fewer risks and complications than other access methods, including venous catheters and AV grafts.

It is important to keep your follow-up appointments after surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

• Bleeding
• Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
• Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
• Chest pain, chest tightness, chest pressure, or palpitations
• Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
• Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
• Loss or change in the pulse in the AV fistula
• Pain that is not controlled by your pain medication
• Unexpected drainage, pus, redness or swelling of your incision

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Deep Vein Thrombosis Treatment

Gradually increasing swelling of the leg starting from calf, thighs and sometimes lower abdomen. In advance stages, it may cause severe pain, inability to walk, bluish discoloration of toes.

DVT is a serious condition and a vascular surgeon should be consulted at the earliest. In earlier stages, it is easier to manage DVT.

Usually simple sonography of the leg (a color doppler scan) gives a fair idea about the extent of the thrombosis in leg veins.

Mild form of DVT can be treated with medicines and injections (blood thinners) and it may not require hospitalization. Severe form of DVT requires hospitalization and a procedure called Catheter Directed Thrombolysis (CDT). It is an endovascular (Key hole) procedure that is done without cuts and sutures.

There are range of medicines called anticoagulants that are used in the treatment of DVT which should only be taken under proper medical supervision.

Newer oral anticoagulants (NOACS), Eg- Rivoraxaban, Apixaban, Dabigatran have largely replaced older medications like Warfarin. These newer medications are more effective and does not need repeated blood tests to monitor their efficacy. However, they are not safe for use during pregnancy or lactation.

In most case the treatment given is for 3 to 4 months. However the duration varies on the basis of various factors and should be done under the supervision of an expert vascular surgeon.

CDT is usually done in an angiography suite where a small tube is passed in the veins and all the clots are removed with that some special injections are given in that catheter to dissolve the clots.

Usually CDT is a safe procedure, very rarely a clot migration is noticed.

Usually, CDT requires hospitalization of 2-5 days.

Compression stockings are advised for 3-12 months. Check sonography is done from time to time. Specific exercises are advised to most DVT patients.

NO. Do not become pregnant while you are on anticoagulation. If so, report to your doctor immediately. If you are planning for pregnancy you have to be off anticoagulation for at least -3 months under the guidance of your doctor. Attention: This medication may cause birth defects and severe bleeding in the foetus during the 1st and 2nd trimester of pregnancy.

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Varicose Veins

Large, tortuous unsightly engorged veins on the legs. Sometimes foot swelling (oedema), pain, cramps, itching, blackening, bleeding and ulcer in later stage

Squatting exercises, Medical compression stockings and few medications might help you only if you have mild symptoms. It can also prevent the progression of the disease. But these measures will not cure this condition. If you have severe symptoms like large painful veins, bleeding, skin darkening, itching or ulcer, a long- term solution would require some surgical or endovenous treatment.

A Color doppler scan of your legs is the most reliable test to determine the severity of varicose veins.

Open surgery, which was the standard treatment in the past, has been largely replaced by endovenous (Minimally invasive) therapies with excellent long-term results and very less recurrence. Endovenous therapies are now the recommended modality for treatment of all types of varicose veins.

They are minimally invasive (typically done as day care) - like Laser, Radiofrequency (RFA), Glue treatment (Venaseal), Sclerotherapy, MOCA etc. In endovenous therapies, diseased veins are treated by a small tube that are inserted in to the diseased vein, through a small needle puncture. Here either heat energy, medications or a medical glue is delivered precisely in to the vein and the culprit veins are selectively treated and cured.

Laser treatment does not require hospital stay. Patients may return to normal activities in two days.

No. We at Veinexperts use the best-in-class German Lasers.

These are all endovenous treatments. Each one uses different energy source. We at Veinexperts give you the best option possible to cure your varicose veins after a detailed evaluation.

There are no restrictions in general after any endovenous treatments but you will have to wear medical compression stockings for 6 weeks after the procedure. You will have a check scan of the treated veins from our OPD after 1 week, 4weeks, 6months and 1year respectively.

For small and medium sized varicose veins sclerotherapy can be considered as an outpatient procedure. This involves injection of a sclerosant solution under ultrasound guidance into the varicose veins. This causes scarring in the vein and destruction of the diseased veins in your legs.

Large or medium sized bunches of veins, that cannot be treated by any of the above modalities are removed surgically by technique through a few 2 to 3 mm cuts.

It involves a 2 to 3 cm incision in the upper thigh and division of diseased thigh vein in the groin after spinal or general anaesthesia. Typically, the whole of the diseased thigh vein is removed by “stripping”. You can get back to work in a week or two and maximum hospitalization required will be 2 days.

Apart from being an open surgical procedure, the surgery involves anesthesia and slightly delays return to normal activities

With presence of newer technologies, there are only few situations when you need an open surgery. Our team at Vein experts are very experienced Vascular and Endovascular surgeons have adopted advanced technology into open surgery. We offer excellent results after surgery with very cosmetical and involves micro incisions.

On most instances any single modality may not be enough to achieve a complete cure of your varicose veins. Our expert team would prepare a detailed “vein mapping” and plan a personalised plan for each patient. Typically, any treatment would involve a combination of Laser / RFA / Glue with phlebectomy and sclerotherpy to achieve best results.

After endovenous treatments you can start walking 2 hours after the procedure is done. Usually one can return to work usually after 2-3 days after endovenous ablations and 7-10 days after open surgery.

Definitely yes. Modern treatments of varicose veins usually have a success rate of more than 90-95% if done by experts. We need to thoroughly examine your legs, investigate and we at Veinexperts would advise you about the best option for you.