St. Thomas Institute of Research on Venous Diseases

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St. Thomas Institute of Research on Venous Diseases, is an exclusive Centre offering modern treatment for diseases associated with the venous system, working in collaboration with the Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, Kerala.

We are engaged in advanced research and studies at par with international standards to impart better knowledge in the field of Phlebology (Venous Studies), whereby we can offer better services to the suffering fellowmen by improving the quality of life.

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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


ENDO-VENOUS CHEMICAL ABLATION (EVCA)
Modified Microfoam Sclerotherapy [MMFST]

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


What are the advantages of EVCA?

  • 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 what types of veins, EVCA can be done?

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.


In what types of veins, EVCA can be done?

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.


How many sittings required?

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.

How to care the leg after the procedure?

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

What is the sclerosant used?

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

Conclusion

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.


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48 Years
Prof. DR. N RADHAKRISHNAN

Medical Administrator & Phlebologist

TTue, Fri Op Time 8 Am To 2 Pm (Mon, Thur Ot)

MRCP, MS, FAIS, FIAMS, FICS, FRCS (G), FRCS (L), FACS, FRSM

Dept. of Phlebology

website : http://www.drradhakrishnan.com


Medical Administrator, 48 years of medical Service, 41 years of surgical practice and 22 years of specialised treatment in Venous Diseases and more than 26000 minimally invasive Varicose Vein procedures (Modified MicrofoamSclerotherapy).

His radical and unconventional technique of Sclerotherapy has brought out ‘Newer outlook & Trends in the Etiopathogenesis& Management of Varicose Vein in Lower Limbs’.

Dr N Radhakrishnan is the Medical Director of St. Thomas Institute of Research on Venous Diseases, the exclusive centre for advanced research in the field of Phlebolymphology (study of Veins &Lymphatics) and offering innovative treatment at par with international standards for diseases associated with the venous system. Working in collaboration with the Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, he was instrumental in identifying the Genes responsible for Chronic Venous Disease (CVD).

He has published many original articles relating to genes in leading international research journals like PLOS-ONE, NATURE.COM (Lab. Investigations), in Indian Journal of Surgery and authored a reference book on CVD, ‘A TREATISE ON VENOUS DISEASES’ an international publication by Jaypee Bros and is also a key resource person for many national & international conferences.

  • Research Article : Arterialization and anomalous vein wall remodeling in varicose veins is associated with upregulated FoxC2-Dll4 pathway, Laboratory Investigation (2016) 96, 399–408; doi:10.1038/labinvest.2015.167; published online 25 January 2016. The article is available online on: http://www.nature.com/labinvest/journal/v96/n4/pubmed/labinvest2015167a.html
  • PLOS ONE publication: “Forkhead box C2 Promoter Variant c.-512C>T Is Associated with Increased Susceptibility to Chronic Venous Diseases” . The article is available online on:
    http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0090682
  • (Note: The gene responsible for Varicose Vein and Chronic Venous Disease was identified for the first time and got officially approved & declared internationally)
  • Original article: “MicrofoamSclerotherapy for Varicose Veins: a Retrospective Analysis of a Modified Technique” published by Indian Journal of Surgery (2013). The article is available online on Springer Link:
    http://link.springer.com/article/10.1007/s12262-013-1013-2
  • “Elimination Of Smallest Tributaries Of The Smallest Veins Of The Lowermost Part Of Leg Pivotal In The Successful Management Of Chronic Venous Disease”at the 26th Annual Meeting of the American Venous Forum, held in New Orleans, Louisiana, U.S.A. (February 19-22, 2014)
  • (Note for 3 & 4: The outlook of venous diseases, which was maintained for the past 55 centuries have been proved scientifically wrong. A new outlook brought out by me got the international acceptance. Accordingly a novel operative technique was devised.)
  • A reference book “A Treatise on Venous Diseases” : foreword written by Padmavibhushan Dr. M. S. Valiathan, National Research Professor, Govt. of India, got published in April 2014 by JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD (New Delhi • London • Philadelphia • Panama) as a reference book. It is also available as e-Book.
  • Prof. N. Ganguly award for young scientists in cardiovascular clinical research for the work entitled “Regulatory polymorphisms in FoxC2 gene in patients with varicose veins” at International Conference on Cardiovascular Research Convergence, All India Institute of Medical Science, New Delhi, 17th and 18thFebruary, 2012. (S. Sumi& Prof. C. C. Kartha of RGCB and N. Radhakrishnan)
  • “Modified MicrofoamSclerotherapy (MMFST) for Varicose Veins in Lower Limbs” is the second book, which is getting ready for publication.
  • Fellow of Royal College of Surgeons of England (FRCS-London) – 2019
  • Fellow of Royal Society of Medicine (FRSM-London) – 2019
  • Fellow of Royal College of Physicians & Surgeons of Glasgow (FRCS-Glasg) – 2019
  • Fellow of American College of Surgeons (FACS – USA & Canada) – 2019
  • The first Fellow of the International College of Surgeons (Phlebolymphology) (FICS)- 2015
  • Fellow of the IMA Academy of Medical Specialties (FIAMS) -1999
  • Founder Fellow of Association of Surgeons of India (FAIS) – 1993
  • Member of the Royal College of Physicians of UK (MRCP-London)
  • Member of the American College of Phlebology (ACP)
  • Member of the American Venous Forum (AVF)
  • Member of the European Venous Forum (EVF)
  • Life Member of the Venous Association of India (VAI)
  • Life Member of the Indian Medical Association (IMA)
  • Life Member of the Indian Academy of Medical Specialties (IMA AMS)
  • Life Member (Founder) of the Association of Surgeons of India (ASI)
    Awards: - International
  • Award of Excellence2012, presented by ALL MOSCOW MALAYALEE ASSOCIATION, for advanced research in the field of medicine particularly in the field of venous diseases, on 09th September 2012 at Moscow, Russia. (Exclusively for Malayalee’s from different disciplines of service). Award presented by E. Mr. AjaiMalhotra, Ambassador of India to the Russian Federation.
  • “International Gold Star Millennium Award” The award was presented he former Dy. Prime Minister of Thailand, KornDabbaransiduring the International Conference on “Indo-Thai Friendship & Economic Co-operation”. The award has been instituted by the National Integration and Economic Council and organized by the Citizens Integration Peace Society. For this award, achievers in the field of medicine, industry, business, public life, administration, social work, educational services and culture were selected. I was awarded for the "Excellence in Promoting Global Integration & Economic Development”on 27th Jan. 2013 at Bangkok, Thailand.
  • “GLOBAL INDIAN OF THE YEAR AWARD – 2014” The award was presented by the former President of India, Her Excellency Smt. PratibhaDevisinghPatil during the International Conclave on “International Unity & industrial Growth” on 19th 2014 at Pune, India.
  • National
  • “Rajiv Gandhi Shiromani Award”. The award was presented during the national symposium on 'Rajiv's Role in Promoting National Integration'. I was awarded for the "Outstanding Individual Achievements & Distinguished Services to the Nation" considering my contributions in health care especially in the field of Vascular Surgery and related on 19th August, 2012at New Delhi.
  • “Indira Gandhi Sadbhavna Award” The award was presented during the national symposium on 'Life & Works of Late Smt. Indira Gandhi’. For this award, achievers in the field of medicine, industry, business, public life, administration, social work, educational services and culture were selected. I was awarded for the "Outstanding Individual Achievements & Distinguished Services to the Nation"on 18th November 2012 at New Delhi.
  • “Gold Medal for Excellence” This special award was presented during the national symposium on 'Life & Works of Late Smt. Indira Gandhi’ on 18th Nov. 2012 at New Delhi.
  • “Pride of India Award” The award was presented during the national conference on “National Unity & Industrial Growth”. I was awarded for the "Outstanding Individual Achievements & Distinguished Services to the Nation"24th March 2013 at New Delhi.
  • “BHARAT JYOTI AWARD”The award was presented during the national conference on “National Unity & Industrial Growth”. I was awarded for the "Outstanding Individual Achievements & Distinguished Services to the Nation"24th March 2013 at New Delhi.
  • “LIFETIME ACHIEVEMENT AWARD”. The award was presented by the former President of India, Her Excellency Smt. PratibhaDevisinghPatil during the International Conclave on “International Unity & industrial Growth” on 19th Jan. 2014 at Pune, India.
  • Regional
  • Award of Excellence from Archeparchy of Changanassery, for the excellent commitment and dedication in surgical practice especially for the patients with varicose vein problems on 19th May, 2012
  • Award of Excellence from Rotary Club of Greater Changanassery, for the excellent commitment and dedication in advanced research in the field of medicine particularly in the field of venous diseases on 11th August, 2012
  • “Achievement Award – 2012”organized by Kerala Breaking Newsfor excellence in Phlebology. Awarded by Hon’ble Minister of Health, Govt. of Kerala,Shri. V.S. Sivakumar&Hon’ble Mayor, Corporation of Thiruvananthapuram, Adv: Chandrika K. on 06th JAN. 2013 at Thiruvananthapuram, Kerala
  • “Professional Excellence Award 2012-13”,presented by Olive Gardens Residents Association, for advanced research in the field of medicine particularly in the field of venous diseases, on 30th JAN. 2013 at Changanassery, Kerala.
  • “NAVARATRI PURASKARAM - 2014”,presented by Punyadarshanam Magazine, for the extreme commitment, unselfish services & the eternal love to the suffering humanity in the field of medicine on 03rd OCT. 2014 at Kottayam, Kerala.
  • “VOCATIONAL SERVICE AWARD - 2014”,presented by ROTARY CLUB of Changanassery Rotary International District 3211 for developing new treatment methods for Venous Diseases on NOV. 2014 at Changanassery, Kerala.
  • “LIFE TIME ACHIEVEMENT AWARD - 2015”,presented by JCI - Changanassery Town, JCI India Zone XXII, for the incredible contributions in the field of medicine on 18th JAN. 2015 at Changanassery, Kerala.
  • Social commitment: -
  • Patron, SUKRITHAM – SEVABHARATHI, Madappally, Changanassery, Kottayam, Kerala for rehabilitation of mentally challenged.
  • A research foundation was formed on 15thJune, 2012 to offer scholarships for post-doctoral fellows doing research on venous disease in the Union of India. It is named “ N. RADHAKRISHNAN FOUNDATION FOR RESEARCH ON VENOUS DISEASES”to offer scholarships for post-doctoral fellow(s) doing/interested in advanced scientific research in Venous Diseases.The aim of the foundation is to prevent the venous disease in future generation by achieving genetic corrections.
  • Services for the Rehabilitation of Street ChildrenatSnehaNivas in Changanassery (Home Town), Kerala. Appreciated by Rotary South East, London (Published in Rotary South East Magazine).
  • Indoor Play Station for Physically Challenged Girls at Mercy Home, Changanassery (Home Town), Kerala. (2006)
  • Emergency Relief Activities for Tsunami affected population over the western coast of Kerala (Arattupuzha, Kollam, in December 2004) as President of Rotary Club.
  • Diabetes Awareness classes for the public organized by Mary Rani Public School & Junior College, Changanassery, SreeNarayana Club, Changanassery and St. Thomas Hospital, Changanassery, Kerala.Dist Chairman for Diabetes Awareness Programme, Rotary Dist 3211, continuously since the last 5 years and nominated upto 2014-15.
  • Varicose Vein Awareness Class for the patients and public on all Tuesdays& Fridays at Thomas Institute of Research on Venous Disease, Changanassery, Kerala.
  • International College of Surgeons (ICS)
  • American College of Phlebology (ACP)
  • American Venous Forum (AVF)
  • European Venous Forum (EVF)
  • Venous Association of India (VAI)
  • Association of Surgeons of India (ASI)
  • Indian Medical Association (IMA)
  • Indian Academy of Medical Specialties (IAMS)
  • Qualified Medical Practitioners Association (QPMPA)
  • Bacterial Resistance to Antibiotics” in Thailand (2007).
  • “Challenging Surgical Techniques in Appendicectomy” in Mauritius. (2008)
  • “Newer Trends in the Management of Varicose Veins of the Lower Limbs” in Istanbul, Turkey (2009)
  • “Newer Outlooks & Trends in the Etiopathogenesis& Management of Varicose Veins of the Lower Limbs” to Vascular Surgeons at Durban, South Africa on invitation by Prof. John V. Robbs. (24th June 2011)
  • “Newer Outlooks & Trends in the Etiopathogenesis& Management of Varicose Veins of the Lower Limbs” for CPD Accredited Meeting at Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa. (7th July 2011)
  • Poster Presentation on Molecular Pathogenesis of Varicose Veins at RGCB in March, 2012. (S. Sumi& Prof. C. C. Kartha of RGCB and N. Radhakrishnan) won the best presentation award.
  • “Fondaparinux& the Surgeon” for the surgeons & allied surgical super specialists 4th surgical clinical meeting at Hotel Jewel of Chembur, Mumbai, India. (20th February 2013)

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