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Ростовский Государственный Медицинский Университет

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Книга_4087_Библиотеки_им_академика_М_И_Перельмана

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Page119

WhichisBetter:InjectionTreatmentorSurgery?

Injectiontreatmentandsurgeryarenotrivals,sinceeachmethodhasitsownapplications.Indeed,itisnotuncommonforbothmethodstobeusedinthesamepatient.

Injectionsworkbyproducingasmallareaofinflammationinthewalloftheveinwhichwillthenbecomesealedoffwithscartissue,thusobliteratingthevaricosevein.

Itisaveryusefultreatmentindealingwiththecommonproblemoffairlysmallveinsbelowthekneeandaroundthecalf.Surgeryisusuallyrequiredformoreextensive

varicoseveinsthatextenduptothethighandthegroin.Afterwards,itmaybenecessarytoinjectanyremainingvaricoseveinslowerdowntheleg.Injectiontreatment

isalsoveryusefulindealingwithsmallrecurrenceswhichmayoccuraftersurgicaltreatment.

WhataretheAdvantagesandDisadvantagesofeachMethod?

Injectiontreatmentisgivenonanoutpatientbasis,sothereisnoneedtobeadmittedtohospitalortohaveananaesthetic.Iftheveinsarenotallclearedup,the

injectionscanberepeatedandiffurthervaricoseveinsdevelopatalaterstagethesetoocanbeclearedupbyfurtherinjections.Thedisadvantageofinjection

treatmentisthatyourlegwillneedtobebandagedforseveralweeks(althoughyouwillbecompletelymobileduringthistime).Occasionallyasmallareaofbrown

discolourationmayoccuratthesiteoftheinjectionand,rarely,theremaybeatinyulcerattheinjectionsiteifanyoftheinjectionmaterialhasescapedundertheskin.

Theulcerwillhealquitequicklywithsimpledressings.

Surgicaltreatmentrequiresadmissiontohospitalandeitherageneralorlocalanaesthetic.Aswithanyotheroperation,thereisalwaysthepossibilityofbleedinginthe

woundorofinfection,eventhoughtheserisksarenowadaysveryslightindeed.

Whatistheriskofrecurrenceofvaricoseveinsaftertreatment?Unfortunatelysomethinglike20%ofveinsufferersarelikelytodevelopfurthervaricoseveins

followingtreatment.Insomecasesthisisbecauseveinsthathavebeeninjectedhaveswollenagainoroneoftheveinsthatwasnottiedoffsurgicallygradually

expands.Moreoften

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theseveinsrepresentnewvaricositieswhichhavedevelopedasfurthervalvesbecomefaulty.However,thedevelopmentoffurthervaricoseveinsisquiteaslow

processandfurtherinjectionsorquiteminorsurgerycandealwiththesenewveinseffectively.

IsClottinginmyVaricoseVeinsDangerous?

Thrombosisinthedeepveinsoftheleg(nottheoneswhichbecomevaricose)isacomplicationthatoccasionallyfollowsmajorsurgery,prolongedbedrestfrom

illnessor,rarely,pregnancy.Inthisconditionthereisindeedasmallriskthattheclotmaydetachandlodgeinthelung(pulmonaryembolism).Clottinginthevaricosed

surfaceveinsoftheleg,calledphlebitis(seebelow)issorarelyaccompaniedbythiscomplicationthatitcanprettywellbeignored.So,theanswertothisquestionis

no!

WhatisPhlebitis?

Thestagnantcolumnofbloodwithinveryswollenvaricoseveinsmayclotandsetupalocalizedareaofinflammation.Thesegmentofaffectedsurfaceveinbecomes

hot,red,swollenandtender.Itisveryrarelyduetoabacterialinfectionandthereforedoesnotrequireantibiotictreatment.Ifyouarefoundtobesufferingfrom

phlebitisyouwillbeadvisedtogotobedandrestyourlegintheelevatedposition,withtheheelabovethekneeandthekneeabovethehip.Thewholeaffairwillthen

settledownquitequickly.Phlebitisbelowthekneeveryrarelycausesanyproblems.However,ifthelongsaphenousveinabovethekneeisaffectedbythrombosis,

thereisariskthatthiscouldspreadintothefemoralveincausingadeepveinthrombosis.Youwillnoticeareddened,tenderareaontheinsideofthethighwhichcan

spreaduptoinvolvethegroin.Thebesttreatmentforthisisanoperationtodisconnectthelongsaphenousveinfromthefemoralvein.Youshouldseekmedical

attentionquicklyforthis.

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ArePeoplewithVaricoseVeinsatSpecialRiskofDeepVeinThrombosis?

Thisiswherethrombusformsinthedeepveinsintheleg.Themajorriskisthatitcanmoveinthecirculationtothelung—calledapulmonaryembolus.Thereisno

evidenceinthemedicalliteraturethatpeoplewithvaricoseveinsareatanincreasedriskofdevelopingclotinthedeepveins.Ifyouhavevaricoseveinsandyouare

goingintohospitalforanoperation,youshouldtellthemedicalstaff.Mosthospitalshaveprotocolsforpreventingdeepveinthrombosisduringyourstayinhospital.

Thismaybegivingyoucompressionstockingstowear,oritmayinvolvegivingyouaninjectionofheparin—abloodthinningagent—orboth.Ifyouarehavingan

operationonyourvaricoseveins,theriskofdevelopingadeepveinthrombosisissmall.

WhataremyChancesofDevelopingaVaricoseUlcer?

Ifyouhaveminorvaricoseveinsandthesearetreated,thereisnotmuchriskofyoudevelopinganulcer.Ulcersusuallydevelopinlegsthathavelongestablished

varicoseveinsandalreadyhavepatchesofinflamedskinknownasvaricoseeczema.Anyonewhohashadathrombosisofthedeepveinsofthelegandwhohasa

swollenanddiscolouredlegasaresultisalsoatrisk.Ulcerationusuallyoccursinsuchlegsasaresultofaminoraccident,soyoushouldbeparticularlycarefulabout

keepingyourlegsoutofharm'sway.

HowcanIgetmyVaricoseUlcerHealed?

Thetreatmentofavaricoseulcerisbasicallysimple.Yourlegshouldbesupportedbyanelasticbandagewhichwillcompresstheaffectedveinsandassisttheir

returningbloodfromthelegtotheheart.Onceyourlegiseffectivelybandaged,youareencouragedtotakeactivewalkingexer

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cisessothatthebloodintheveinsisreturnedthroughthemusclepumpoftheleg.Drainageisalsohelpedbyelevatingyourlegatnightinbed,byavoidingstanding

andbykeepingyourlegelevatedwhenyou'resittingdown.Thereisnoneedtoapplyanyointments,salvesorantibiotics;indeed,thesensitivityoftheskintothese

oftenonlymakestheulcerworse.Ifyouareoverweightthiswillmaketheefficientbandagingofthelegsdifficultandwillmakeactiveexercisinghardersothatyouwill

needtogoonastrictweightreducingdietbeforetreatmentcanbereallyeffective.

CanIStopVaricoseVeinsfromDeveloping?

Unfortunately,atpresentweknowofnowayofdoingthis.However,earlytreatmentofvaricoseveins,eitherbyinjectionorbysurgery,ishighlyeffectiveandithasa

verygoodchanceindeedofstoppingyoudevelopingthecomplicationsofthiscondition.Ifyouhavevaricoseveins,youcanhelpthesurgeonimmenselybyafew

simplecommonsensemeasures:avoidstanding;learntokeepyourlegsraisedwhenyouaresittingdownorlyinginbed;takeplentyofactiveexercisetokeepthe

musclesofyourlegspumpingthebloodbacktoyourlungs;andkeepslim!

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