Dr. CHOPRA VESCULAR CLINIC LASER

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Dr. CHOPRA VESCULAR CLINIC LASER

Posted On : Jan-30-2012 | seen (588) times | Article Word Count : 1992 |

Dr. Chopra Vascular Clinic is a healthcare Clinic which provides a service concerned with the diagnosis, treatment and prevention of diseases affecting arteries, veins and lymphatics.

Don’t ignore leg pain-it could be vascular

Most of us experience pain in the legs while resting, but a majority of us ignore the pain or at the most take some pain killers and get momentary relief. But such repeated occurrence of leg pain is not to be ignored as it could be due to an underlying vascular problem.

The Vascular disease is caused due to the blockage of artery to the leg. It is due to the deposition of fat within the artery wall narrowing it and thus leading to reduced blood supply to the leg and causing pain and other problems. Diabetics and heavy smokers have to be extra careful. The following are the symptoms of vascular disease. Pain on walked relieved by rest.

Pain preventing you from sleeping at night (rest pain)
Pain in the legs, hips, buttock, while walked they relieved by rest. Pain when lying down (or when legs are elevated) relieved by dangling or lowering legs.
Change in colors appearance of legs and feet. Thin shiny on the legs. Thickened brittle toe nails No hair on toes, legs and calves. Feet turn dark when down, tum pale when up, Blue or purple toes.

Wounds (Ulcers) on the lower legs found between toes or on the tip of the toe. Outside of the ankles anywhere your shoes rub. According to Vascular surgeon, if the pain prevents you from sleeping at night, one may be in danger of losing his leg and has to the notice of a vascular surgeon”.

Doctors further says not everybody needs hospitalization if the pain is not interfering with your life style then exercise and complete abstinence from smoking is required. The patient suffering from the above symptoms has to undergo as Vascular.

Firstly, color Doppler or Ultrasound of the leg arteries to show the site of narrowing or blockage, and seeing if collaterals will be capable of taking the increased blood flow post operatively.
The second test is Angiogram before the surgery. It is a slightly painful invasive technique showing the inner lining of deceased arteries along with the extra channels (collaterals) making the legs survive so long.

As mentioned earlier, if the patient has pain only while walking and that is not interfering with his life style, then probably exercise and complete abstinence from smoking will help. In other cases two kinds of surgeries are performed depending on the intensity of the problems. In the case of Minimal Invasive Surgery, a patient needs hospitalization for 1-2 days.

This technique is basically ballooning of the arteries (angioplasty). It is dependent on the site and length of the blockage. A wire is passed from the groin or the arm to the site of mischief. A Balloon is pass over this wire to dilate the narrowing or blockage once achieved then a stainless steel spent is put into the area to prevent narrowing again. If possible, this is an excellent option with good results and long potency rate, says Doctors.

The second type is Bypass Surgery where the patient needs Surgery where the patient needs hospitalization for 7-10 days. It is similar to the heart bypass except here the leg artery is being bypass using your own vein or synthetic graft. In high flow system like the Aorta these last well over 20 years, while those below the groin last anywhere from 10-15 years. Good collaterals develop in the mean time and give enough blood to the leg. The last and final option of not performing a surgery is possible in a critically” Ischemic leg “

Then Intra-Venous strong vasodilator drugs may be given over 5 days to try and dilate your vessels by drugs. Doctors further says that less than 2% land up with major amputation if timely advise is taken from the vascular surgeon .Life would become much better if not absolutely normal.
In US, 10% of the people over 70 years have blocked arteries and those in the age group of 40-69 have 3 to 4% blocked arteries. The statistics for India are not available but presume that they are higher than US.

reflux, lesser saphenous reflux and large varicosities. The contraindications are allergy to sclerosant.
The venous system constitutes the main deep system that directs blood upward by the help of the muscular contractions while one way valves prevent reflux of blood due to the gravitational pull while in the erect posture. This is connected to the less supported superficial system by the perforating veins. Both these have one way valves directing blood towards the deep system and upwards. The perforating veins pierce the deep fascia. Superficial to this in the dermis is the post-capillary venules which run horizontally and empty into the collecting venules which also have unidirectional valves.

Post capillary venules have single endothelial layer surrounded by basement membrane and some collagen fibres + rare muscle fibre. Collecting system has the same structure but more muscle fibres while the larger veins have a full muscle coat.

It has been shown that AV fistulae are present due to venous hypertension and the break down of the capillary barrier. Telangiectasias have communication with deep veins and thus dilate due to gravitational pressure or during muscular exercise. Thus the main purpose of the therapy is to eliminate the source of venous hypertension.

Microsclerotherapy
This is injection into the large veins and the indications are – symptoms like leg ache at the end of the day or standing for long. Symptoms at the termination of the menstrual cycle or the first day of the menstrual period. Cosmetic reasons are also an indication.
If gross reflux is present then correct if surgically before sclerotherapy. However palliation may be achieved for 2-4 years by this technique of sclerotherapy but recurrence may be expected. It may be needed to control bleeding varicosities even if the venous hypertension has not been corrected. Even thrombophlebitis it can be used to obliterate the varices without controlling reflux.

Contraindications are arterial occlusive disease, immobility and presence of uncontrolled malignant tumour, hypersensitivity to drug, acute thrombophlebitis and huge varicosities communicating with the deep veins.
The objective of sclerotherapy is endothelial damage and fibrosis of the entire vein wall without recanalization.

Hypertonic saline is very effective in concentrations of 11.7%
VVs of 3-8mm need 0.5-1.0 ml of STD
Place a butterfly cannula in the vein while the patient is standing with dilated veins. Proximal tourniquet is not needed. Multiple cannula is placed while the patient is standing. These are placed at linear continuity in the same vein or at multiple sites in the same cluster. It is preferable to locate the site of reflux to have long term success. Once all the needles have been inserted and held in place by tapes then the patient is asked to lie and the leg is elevated to 45 degrees, to empty the veins. 0.5 – 1.0 ml is injected and there should be no pain, irritation or burning sensation.

These occur due to extravasation and injection must be stopped at once. At the site of each injection, apply dental role and hold in place by a tape. Elastic bandage is applied from the toes to 3 inches above the most proximal injection. Elastic stocking are placed above the elastic bandage for additional compression. The length of compression varies according to the preference of the operator. Some give no compression but most give it for 3-7 days. Histopathological studies show that fibroblastic healing needed for obliteration of medium size varicosities is 12 days.

All patients must walk in the clinic for 30 minutes for 3 reasons –

1. If any allergic reaction is seen it can be treated.
2. Comfort of the elastic compression can be assessed.
3. To stimulate the deep system to wash away any sclerosant that may have accidentally entered the deep veins.

Treatment of talengiectatic blemishes (microsclerotherapy)
It is important to obliterate the source of venous hypertension through a minute incompetent perforator. This has to be identified by a careful doppler examination. This treatment may fail because the sclerosant does not reach the feeding vein in concentration enough to obliterate it. It may be difficult to identify the feeding vessel and in this case the sclerosant is injected into the site where the telangiectasias converge.

The patient is lying supine of prone and site cleaned with spirit to make the tiny vessels more prominent. A 30 gauge needle is bent to 10-20 deg. The needle must be parallel to the skin surface. Use 2 ml syringe. Stretch the skin at the site of the injection and pierce the needle into the skin and the tiny vein. Inject the sclerosant. If there is a wheel immediately after the injection then it has extravasated. If it is intravascular injection then one sees the clearing of the telangiectatic web. 0.1-0.2 ml of sclerosant is injected over 15 secs. Do not over inject the volume proscribed as extravasation. Pain and skin infarction may occur.

Should waxy white color of the skin due to extravasation be seen flush the site thoroughly with Normal saline. This dilutes the extravasated sclerosant and relieves vessel spasm. Pressure by foam, gauze or cotton balls is used followed by compression by crape bandage or stockings. The use of compression is personal and some do not use any compression, others use it for 18 hours while others use it for 2 weeks. There is general agreement that at least compression must be for 72 hours. Patients must walk as much as possible. Repetition of injection is done after 2-4 weeks and it depends on the success of the last treatment. Generally 3-4 sessions are needed.
Reticular varicosities and feeding veins are treated with no 30 needle in the same way as above but the STD (sodium tetradecyl sulphate) injection is diluted to 0.1-0.2%

Solutions to treat telangiectasias and reticular veins are always diluted to 0.1-0.2%. If 11.7 or 23.4% hypertonic saline is used, air block test for injection is indicated prior to the injection.

Side effects
The incidence is very low but the recognized SE is – anaphylaxis, allergic reactions, thrombophlebitis, cutaneous necrosis, pigmentation and neoangiogenesis.

The most dreaded complication is anaphylaxis. It occurs in 0.2% of the cases and can cause itching, erythema, flushing and angioedema. The worrying factor is oedema of the mucous membranes leading to laryngeal oedema and stridor. The treatment is immediate Epinephrine which counters vasodilatation and bronchoconstriction and further release of mediators form mast cells. This followed by injection of corticosteroids and antihistamines. Polidocanol is a safer sclerosing agent with much lower side effects.
Thrombophlebitis occurs in 1-3%.
DVT may occur following the flushing of sclerosant into the deep venous system.

Ulceration and necrosis of the skin are complications found occasionally due to the extravasation of the sclerosant. It is due to arterial occlusion by the sclerosant. This is avoided by using diluted sclerosant.
Post sclerosant hyperpigmentation is common and seen in 30%. The incidence with STD and hypertonic saline is high but with polidocanol it is extremely low. The way to avoid this is by injecting with low pressure and diluted solutions. Should it occur then make an incision over the site and expressing the blood containing hemosiderin containing RBC. Any way 90% automatically disappear in 12 months. The treatment of hyperpigmentation is unsuccessful to date.

At times new telangiectasias appear. This is thought to be due to response to the endothelial growth factor, mast cell products or platelet derived growth factor. May be estrogen is responsible. This neoangiogenesis is prevented by the dilution of sclerosant injection and using very low quantities per injection – 0.1-0.2 ml. Most treatment is ineffective but it mostly resolves in 3-6 months. Pulse-dye laser therapy has been helpful but is very expensive and not available in most centres.

Re-Publish this Article

<h1>Dr. CHOPRA VESCULAR CLINIC LASER</h1> Author: <a href='http://www.articleseen.com/profile_pinku.aspx'>pinku</a> Don’t ignore leg pain-it could be vascular

Most of us experience pain in the legs while resting, but a majority of us ignore the pain or at the most take some pain killers and get momentary relief. But such repeated occurrence of leg pain is not to be ignored as it could be due to an underlying vascular problem.

The Vascular disease is caused due to the blockage of artery to the leg. It is due to the deposition of fat within the artery wall narrowing it and thus leading to reduced blood supply to the leg and causing pain and other problems. Diabetics and heavy smokers have to be extra careful. The following are the symptoms of vascular disease. Pain on walked relieved by rest.

Pain preventing you from sleeping at night (rest pain)
Pain in the legs, hips, buttock, while walked they relieved by rest. Pain when lying down (or when legs are elevated) relieved by dangling or lowering legs.
Change in colors appearance of legs and feet. Thin shiny on the legs. Thickened brittle toe nails No hair on toes, legs and calves. Feet turn dark when down, tum pale when up, Blue or purple toes.

Wounds (Ulcers) on the lower legs found between toes or on the tip of the toe. Outside of the ankles anywhere your shoes rub. According to Vascular surgeon, if the pain prevents you from sleeping at night, one may be in danger of losing his leg and has to the notice of a vascular surgeon”.

Doctors further says not everybody needs hospitalization if the pain is not interfering with your life style then exercise and complete abstinence from smoking is required. The patient suffering from the above symptoms has to undergo as Vascular.

Firstly, color Doppler or Ultrasound of the leg arteries to show the site of narrowing or blockage, and seeing if collaterals will be capable of taking the increased blood flow post operatively.
The second test is Angiogram before the surgery. It is a slightly painful invasive technique showing the inner lining of deceased arteries along with the extra channels (collaterals) making the legs survive so long.

As mentioned earlier, if the patient has pain only while walking and that is not interfering with his life style, then probably exercise and complete abstinence from smoking will help. In other cases two kinds of surgeries are performed depending on the intensity of the problems. In the case of Minimal Invasive Surgery, a patient needs hospitalization for 1-2 days.

This technique is basically ballooning of the arteries (angioplasty). It is dependent on the site and length of the blockage. A wire is passed from the groin or the arm to the site of mischief. A Balloon is pass over this wire to dilate the narrowing or blockage once achieved then a stainless steel spent is put into the area to prevent narrowing again. If possible, this is an excellent option with good results and long potency rate, says Doctors.

The second type is Bypass Surgery where the patient needs Surgery where the patient needs hospitalization for 7-10 days. It is similar to the heart bypass except here the leg artery is being bypass using your own vein or synthetic graft. In high flow system like the Aorta these last well over 20 years, while those below the groin last anywhere from 10-15 years. Good collaterals develop in the mean time and give enough blood to the leg. The last and final option of not performing a surgery is possible in a critically” Ischemic leg “

Then Intra-Venous strong vasodilator drugs may be given over 5 days to try and dilate your vessels by drugs. Doctors further says that less than 2% land up with major amputation if timely advise is taken from the vascular surgeon .Life would become much better if not absolutely normal.
In US, 10% of the people over 70 years have blocked arteries and those in the age group of 40-69 have 3 to 4% blocked arteries. The statistics for India are not available but presume that they are higher than US.

reflux, lesser saphenous reflux and large varicosities. The contraindications are allergy to sclerosant.
The venous system constitutes the main deep system that directs blood upward by the help of the muscular contractions while one way valves prevent reflux of blood due to the gravitational pull while in the erect posture. This is connected to the less supported superficial system by the perforating veins. Both these have one way valves directing blood towards the deep system and upwards. The perforating veins pierce the deep fascia. Superficial to this in the dermis is the post-capillary venules which run horizontally and empty into the collecting venules which also have unidirectional valves.

Post capillary venules have single endothelial layer surrounded by basement membrane and some collagen fibres + rare muscle fibre. Collecting system has the same structure but more muscle fibres while the larger veins have a full muscle coat.

It has been shown that AV fistulae are present due to venous hypertension and the break down of the capillary barrier. Telangiectasias have communication with deep veins and thus dilate due to gravitational pressure or during muscular exercise. Thus the main purpose of the therapy is to eliminate the source of venous hypertension.

Microsclerotherapy
This is injection into the large veins and the indications are – symptoms like leg ache at the end of the day or standing for long. Symptoms at the termination of the menstrual cycle or the first day of the menstrual period. Cosmetic reasons are also an indication.
If gross reflux is present then correct if surgically before sclerotherapy. However palliation may be achieved for 2-4 years by this technique of sclerotherapy but recurrence may be expected. It may be needed to control bleeding varicosities even if the venous hypertension has not been corrected. Even thrombophlebitis it can be used to obliterate the varices without controlling reflux.

Contraindications are arterial occlusive disease, immobility and presence of uncontrolled malignant tumour, hypersensitivity to drug, acute thrombophlebitis and huge varicosities communicating with the deep veins.
The objective of sclerotherapy is endothelial damage and fibrosis of the entire vein wall without recanalization.

Hypertonic saline is very effective in concentrations of 11.7%
VVs of 3-8mm need 0.5-1.0 ml of STD
Place a butterfly cannula in the vein while the patient is standing with dilated veins. Proximal tourniquet is not needed. Multiple cannula is placed while the patient is standing. These are placed at linear continuity in the same vein or at multiple sites in the same cluster. It is preferable to locate the site of reflux to have long term success. Once all the needles have been inserted and held in place by tapes then the patient is asked to lie and the leg is elevated to 45 degrees, to empty the veins. 0.5 – 1.0 ml is injected and there should be no pain, irritation or burning sensation.

These occur due to extravasation and injection must be stopped at once. At the site of each injection, apply dental role and hold in place by a tape. Elastic bandage is applied from the toes to 3 inches above the most proximal injection. Elastic stocking are placed above the elastic bandage for additional compression. The length of compression varies according to the preference of the operator. Some give no compression but most give it for 3-7 days. Histopathological studies show that fibroblastic healing needed for obliteration of medium size varicosities is 12 days.

All patients must walk in the clinic for 30 minutes for 3 reasons –

1.	If any allergic reaction is seen it can be treated.
2.	Comfort of the elastic compression can be assessed.
3.	To stimulate the deep system to wash away any sclerosant that may have accidentally entered the deep veins.

Treatment of talengiectatic blemishes (microsclerotherapy)
It is important to obliterate the source of venous hypertension through a minute incompetent perforator. This has to be identified by a careful doppler examination. This treatment may fail because the sclerosant does not reach the feeding vein in concentration enough to obliterate it. It may be difficult to identify the feeding vessel and in this case the sclerosant is injected into the site where the telangiectasias converge.

The patient is lying supine of prone and site cleaned with spirit to make the tiny vessels more prominent. A 30 gauge needle is bent to 10-20 deg. The needle must be parallel to the skin surface. Use 2 ml syringe. Stretch the skin at the site of the injection and pierce the needle into the skin and the tiny vein. Inject the sclerosant. If there is a wheel immediately after the injection then it has extravasated. If it is intravascular injection then one sees the clearing of the telangiectatic web. 0.1-0.2 ml of sclerosant is injected over 15 secs. Do not over inject the volume proscribed as extravasation. Pain and skin infarction may occur.

Should waxy white color of the skin due to extravasation be seen flush the site thoroughly with Normal saline. This dilutes the extravasated sclerosant and relieves vessel spasm. Pressure by foam, gauze or cotton balls is used followed by compression by crape bandage or stockings. The use of compression is personal and some do not use any compression, others use it for 18 hours while others use it for 2 weeks. There is general agreement that at least compression must be for 72 hours. Patients must walk as much as possible. Repetition of injection is done after 2-4 weeks and it depends on the success of the last treatment. Generally 3-4 sessions are needed.
Reticular varicosities and feeding veins are treated with no 30 needle in the same way as above but the STD (sodium tetradecyl sulphate) injection is diluted to 0.1-0.2%

Solutions to treat telangiectasias and reticular veins are always diluted to 0.1-0.2%. If 11.7 or 23.4% hypertonic saline is used, air block test for injection is indicated prior to the injection.

Side effects
The incidence is very low but the recognized SE is – anaphylaxis, allergic reactions, thrombophlebitis, cutaneous necrosis, pigmentation and neoangiogenesis.

The most dreaded complication is anaphylaxis. It occurs in 0.2% of the cases and can cause itching, erythema, flushing and angioedema. The worrying factor is oedema of the mucous membranes leading to laryngeal oedema and stridor. The treatment is immediate Epinephrine which counters vasodilatation and bronchoconstriction and further release of mediators form mast cells. This followed by injection of corticosteroids and antihistamines. Polidocanol is a safer sclerosing agent with much lower side effects.
Thrombophlebitis occurs in 1-3%. 
DVT may occur following the flushing of sclerosant into the deep venous system.

Ulceration and necrosis of the skin are complications found occasionally due to the extravasation of the sclerosant. It is due to arterial occlusion by the sclerosant.  This is avoided by using diluted sclerosant.
Post sclerosant hyperpigmentation is common and seen in 30%. The incidence with STD and hypertonic saline is high but with polidocanol it is extremely low. The way to avoid this is by injecting with low pressure and diluted solutions. Should it occur then make an incision over the site and expressing the blood containing hemosiderin containing RBC. Any way 90% automatically disappear in 12 months. The treatment of hyperpigmentation is unsuccessful to date.

At times new telangiectasias appear. This is thought to be due to response to the endothelial growth factor, mast cell products or platelet derived growth factor. May be estrogen is responsible. This neoangiogenesis is prevented by the dilution of sclerosant injection and using very low quantities per injection – 0.1-0.2 ml. Most treatment is ineffective but it mostly resolves in 3-6 months. Pulse-dye laser therapy has been helpful but is very expensive and not available in most centres.
About the Author: I am Rajnish Kumar, in this time I am working a job on SEO. Now I am Permotting an http://vascularclinic.in/ site that is related from health and as far as I know about this site this is one of the best sites in health category. So please visit this site and gain a lot of knowledge about vascular. I am doing job in Aninfosolutions LTD. Article Source: <a href='http://www.articleseen.com/Article_Dr-CHOPRA-VESCULAR-CLINIC-LASER_140738.aspx'> http://www.articleseen.com/Article_Dr. CHOPRA VESCULAR CLINIC LASER_140738.aspx</a>

Article Source : http://www.articleseen.com/Article_Dr. CHOPRA VESCULAR CLINIC LASER_140738.aspx

Author Resource :
I am Rajnish Kumar, in this time I am working a job on SEO. Now I am Permotting an http://vascularclinic.in/ site that is related from health and as far as I know about this site this is one of the best sites in health category. So please visit this site and gain a lot of knowledge about vascular. I am doing job in Aninfosolutions LTD.

Keywords : Ulcer leg, Diabetic foot, Gangrene foot, Laser Varicose Veins, RFA Varicose Veins, Vascular Clinic, Vascular Clinic in India, ,

Category : Health and Fitness : Medicine

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