Varicose Vein is a not a disease.Varicose veins, often misunderstood as a disease, are, in fact, a natural physiological phenomenon of veins. These veins are not a sign of illness but rather a response to the everyday stresses that our circulatory system endures. Varicose veins are enlarged, twisted, and sometimes bulging veins that most commonly appear in the lower limbs, such as the legs and feet. The term "varicose”, itself means "dilated and tortuous," which accurately describes the appearance of these veins.

About The Treatment

Principle

MMFST is a new technique based on knowledge of the microscopic veins and micro circulatory impediment. In order to prevent the backflow towards the capillary through the superficial venous system the collecting venous system at the tissue level has to be eliminated by a good sclerosant - Polidocanol [POL].

The treatment is initiated by elimination of the superficial venous system from foot towards the leg by injecting Microfoam Polidocanol through the very fine tributaries. The specific property of POL is made use of in eliminating the minute collecting system. The drug has got a centrifugal retrograde distribution from bigger to smaller and from smaller to smallest veins unlike any other IV injections which promptly go from smaller to the bigger and to the heart.

Drug Dilution

Twelve hours after intravenous application, about 90% of the POL administered will have been eliminated from the blood. No accumulation is to be expected even after repeated doses of POL at intervals, which are normal for Sclerotherapy. The daily dose should not exceed 2 mg/kg body weight.

The dose and concentration of the solution in conventional technique of sclerotherapy depend on the size of varicose vein. The smallest Varices are preferably treated with 0.5% -1.0% solution, medium-sized Varices with 1%-2.0% solution and large Varices with 3.0%-5.0% solution. It is available in the market in 2 ml ampules and each mL contains 30 mg of POL.

In EVCA (MMFST) the dilution is totally different. Variable concentrations based on vein size appear practically unnecessary. In more than 40,000 patients treated, we have observed that the concentration does not increase the potency and a standard dilution of 0.25% POL is very effective in sclerosing small as well as large veins. This would help to cover a large area without any risk and help to avoid subsequent repeated interventions.

A normal healthy adult human with an average weight of 70 kg, a total quantity of the sclerosant [POL] is 140mg. The drug administered is below the standard quantity whereby the safety margin is very high. We are using 0.25% [universal dilution] irrespective of the size of vein so that the coverage would be very large and in one sitting in majority of cases the whole leg can be treated. While completing 40,000 cases no notable or remarkable complications were observed. Crepe-bandage is only applied immediately after sclerotherapy to keep the veins compressed to help the lumen of the vein adhere during the healing process. The bandage application is only for 3 weeks.

Wearing of kneecaps, socks and tight bandages must be avoided to prevent proximal lympho-venous obstruction. The leg has to be kept elevated continuously during day time with a frequent dorsi-flexion exercise. Elimination of trunkal veins alone is not the treatment of chronic venous disease but it is elimination of the so-called varicose vein. No equipment or instrument so far available can reach the venous network [minor tributaries, venules and venulets]. Nobody treats below the tibial malleolus, and the foot is always spared maximum intervention over the vein of the thigh and lower half of the leg.

The Modified Microfoam sclerotherapy is just the opposite of the conventional method of treatment so far described and practising throughout the world. The MMFST gives excellent results in non-healing ulcers especially after repeated various surgical interventions and those left to fate. The safety and efficacy is exceptionally remarkable.

• Side effects, if at all, are very mild. Some patients may complain of some heaviness of head and dryness of mouth.

• Some may complain of itching over the injection site.

• After a few weeks, there may be some swelling of the lower limbs, pain, redness, indurations and/or discoloration at the injection site.

• Bleb formation: when infused into very small veins, with large area of conglomeration of veins especially over the dorsum of foot ankle region and lower leg. This is due to burning of these veins.

• In case of extravasation of the sclerosant, it can cause excruciating pain locally. 6. Local Hirsutism or hypertrichisias has been observed in a few patients.

• Allergic or Hypersensitivity reactions (extremely rare)

• Recurrence of new Varices due to regeneration

• Recanalisation of large veins

• Local reactions, tissue necrosis, itching (very rare)

• Chance of developing Deep Vein Thrombosis (DVT) is extremely rare

• More effective than all other technique

• No anaesthesia is required, hence no risk of anaesthesia

• Very safe when compared to any other techniques

• The procedure may take only a few minutes

• The least expensive of all the procedures

• Can go back to normal activities depending on the stage of disease 7. Safe, even for the very aged patients and those having other organic system disorders.

The word 'sclero' means 'hardening'. A chemical solution is infused into the vein, which selectively burns the innermost lining of the vein. The chemical burn thus produced, makes the wall inflamed and hence the veins become swollen. Over a period of weeks, the inflamed vein wall will stick together and heals by scarring (fibrosis) and the vein lumen is completely occluded. The vein, though it will shrink immediately after the procedure, it will become harder and harder for about a few months. A crepe bandage is applied immediately after the procedure to keep the vein wall stick together during the process of healing. The bandage is not be used after 3 weeks of the procedure.

In all types of veins from the smallest to the biggest and in all stages of the disease it can be used. It can be applied in recurrent varicose veins after any other surgical procedures as well.

• In established Deep Vein Thrombosis (DVT)

• If the patient is allergic/hypersensitive to the drug.

• In pregnancy.

• In lactating mothers.

Usually not, it is preferable to do the next leg after three months, after the first leg is set alright. This is mainly due to the following reasons:-

• To give better care for the leg, especially in advanced stages the disease.

• Any recanalisation, revascularisation or skipped veins can be detected and corrected during the procedure of the 2nd leg

• There is also dosage limit for the drug used.

Almost 90% can be treated in one sitting. However, in very extensive and very large veins, it may require multiple sittings due to dosage limitations. Recanalisation/revascularisation of veins will also require multiple sittings.

(Please see the "instructions to be followed by patients after Sclerotherapy")

There are two drugs available. Polidocanol (POL) & Sodium TetradecylSulfate (STS). Polidocanol (POL) is the one preferred in our Centre.

The most cost effective technique.A very safe promising technique.This procedure is done in all stages of the disease, in all sizes of veins, in all people irrespective of age and with any co-existing diseases.

• edee