Varicose Veins ke liye Drugs aur Treatment Options
Pehli Line Treatment: Endovenous Thermal Ablation
Symptomatic varicose veins jo documented valvular reflux ke saath hain, unke liye endovenous thermal ablation (radiofrequency ya laser) sabse pehla aur best treatment hai. 1
Treatment ke liye Criteria:
- Great saphenous vein ka diameter kam se kam 4.5mm hona chahiye 1
- Reflux time >500 milliseconds superficial veins mein aur >1,000 milliseconds femoropopliteal veins mein 1
- Conservative management (compression stockings) 3 mahine tak try karne ke baad bhi symptoms persist karein 1
Thermal Ablation ke Fayde:
- Local anesthesia ke under ho sakta hai 1
- Procedure ke turant baad walking kar sakte hain 1
- Jaldi kaam par wapas ja sakte hain 1
- 1 saal mein 90% success rate 1
- Surgery se kam complications 1
Risk:
- Approximately 7% chance hai surrounding nerve damage ka due to thermal injury 1
Dusri Line Treatment: Sclerotherapy (Varithena/Polidocanol)
Chhoti aur medium-sized varicose veins ke liye, ya thermal ablation ke baad remaining veins ke liye, sclerotherapy recommend kiya jata hai. 1
Sclerotherapy ke liye Requirements:
- Vein diameter kam se kam 2.5mm hona chahiye 2
- Recent ultrasound (6 mahine ke andar) jo reflux duration ≥500 milliseconds confirm kare 2
- Specific vein segments clearly identified hon 2
Common Sclerosing Agents:
Efficacy:
- 1 saal mein 72% se 89% occlusion rates 1, 2
- Veins jo 2.0mm se chhoti hain, unka sirf 16% primary patency 3 mahine mein, compared to 76% for veins >2.0mm 2
Important Caveat:
Sclerotherapy alone ka long-term outcome thermal ablation se worse hai - 1,5, aur 8 saal ke follow-up mein higher recurrence rates dekhne ko milte hain. 2 Isliye main saphenous trunk ko pehle thermal ablation se treat karna chahiye, phir tributary veins ke liye sclerotherapy use karein 1, 2
Conservative Management: Compression aur Lifestyle Modifications
Jo patients interventional treatment ke candidates nahi hain, intervention nahi chahte, ya pregnant hain, unke liye conservative measures recommend kiye jate hain. 1
Conservative Measures Include:
- Medical-grade gradient compression stockings 1
- Affected leg ko elevate karna 1
- Weight loss 1
- Regular exercise 1
- Prolonged standing/sitting se bachna 1
Insurance Requirement:
Insurance companies aksar 3 mahine ka compression therapy trial demand karti hain interventional treatments approve karne se pehle 1
Exception:
Agar severe symptoms hain jo daily activities interfere kar rahe hain, recurrent superficial thrombophlebitis hai, ya ulceration present hai, to compression trial ki zaroorat nahi hai 1, 3
Phlebotonics/Venoactive Drugs
Flavonoid drugs venous function improve kar sakti hain, lekin United States mein koi bhi FDA-approved nahi hai. 4
Available Options:
- Diosmiplex (flavonoid medical food product derived from oranges) - FDA approved for CVI management 4
- Flavonoids, saponins, aur other venoactive drugs chronic venous disorders mein therapeutic effect dikhate hain 5
- Antioxidant medications from flavonoid groups arterial blood pressure reduce karte hain aur thrombotic incidents prevent karte hain 5
Natural Sources:
Treatment Algorithm Summary
Pehle: 3 mahine conservative management (compression stockings, elevation, lifestyle changes) 1
Agar symptoms persist karein:
Combined approach: Aksar multiple procedures ek saath perform kiye jate hain comprehensive treatment ke liye 2
Important Pitfalls to Avoid
- Sclerotherapy alone mat karein main saphenous trunk ke liye - long-term outcomes poor hain 2
- 2.5mm se chhoti veins treat karne se bachein - poor patency rates 2
- Saphenofemoral junction ko treat karna critical hai long-term success ke liye 2
- Ulceration present ho to compression trial ki zaroorat nahi - direct interventional treatment proceed karein 3
Complications to Monitor
Thermal Ablation:
- Deep vein thrombosis (0.3% cases) 2
- Pulmonary embolism (0.1% cases) 2
- Nerve damage (7% cases) 1
- Thrombophlebitis, hematoma, infection 2