Sclerotherapy Health Dictionary

A defect of the valves in the leg veins causes blood to pool in the veins near the surface of the skin, causing them to become varicose. Contributing factors include obesity, hormonal changes and pressure on the pelvic veins during pregnancy, hormonal changes occurring at the menopause, and standing for long periods of time. Varicose veins are common, tend to run in families, and affect more women than men.Varicose veins may not cause any problems but may ache severely; swollen feet and ankles and persistent itching may occur. These symptoms may worsen during the day and can be relieved only by sitting with the legs raised. In women, symptoms are often worse just before menstruation. In severe cases, leg ulcers may occur. Thrombophlebitis may be associated with varicose veins.

Usually, support stockings, regular walking, and sitting with the feet up as much as possible are the only measures required.

In more severe cases, sclerotherapy may be carried out.

Varicose veins may require surgical removal if they become painful or ulcerated, but they may later develop elsewhere.... varicose veins

Varicose veins are dilated tortuous veins occurring in about 15 per cent of adults – women more than men. They most commonly occur in the legs but may also occur in the anal canal (HAEMORRHOIDS) and in the oesophagus (due to liver disease).

Normally blood ?ows from the subcutaneous tissues to the super?cial veins which drain via perforating veins into the deep veins of the leg. This ?ow, back towards the heart, is aided by valves within the veins. When these valves fail, increased pressure is exerted on the blood vessels leading to dilatations known as varicose veins.

Treatment is needed to prevent complications such as ulceration and bleeding, or for

cosmetic purposes. Treatment alternatives include injection with sclerosing agents to obliterate the lumen of the veins (sclerotherapy), or surgery; in the elderly or un?t, an elastic stocking may su?ce. One operation is the Trendelenburg operation in which the saphenous vein is disconnected from the femoral vein and individual varicose veins are avulsed. (See also VASCULITIS.)

Thrombosis Thrombosis occurs when blood, which is normally a liquid, clots within the vein to form a semisolid thrombus (clot). This occurs through a combination of reduced blood ?ow and hypercoagulability (a reduced threshold for clotting). The most common site for this to occur is in the deep veins of the leg, where it is known as a deep-vein thrombosis (DVT).

Predisposing factors include immobility (leading to reduced blood ?ow), such as during long journeys (e.g. plane ?ights) where there is little opportunity to stretch one’s legs; surgery (leading to temporary post-operative immobility and hypercoagulability of blood); oestrogen administration (low-dose oestrogen oral contraceptives carry a very low relative risk); and several medical illnesses such as heart failure, stroke and malignancy.

Deep-vein thrombosis presents as a tender, warm, red swelling of the calf. Diagnosis may be con?rmed by venogram (an X-ray taken following injection of contrast medium into the foot veins) or by ultrasound scanning looking for ?ow within the veins.

Prevention is important. This is why patients are mobilised and/or given leg exercises very soon after an operation, even major surgery. People should avoid sitting for long periods, particularly if the edge of the seat is hard, thus impeding venous return from the legs. Car drivers should stop regularly on a long journey and walk around; airline travellers should, where possible, walk round the aisle(s) and also exercise and massage their leg muscles, as well as drinking ample non-alcoholic ?uids.

Diagnosis and treatment are important because there is a risk that the clotted blood within the vein becomes dislodged and travels up the venous system to become lodged in the pulmonary arteries. This is known as PULMONARY EMBOLISM.

Treatment is directed at thinning the blood with ANTICOAGULANTS, initially with heparin and subsequently with WARFARIN for a period of time while the clot resolves.

Blocked super?cial veins are described as super?cial thrombophlebitis, which produces in?ammation over the vein. It responds to antiin?ammatory analgesics. Occasionally heparin and ANTIBIOTICS are required to treat associated thrombosis and infection.... veins, diseases of

Rectal bleeding and discomfort on defaecation are the most common features. Prolapsing haemorrhoids often produce a mucous discharge and itching around the anus. A complication of prolapse is thrombosis and strangulation; this can cause extreme pain.

Diagnosis is usually by proctoscopy. Mild cases are controlled by drinking plenty of fluids, eating a high-fibre diet, and establishing regular toilet habits. Rectal suppositories and creams containing corticosteroid drugs and local anaesthetics reduce pain and swelling. More troublesome haemorrhoids may be treated by sclerotherapy, cryosurgery, or by banding, in which a band is tied around the haemorrhoid, causing it to wither and drop off. A haemorrhoidectomy is generally required for prolapsing haemorrhoids.... haemorrhoids

Diagnosis is usually made from the symptoms and signs.

Doppler ultrasound scanning may be used to assess the pressure in the portal vein.

Various treatments may be used to stop bleeding or prevent further bleeding.

For example, ruptured blood vessels may be treated by sclerotherapy, in which a chemical is injected into the veins to block them.

A shunt is sometimes carried out to prevent further bleeding.

Ascites is controlled by restriction of salt and with diuretic drugs.... portal hypertension