varicose Veins In Obese patients

Obesity patients often have significant skin damage, lipodermatosclerosis, or active ulcers

Intense reflux and stagnating venous circulation at the venular level could be a manifestation of pathology ranging from saphenous or deep vein reflux, obstruction, or elevated central venous pressure. Again, thinking out of the “vascular box” and considering all causes of edema are vital to the management of vein symptoms in patients who have high body mass index.

Factors to be cognizant of when making a treatment decision include:

Vein size • Vein length • Tortuosity • Location (eg, above/below the knee, suprafascial) • Concerns regarding neighboring anatomy such as nerves or skin • Disease state

“Rules to live by” for treating superficial disease are:

1. Treat to the lowest point of incompetence.
2. Use whatever option is safest to achieve the first point.

The NonThermal Non Tumsscent devices(Glue therapy) can treat under these areas either from an ankle or a retrograde approach. Non thermal Glue therapy is a better choice to treat to the lowest point of incompetence, especially with advanced disease, which can safely be accomplished with these technologies. More over It is difficult to place tumescence under these areas if ablation to the level of superficial vein when associated with Leg swelling and skin changes with Leg ulcers due to over weight.

Radiofrequency ablation and endovenous laser ablation require tumescent anesthesia, which can cause discomfort. Current data suggest that nonthermal truncal ablation techniques are comparable to thermal ablation and appear to be less painful.