Dr. Pankaj Patel is a leading mumbai based vascular surgeon and an expert in endovascular interventional procedures. His main area of interest is varicose veins, where he has a record of performing more than 4000 varicose vein surgeries. Besides people with varicose veins, he is much sought after by patients with peripheral vascular disease, lymphedema, deep vein thrombosis and aortic aneurysms. He is a well known and highly respected member of vascular surgery community in India and was elected as the secretary of vascular society of India earlier. For more information regarding Dr. Pankaj Patel and the procedures that he performs, please visit his website http://drpankajpatel.com/
Studies suggest as high as 10% of general population may be having varicose veins and most of them are asymptomatic. At what point in the course of disease process should one undergo surgery or other interventions like radiofrequency ablation, sclerotherapy and laser ablation? For example let us consider an imaginary patient. The varicose veins are very prominent but symptom wise only a mild pain on standing is present. There is no ulcers but some skin discoloration is present. Do you advice any interventions or do you manage it conservatively?
Primary varicose veins which are asymptomatic and small in size with no reflux seen in the LSV/SSV, Conservative treatment is advised. Intervention is required for symptomatic veins, which are unsightly, cause skin changes, ulceration etc.
Since several modalities of treatment like vein stripping, CHIVA, sclerotherapy, endovenous laser ablation and radiofrequency ablation are available for varicose veins, one is often confused what is the best modality. In your personal experience which of the above produce best long term outcomes?
All published data shows good result with all the current form of treatment. The best option is with the doctor treating the patient as varicose veins can never be treated with only one method. Any skilled surgeon having good result with the technique he uses is best, provided he is truthful of his result and the patient is happy. All the current newer methods of treatment are never successful if they are not combined with either sclerotherapy or surgical avulsions. Best results are obtain when combination therapy is used. Laser or radiofrequency cannot ablate tortuous dilated veins. My current practice is to treat patient on individual basis. Majority of them undergo endovenous laser ablation with avulsions. Small veins are treated with sclerotherapy and sometimes all the above modalities are used depending on the size of the vein. Surgical stripping is done if the vein is more than 9 mm in size or has saphena varix.
Patients suffering from varicose veins may be at high risk of thrombus formation in the veins because of stagnation and defective venous flow. Many of them travel to international destinations with limited activity during airtravel. Does long duration travel in flight increase the risk of thrombosis and is so should they be suggested antiplatelet agents like aspirin as a prophylaxis?
Wearing stockings, which should be class II gradient for varicose veins is the best option for long travel. If they are high risk group with past history of thrombosis then a shot of Low Molecular weight heparin is good.
With the current lifestyles and general stress in day to day life, significant percentage of people develop coronary artery disease and many end up with triple vessel disease requiring coronary artery bypass surgery (CABG). The grafts are usually obtained from the veins of lower limbs. Surgical stripping of the veins may deprive the individual a vein that can be used as a graft later. Is there any way to preserve the vein without stripping so that it can be used later?
The vein used for bypass should be of good quality. If there are varicosities involving the veins then they cannot be used. Therefore removing them is the best option. Now a days, Radial artery is used for CABG.
Aortic aneurysm repair is one of the complicated procedures that vascular surgeons do. What is the long term prognosis and 5 year survival rate in patients undergoing elective aortic aneurysm repair?
Aortic aneurysm treatment has become minimally invasive with the advent of stent graft and now the 5 year survival rate has improved dramatically.
One of the dreaded complication of smoking is the peripheral vascular disease/ Buerger's disease. How common is that in India. What are the latest advances in the treatment of Buerger's disease?
Buerger's disease is 3% of our practice. The only treatment is to quit smoking. For limb salvage angioplasty and bypass surgery are performed.
Contact Information
Address : "AMEYA" 147,
Pandurang Naik Road, Shivaji Park,
Mumbai - 400 016,
India.
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5.00 p.m. to 7.00 p.m. (By Appointment Only)
Tel No. : 2445 5320/2445 5322
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