IN THE MANAGEMENT OF VARICOSE VEINS AND DISORDERS OF THE VENOUS
CIRCULATION - PART II
S. Pehar, M. Dilić and S. Švrakić .
of Vascular Diseases, Clinical Center University of Sarajevo,
Bosnia and Herzegovina
is one of the treatment options in varicose veins of the lower
limbs. Percentage of adult patiens suffering from varioce veins
ranges between 25-32% in females, and 15-20% in males. The new
concepts in the management of the varicose syndrome include combination
and simultaneosly applied measures - elimination of risk factors,
bandage protection, medication, sclerotherapy, surgical treatment.
First step of any serious approach to pts. with varicose veins
is: (i) constant and long term elimination of risk and provocating
factors, (ii) futher step is appropriate bandage prevention with
multilevel grading elastic stockings, (iii) medication, (iv) sclerotherapy
by the injection of sclerosing solutions, (v) surgical treatment.
Sclerotherapy and surgery are used to remove the varicose veins
and heal terminal stage of the disease. Both methods show good
results only if they are applied following a valid assessment
of deep venous flow, valve condition, and perforating vein condition.
Additionally, a careful planning of the treatment is nessesary.
Due to the complexity of the problem an expert teams should be
in the charge of the planning and overall management. The techniques
differ in many respects due to clinical aspects, sclerosant drugs,
approach to risk-areas, possible complications, and cost-effectivness
of treatment. Combination of sclerotherapy and operative therapy
shows good results and maximum success. The criteria for application
of sclerotherapy, as well as the equipment needed for the application,
are specified in the paper but special point is perforating and
reccurent varicose veins. The effect of the sclerosing solutions
upon the blood vessels and contraindications are also described.