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How to treat varicose veins with ulcers?

Answered by: Dr. Shiban K. Chaku
Senior Consultant Surgeon,
Indraprastha Apollo Hospitals,
New Delhi

Q. I am 46 years old and have been suffering from varicose veins for the past 18 years and have developed ulcers on my legs. It is very painful. Could you please give me an outline of the treatment for varicose veins with ulcers?

A.  There are two problems inter-twined into one. The first problem, which takes precedence is that of varicose ulcers and needs immediate and urgent attention. The second problem is the long-term problem of varicose veins. I suggest that you get the ulcer treated with application of 3/4 layer bandages and also making sure the infection element is taken into consideration and required cultures of the wound suggesting appropriate antibiotics, either local or systemic or both administered depending on the extent of infection. I would also like to advise ambulation as soon as the pain settles, even though the ulcer has yet to heal. Leg should be kept elevated while sitting. Standing for long and sitting with legs hanging down should be avoided. I am confident with this regime the ulcer should heal unless there is an arterial component associated. Once the ulcer is healed then the second and more long-term solution to the problem of varicose veins and varicose ulcers is to be addressed. This can be done by investigating the status of the veins in the leg. This shall inevitably mean Duplex scan of the legs and based on the findings of the scan the definitive procedure can be planned. The treatment strategy shall be dictated by the determination of the site of the problem, that is the status and the site of the valvular damage. It is also be guided by the local expertise where the treatment is done and availability of the specialised equipment. Of course the patients wishes would also be a major factor in deciding the course and type of procedure. If all modalities are available then the treatment ought to be tailor made to suit the condition and extent of the disease. Patient can get consultation from a vascular surgeon and ask for patient testimonials, from the ones treated before.

A.  There are two problems inter-twined into one. The first problem, which takes precedence is that of varicose ulcers and needs immediate and urgent attention. The second problem is the long-term problem of varicose veins. I suggest that you get the ulcer treated with application of 3/4 layer bandages and also making sure the infection element is taken into consideration and required cultures of the wound suggesting appropriate antibiotics, either local or systemic or both administered depending on the extent of infection. I would also like to advise ambulation as soon as the pain settles, even though the ulcer has yet to heal. Leg should be kept elevated while sitting. Standing for long and sitting with legs hanging down should be avoided. I am confident with this regime the ulcer should heal unless there is an arterial component associated. Once the ulcer is healed then the second and more long-term solution to the problem of varicose veins and varicose ulcers is to be addressed. This can be done by investigating the status of the veins in the leg. This shall inevitably mean Duplex scan of the legs and based on the findings of the scan the definitive procedure can be planned. The treatment strategy shall be dictated by the determination of the site of the problem, that is the status and the site of the valvular damage. It is also be guided by the local expertise where the treatment is done and availability of the specialised equipment. Of course the patients wishes would also be a major factor in deciding the course and type of procedure. If all modalities are available then the treatment ought to be tailor made to suit the condition and extent of the disease. Patient can get consultation from a vascular surgeon and ask for patient testimonials, from the ones treated before.

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