Sharmila, D N (2014) Endovenous Ablation Vs Open Surgery for the treatment of Varicose Veins - A Comparative study. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION : Varicose veins are a common problem and one of the most prevalent medical disorders affecting approximately 10 to 40% of the general population. The lower limb venous system is classified into the superficial system, the perforator and communicating systems and the deep system. In most of the cases the varicose veins of lower limbs are due to superficial venous incompetence which results in the development of truncal varicosities. This occurs in 32% of women and 40% of men (Edinburg Vein Study). Varicose veins are classified as primary and secondary varicose veins. About 60 to 70% of primary varicose vein develop due to Sapheno Femoral Junction (SFJ) incompetence and Great Saphenous Vein (GSV) reflux while in about 10% it is due to Sapheno Popliteal Junction (SPJ) and Small Saphenous Vein (SSV) incompetence. Asymptomatic superficial venous reflux occur in 39% of cases and present as cosmetic problem alone, but in the rest of the cases it presents with symptoms such as restless leg, discomfort, ache, heaviness, pain, swelling, hyper pigmentation and eczematous skin changes, ulcers, bleeding, superficial thrombophlebitis and disability such as talipes equino varus. Treatment of varicose veins is for three main reasons. In the first instance, treatment is to prevent occurrence of complications, such as bleeding, edema, eczema, lipodermatosclerosis and leg ulcers. Leg ulcer treatment is intense and sincere perseverance and endurance is required from both the patient and physician side. It is very expensive owing to its chronicity the duration of treatment required is prolonged. Leg ulcers have a major impact on patients’ social life as reflected by the health related quality of life (HRQOL). Secondly, varicose vein treatment also relieves symptoms caused by varicose veins, such as heaviness, tired legs and cramps. Cosmetic reasons are the third reason for treatment. This study compares the outcome of the management of truncal varicose veins in a series of patients presenting to our tertiary care referral centre over a period of one year. The traditional conventional open surgical technique is compared with that of the latest and the newest minimal access endovenous ablative procedures. This comparative study is made feasible because our centre, the Govt. Stanley Medical College and Hospital, Chennai is the first in the government set up to have these endovenous ablation gadgets and provide these minimally invasive endovenous ablations. AIM : The purpose of this study was to compare the pre procedural, intra procedural and post procedural assessments and thereby evaluate the efficacy of treatment with endovenous technique in comparison with open technique for abolishing primary superficial venous incompetence and thereby bringing about clinical improvement. CONCLUSION : This study shows that the short term efficacy and safety of endovenous ablation and open surgery are similar in the treatment of varicose veins. Endovenous ablation presents with lesser post operative morbidity in terms of post operative pain, bruising and hospital stay which was significantly higher in HL/S group. Both the treatments are equally safe and efficient in eliminating great saphenous vein reflux, thereby alleviating symptoms and signs of GSV varicosities and improving quality of life. Symptom reduction and cosmetic improvement after endovenous procedures are slightly better when compared to surgery. Endovenous procedures can be done as a day care procedure which allows a rapid return to normal activity and also earlier return to work. Endovenous procedures has lower complication rates than surgery, particularly in respect of saphenous parasthesia wound problems, hematoma formation and bruising. Although it might appear that EVLA has some advantages over RFA in terms of frequency of complications like bruising, skin burns and “cord like pulling sensation”, there is no clear evidence that one or the other should be the preferred procedure. Given the choice, most patients will choose endovenous procedures instead of an operation with a cut in the groin and vein stripping. This will become particularly true if the long term outcomes, including the recurrence rates, remain equal. Considering the ease and comfort of the procedure, with fewer peri procedural complications and equivalent short and midterm results the endovenous procedure definitely has an edge over the traditional open procedure.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Endovenous Ablation ; Open Surgery ; Varicose Veins ; Comparative study. |
| Subjects: | MEDICAL > Vascular Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 24 Jul 2017 04:06 |
| Last Modified: | 24 Jul 2017 04:06 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2077 |
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