engleski

Pulsatile varicose veins

We report 2 cases of octogenarian patients with pulsatile varicose veins successfully treated with endovenous laser ablation (EVLA). On clinical presentation both patients involved had bilateral varicose veins with pulsations felt on physical exam. One patient had an extreme clinical presentation with huge thigh varicosities and suffered 2 previous episodes of severe bleeding following minor skin lacerations, whilst other experienced 2 episodes of cellulitis in recent years. Both patients also complained of fatigue during physical activity, limb swelling and had skin damage from chronic venous insufficiency. Venous duplex scan demonstrated grossly incompetent sapheno-femoral junctions with abnormal wave forms with an arterial-like pulsating flow along the course of great saphenous veins (GSV’s). Male patient with extreme varicosities also had CT scans done to exclude arteriovenous fistula and deep venous obstruction. Both patients were on long term anticoagulant therapy due to atrial fibrillation (AF) and had tricuspid regurgitation. They were managed conservatively with thigh high compression stockings, however with low compliance because of the difficulties of having them put on their legs. Because of a significant bleeding risk due to elevated venous pressure and anticoagulant therapy, bilateral EVLA of GSV was performed in local and tumescent anaesthesia on both patients followed by successive staged sessions of ultrasound guided foam sclerotherapy (UGFS) for the treatment residual varicose veins. Follow up visits demonstrated successful occlusion of GSV’s , reduction in size of tributary varicose veins with only mild post-procedural pain, bruising and tightness in thighs. Treatment resulted in significant clinical recovery and marked improvement in quality of life for both patients. EVLA represents a safe and efficacious therapeutic technique for the treatment of pulsatile varicose veins of lower limbs in carefully selected patients with durable results despite severe venous hypertension in this group of patients.

bleeding ; compression ; endovenous treatment ; laser ablation ; pulsatile veins

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