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  • D-dimer testing: This test identifies compounds in the blood that can indicate clotting. While it cannot be used to confirm the diagnosis of DVT, it can help rule it out; and
  • Plethysmography, a test that measures changes in the blood volume of an extremity to determine if a blockage is present. To test for DVT, a blood pressure cuff is placed on the thigh above a suspected clot and inflated to temporarily obstruct blood flow returning from the leg. A lower cuff placed near the ankle records any increase in volume, either through changes in a weak electrical current or a change in the circumference of the leg. The upper cuff is then deflated to allow the leg to empty. In patients with DVT, there is no initial change in volume and the leg drains slowly after the top cuff is released. Plethysmography can adequately detect clots between the knee and groin but detects calf vein clots less than 20 percent of the time. Overall, it is somewhat less sensitive than ultrasound testing.

TREATMENT APPROACH

Compression stockings are used to treat varicose veins.
Compression stockings are used to treat varicose veins.
Varicose veins. Simple treatments can control most cases of varicose veins. They include:

  • Leg elevation: Leg elevation allows blood to drain from the legs.Patients should elevate the legs for 15 minutes 3 or 4 times daily.
  • Compression stockings: Compression stockings squeeze the veins. Compression stockings are tightest at the bottom of the legs, where the greatest pressure is needed, and gradually loosen toward the top of the legs. The pressure they create prevents blood from flowing backward and pooling.

If the symptoms are severe or if the above methods are ineffective at treating varicose veins, the physician may recommend the following:

  • Sclerotherapy: In sclerotherapy, the physician injects a chemical, called a sclerosant, into the affected veins. The chemical scleroses, or hardens, the veins from the inside out. The hardened veins are no longer able to fill with blood and eventually they are reabsorbed by the body. After sclerotherapy, blood returns to the heart through the remaining healthy veins. Sclerotherapy usually treats smaller varicose veins.
  • Endovascular ablation: Also known as thermal or radiofrequency ablation, endovascular ablation uses a thin, flexible catheter to destroy tissue inside a varicose vein. In this relatively new, minimally invasive procedure, the physician makes a tiny incision over a varicose vein and pulls a small part of the vein out of the body. A guide wire is inserted into the exposed vein, and a catheter sheath, or hollow tube, is then guided over the wire. The physician then passes a catheter through the sheath and into the vein itself. Ultrasound allows the physician to watch the catheter as it moves inside the vein. The tip of the catheter is equipped with tiny electrodes. These electrodes touch the inside of the vein wall and transmit bursts of radiofrequency energy, which heats the vein walls and destroys the tissue along the length of the vein. As with chemical sclerotherapy, the vein is then no longer able to carry blood, breaks up naturally, and is reabsorbed by the body.
  • Endovenous laser treatment (EVLT): An emerging treatment for varicose veins, EVLT transmits laser energy through a tiny fiber that is inserted into a varicose vein via a catheter. The laser energy kills the tissue of the diseased portion of a varicose vein, causing the vein to close and eventually be reabsorbed by the body. According to recent research, the long-term results of EVLT are equal to or better than results for surgery (such as vein stripping), sclerotherapy, and radiofrequency ablation. However, more research is needed to verify the long-term results of EVLT.
  • Vein stripping: Vein stripping is used to remove large varicose veins and their tributaries. In this procedure, after making a small incision in the groin, the physician removes the great saphenous vein after disconnecting any tributary veins.
  • Small incision avulsion: An outpatient procedure that is performed under local anesthetic, small incision avulsion enables the physician to remove smaller varicose and spider veins. During the procedure, which is also called ambulatory phlebectomy, the physician removes varicose and spider veins through tiny incisions of about 2 to 3 millimeters. The physician grasps varicose veins with a tool called a phlebotomy hook and pulls them through the incisions. Because the incisions are so small, they need no stitches. Small incision avulsion can be performed in conjunction with vein stripping.

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