Our Doctors are always happy to answer all questions sent by their patients. Below you will a list of important issues related to the diagnosis and treatment of venous system disorders.
1Should I worry if the presence of several different bacteria was determined in the culture of ulcer? Which antibiotic would be the best?
The characteristic feature of chronic wound is that they are colonized by bacteria. Thus, it would be very improbably if culture from the wound would be sterile. It is the truth that in the majority of wounds, the presence of bacteria may slightly slow down the healing process. Usually, however, such lesions do not require treatment with antibiotic. Furthermore, application of antibiotic may in some cases be harmful rather than helpful. We should remember that it is FORBIDDEN to use antibiotics locally, i.e. creams or ointments applied on the wound. If administration of antibiotic is required, then physician, most preferably based on the culture of wound biopsy, should order antibiotic administered orally, and in special situation even intravenously.
2Dressing applied on the wound smells unpleasant. Does it mean that something bad is going on with the wound?
Unpleasant smell, especially if it is accompanied by escalating pain may be a signal of infection of the wound. Most frequently, however, it is associated with large amount of exudate from wound, collected under the band. In such situation, more frequent change of band is usually sufficient enough. It is also possible to apply bands with filler neutralizing unpleasant smell. PLEASE REMEBER!!! If you have any doubts, it is always better to contact with specialist.
3For several years, my neighbour have a similar wound on leg as mine, however, the physician did not instruct her to wear compression bands. Why?
Use of compression materials is a kind of therapeutic procedure, which as in case of the majority of drugs or procedures, has precisely defined indications and contraindications. It means that in some patients it cannot be applied. If the neighbour has e.g. advanced arterial ischemic disorder of lower extremities, severe heart failure, cirrhosis or protein insufficiency in organism, then compression bands could be harmful for her.
4I have heard of new bands from TV advertisement. I applied it on my wound, however, there was no effect. My physician wants to use it again. Does that make sense? They have not helped me.
Most frequently, media advertisements do not contain detailed instructions how to apply bands. Thus, even the most optimal band, if it was used inadequately, may be ineffective. Healing of wounds require knowledge and experience, but also improving ones qualifications. Therefore, physicians and nurses who deal with this problem participate regularly in trainings where they have a chance to learn the most recent methods of treatment, new bands and rules of their adequate use.
5How should I prepare for Doppler ultrasound of veins of abdominal cavity, small pelvis and perineum?
For 48 hours prior to the examination, meals that could produce gases in the intestine, i.e. sweets, fruits and dairy products should be avoided. On the day of examination, patient should fast and drink a moderate amount of non-carbonated water (up to 0.5 litre 2-3 hours before the examination). Just before the examination, patient should go to the toilet to empty the bladder.
6What are the advantages of interventional radiology in the treatment of pelvic venous insufficiency?
Interventional radiology procedures are very effective. They are performed without general anaesthesia, only with shallow sedation under the control of anaesthesiologist. Due to the "sandwich", a technique we employ, we may precisely and without any pain close practically all varicose veins that appeared after pregnancy.
Due to a number of questions asked by patients, below we present a list of advantages of such therapeutic approach:
- lack of incision and scars on skin
- bilateral venous embolization performed from one access on skin on leg or arm
- lack of general anaesthesia (shallow sedation is used)
- short period of procedure (a total of 4-6 hours stay in hospital)
- quick recovery to normal life activity
- much lower risk of infection and other post-procedure complications, including postthrombotic ones compared to classic surgical and gynaecological procedures
- high post-procedural effectiveness in several years observations
7What are the features of postpartum ovarian vein thrombosis?
It is a special type of vein thrombosis affecting pregnant women after the delivery. A risk of such thrombosis, which may result from bacterial infection, substantially increases in women who were pregnant more than one time. Probability of its occurrence is also on the increase in case of females giving birth through caesarean section. Increased risk of thrombosis in this period of female life results from several factors. During postpartum period, there is a naturally increased hypercoagulability of blood, excessively dilated veins and pelvic venous plexus with a slow flow in their lumen. These are ideal conditions for forming thrombus.
Symptoms of ovarian vein thrombosis include heavy and acute abdominal pain which is frequently accompanied by fever. Such symptoms appear usually up to a week after the delivery. Besides the initiation of antimicrobial therapy and antipyretic treatment, fever does not disappear totally. Right-side pain is dominant (90% of thrombosis after the delivery affects right ovarian vein). Backaches and nauseas with vomiting may also be present.
8Do postpartum varicose veins in the region of anus have any relation with perineum varicose veins?
In case of significant percentage of females who delivered children, there is a correlation between the presence of varicose veins in the region of small pelvis and anus. They appear as the result of midpregnancy dilatations of venous plexus near the anus. It is not a rare situation, in which treatment of these two diseases requires the collaboration of proctologist and phlebologist.
9What are the indications for diagnostic phlebography and varicography (venogram)?
In the times of digitalization of angiographic equipment (based on x-rays), improvement of imaging quality and increased safety of contrast agents, diagnostic phlebography performed in room for intravascular procedures became a precise tool for evaluating a number of clinical conditions associated with venous system diseases. Most frequently, we perform it in the following situations:
- suspicion of active thrombosis or postthrombotic changes in veins of small pelvis and abdominal cavity
- planning treatment of pelvic venous insufficiency and varicose veins in intimate area in females
- planning treatment of varicose veins of spermatic cord in males
- suspicion of compression syndromes on venous plexus in small pelvis and abdominal cavity
- atypical veins on legs combined with varicose veins in intimate area and pelvis
10What are other indications for venous embolization?
- symptomatic pelvic venous insufficiency (pelvic congestion syndrome)
- atypical varicose veins on lower extremities resulting from pelvic venous insufficiency
- recurrent varicose veins on lower extremities subject to surgeries resulting from pelvic venous insufficiency
- venous malformations and hemaangioma in different locations, e.g. intimate area
11Does elimination of leg varicose veins have any sense prior to the pregnancy?
Everything is dependent on the clinical situation. In a number of cases, mechanism of simple venous insufficiency is visible. Its elimination substantially decreases the risk of developing massive insufficiency after the pregnancy. Currently, we use minimally invasive methods. Simultaneously, they move in the direction of miniaturization. Thanks to that, we may eliminate reflux in small veins which are not accessible via classic surgery.
12When should I visit the phlebologist to evaluate the status of my veins after the delivery?
A follow-up visit, during which postpartum status of veins is evaluated, usually takes place at least 3 months following the procedure.
13Is breastfeeding forbidden during sclerotherapy?
Breastfeeding itself is not a contraindication for procedures. We recommend our patients, however, to stop breastfeeding for 24 hours following the procedure.
14May compression sclerotherapy be used in the treatment of varicose veins of every size?
Compression sclerotherapy performed using needle method with the administration of foam under the guidance of ultrasound (echosclerotherapy) is an effective procedure up to a certain dilatation of vein and degree of complication of incompetent venous trunks. Based on a number of clinical trials and own experience of the Clinic of Phlebology, it is estimated that the effectiveness of classic sclerotherapy substantially decreases in case of veins of diameter higher than 6 mm.
Thus, there is an alternative method, i.e. mechanical and chemical obliteration with PHLEBOGRIFFE, whose effectiveness in case of large varicose veins exceeds the classic needle echosclerotherapy.
15Which of the method of sclerotherapy is the most effective?
The most effective methods of sclerotherapy are those which are performed intravascularly using catheter systems and at maximal clearance of vein from blood. In this respect, PHLEBOGRIFFE is the most promising method. Procedures with such system may be performed additionally under tumescent anaesthesia which increases the effectiveness of the procedure in long-term observation.
16Is the closure of varicose veins using PHLEBOGRIFFE done under local anaesthesia?
The majority of incompetent veins qualified in the Clinic of Phlebology for obliteration with PHLEBOGRIFFE is closed without tumescent anaesthesia, which is always applied in thermal methods. Exclusively local anaesthesia at the side of access to the major trunk (usually in the upper part of limb) is required. Thus, this procedure is exceptionally painless for patient which is its main advantage.
17Is that true that varicose veins following sclerotherapy are recurring?
Treatment of chronic venous disease is often compared to the treatment of cavities.... Sometimes, effect is maintained for many years, but sometimes interventions are required again, even every 2-3 years. Everything is dependent on the tendency for recurrences.
Ultrasound is a decisive factor with regard to the need of supplemental procedure in veins treated with sclerotherapy. Usually, the aim of our action is to anticipate the moment in which varicose veins may re-appear.
It should be stated, however, that the risk of varicose vein recurrence may affect one in three patient following sclerotherapy while in case of surgeries, it may affect one in five patients within 5 years. It should be highlighted, however, that the level of difficulties of the next sclerotherapy is usually comparable to the first procedure, while each successive surgery of the same leg is more difficult for the surgeon and burdened with higher risk of complications.
18What is the frequency of control visits following sclerotherapy?
Following sclerotherapy performed in the Clinic of Phlebology, patient is always given detailed instructions with regard to further proceedings, including dates of control visits. We always adopt an individual approach. Postprocedural control visit usually takes place within 2-3 weeks following the first procedure. Next visits are arranged depending whether supplementary procedures are planned for patient.
The frequency of next visits and control examination is dependent on the level of advancement of venous conditions and intensification of ailments. If there are no ailments and treated lesions on legs are of cosmetic character (varicose veins, small veins), control visits may be carried out every dozen of months (e.g. once in 12-18 months). In case of treatment of larger varicose veins or the co-existence of more severe ailments, more often visits are indicated, usually every several months (e.g. every 6 months). Irrespective of recommended schedule, consultation is indicated if patient declares that his/her health is quickly deteriorated.
19What is the cost of sclerotherapy dependent on?
Currently, sclerotherapy is the cheapest available method of venous problem treatment. The cost of procedures, however, varies with regard to its variants. Procedures with the use of catheters and tumescence are more expensive compared to traditional sclerotherapy, however, its cost is substantially lower compared to laser therapy and glue treatment.
In our Clinic, the cost of each sclerotherapy procedure is specified in the PRICE LIST. It does not increase, e.g. dependent on the number of ampoules used. Having assessed the cost of treatment, it is worth to remember that some patients would require a full series of sclerotherapy procedures while others would just need one or two such procedures. Each patient is different, thus, we are not able to precisely anticipate how many procedures we have to perform to achieve a satisfactory effect. Thus, the cost of such treatment is dependent on its difficulty and work load of physician.
20Is wearing of compression stockings necessary following each procedure of sclerotherapy?
Compression sclerotherapy consists in injecting of sclerosant to the lumen of treated vein, however, the final effect of treatment is highly affected by these several /dozen of days following the procedure. Most optimally, treated vein should remain pressed in this time as it facilitates its contracting, lowers inflammation and risk of discolouration.
Compression stockings are the most effective manner in which optimal, controlled pressure may be ensured. If they are adequately adjusted, they are the most comfortable and, above all, the safest solution for the patient as their usage decreases the risk of venous thrombosis.
Sclerotherapy is less popular in summer as the patients complain about the discomfort associated with wearing of stockings following the procedure, especially at high temperatures. However, it is still possible to perform it.
In case of patients who definitely do not tolerate compression devices or have contraindications to their use, e.g. due to advanced atherosclerosis, treatment with the use of intravascular adhesive may be a good solution. It is worth to highlight that physicians working in the Clinic of Phlebology have the greatest experience in the closure of varicose veins with intravascular adhesive in Poland as they were first who began to use this method in our country. More information on compression devices is accessible in the section COMPRESSION THERAPY.
21How long should I avoid the exposure to sun following sclerotherapy of varicose veins?
Following sclerotherapy, skin is more sensitive. Thus, it is recommended to avoid exposure to natural ultraviolet radiation and light used in solarium for at least 3-4 weeks. Unfortunately, the use of creams with UV filters does not resolve the problem. Some of these products may cause skin allergic reactions.
Irrespective of the procedures performed, patients with venous problems should beware of sun also due to a large dose of infrared radiation. It leads to skin overheating and dilatation of veins.
22How should I prepare for endovenous laser therapy? Is it necessary to perform additional laboratory testing?
Endovenous laser therapy is a minimally invasive procedure, however, prior to it, basic parameters in blood examination should be checked: blood count, creatinine level, sodium and potassium ions and coagulation function. We also recommend testing for antibodies of hepatitis B and C. A full set of laboratory tests may be always done in our center.
23Is the procedure performed with laser system ELVeS 1470 nm painful?
Due to the use of tumescence (type of local anaesthesia applied around the closed vein), there is no need for additional anaesthesia in endovenous laser therapy. In the Clinic of Phlebology, we do not apply anaesthetic agent to the spine. Besides the fact that it slightly prolongs the duration of procedure, such type of anaesthesia allows for performing it under practically painless condition.
24Is it possible to use short general anaesthesia instead of tumescent one which prolongs the procedure?
Besides ensuring insensitivity to pain, tumescence has a very high impact on improving the effectiveness and safety of the procedure. Having pressed the vein from the outside, tumescent liquid leads to its constricting and better adhering to the ending of optical fibre. Thanks to that, the energy of laser radiation may easier and more equally reach the vein wall, facilitating its closure.
Tumescence also improves the safety of patient as due to such anaesthesia the risk of damage of neighbouring tissues by transmitting thermal energy is minimized. Nevertheless, it is important for patient to walk normally following the procedure. Such approach highly decreases the risk of postsurgical thrombosis.
25Is it necessary to wear compression stocking following the laser therapy?
Compression stocking put on the leg after the procedure decreases swelling and inflammation around the closed vein. It also facilitates its constricting. It is also of great importance as it is the element of postthrombotic prophylaxis. Thus, we recommend wearing it for 2-3 weeks following the procedure. Provided patient cannot wear compression stocking (e.g. advanced arteriosclerosis or inability to adjust the adequate size of stocking), obliteration of vein with intravascular adhesive should be considered.