Arterial and Varicose Vein Surgery Mr Lasantha Wijesinghe
- Slides: 33
Arterial and Varicose Vein Surgery Mr Lasantha Wijesinghe Consultant Vascular and General Surgeon 4 th December 2015
Vascular Update GP Refresher Day Friday 4 th Dec Mr Lasantha Wijesinghe Consultant Vascular Surgeon
Varicose Veins
Symptoms Itching
Symptoms Itching Aching
Symptoms Itching Throbbing or heaviness Aching
Symptoms Phlebitis
Symptoms Phlebitis Skin changes
Symptoms Phlebitis Skin changes Leg ulcer
Varicose Veins Is it worth treating them? Varicose veins lower quality of life; improved after surgery – Journal of Vasc Surg 1999 Surgery improves quality of life – JA Michaels 2006 Surgery and laser equally effective and safe – K Rass 2012 (400 patients) Laser and radiofrequency equivalent at 3 years – I Nordon 2012 (159 patients) Reduce chance of ulcer recurring
Varicose Veins Referrals CCG v NICE CCG: phlebitis, severe skin changes, bleeding, ulcer NOT for pain or cellulitis
Varicose Veins What treatment? Sclerotherapy (injection of foam) EVLT (laser) RF (radiofrequency) Surgery Others
EVLT endovenous laser Day case Local anaesthetic No groin wound Quick return to activity Long term results awaited Probably as good as surgery
Surgery Day case General anaesthetic Small groin wound Slower return to activity Long term results good Probably as good as EVLT
Results Before After
Vladek Sheybal
Aortic aneurysms National Screening National Screening Programme Men >65 Ultrasound Automatic referral from the programme or recall (>3 cm) or discharge (<3 cm) Unscreened AAAs: – 5. 5 cm diameter is threshold for treatment Information leaflets from NAAASP or Vascular Society
Aortic aneurysms Management Control risk factors bp, smoking, wt loss No driving if over 65 mm Don’t treat just because you can
Claudication Muscle pain/cramp Not at rest or in bed Brought on by exercise Relieved by rest Reproducible Buttock Thigh Calf
Claudication Not dangerous Risk factors – Smoking, diabetes, bp, obesity Naftidrofuryl 100 mg tds Aspirin Statin Exercise classes
Claudication differential diagnosis Spinal claudication Orthopaedic Myopathy Combination Pulses ABPI
ABPIs Easy? >0. 8 = fine Incompressible, don’t worry
Foot ulcers Ischaemic refer Diabetic, pulseless refer (foot clinic)
Leg ulcers Arterial (no venous problem) refer Venous – ABPI > 0. 8 compression – Not healing despite compression refer – ABPI <0. 8 refer Oedema Arthritis (steroids/methotrexate) Heart failure Renal Failure
BMI Harbour Clinics Thursday afternoons 01202 702832 Christine. roper@nuffieldhealth. com
Case 1 42 yr old woman Primary varicose veins Itchy No visible skin changes
Case 2 78 yr old man Comes to discuss ingrowing toenail AF warfarin Poor cardiac function on echo Pitting oedema to knees You notice lipodermatosclerosis and mild varicose veins
Case 3 33 yr old ex IV drug user, cannabis and tobacco use Old left leg DVT Pain in left foot at night and in calf when walks Good femoral and popliteal pulses No foot pulses on left ABPI 0. 7 Normal ABPI and pulses on right
Case 4 65 yr old man Fit, plays 2 rounds of golf a week Sudden onset of pain right calf and foot 3 days ago Some improvement but now only 9 holes Excellent pulses on left (prominent popliteal) Good right fem, no right pop pulse
Case 5 24 year old female nurse Fit and well Swelling left calf 3 weeks No trauma Non tender, no erythema Normal pulses No varicose veins Pitting oedema
Case 6 45 year old woman MS, wheelchair Blue discolouration in both feet Cool Pink when feet are elevated Good pulses
- Legs
- Hsp vs itp
- Dr wathsala wijesinghe
- Lsv vein
- Varicose borer
- Left posterior oblique
- Inverted champagne bottle sign
- The proles 1984
- Arterial arcades of jejunum and ileum
- Jvp measurement
- Intraarterial route
- Tunica media
- Facial vein
- Great and small saphenous vein
- Artery and vein
- Dorsalis pedis vein
- ชนิดของหลอดเลือด
- Lower extremity pulses
- Lingual artery and vein
- Difference between arteries veins and capillaries
- Blood supply to thoracic wall
- Pulses location
- Mean arterial pressure formula
- Modified allen test
- Lateral venous lacunae
- Frecuencia respiratoria valores normales
- Veia pulmonar sangue arterial
- Tensão arterial valores normais
- Sinais vitais
- Divisoes do abdome
- Rutas integrales de atencion en salud
- Ichki va tashqi qon ketishi
- Veia pulmonar sangue arterial
- Arterial wave form