How are post-operative varicose vein complications treated?

  The treatment of varicose veins in the lower extremities is mainly surgical, and in recent years, the application of minimally invasive surgical techniques has led to the emergence of improved and minimally invasive procedures such as sclerotherapy injection, transilluminated direct vision spinotomy TriVex, endovascular radiofrequency, endovenous laser treatment, and transendoscopic subfascial traffic vein ligation [1]. In particular, sclerotherapy with sclerotherapy injection is an early method used and is now widely adopted in clinical practice. Studies have shown that the early results of liquid sclerotherapy and surgical efficacy are comparable, and as time increases, the recurrence rate is significantly higher in the sclerotherapy injection group relative to the high saphenous vein ligation style, with a significantly higher recurrence rate of 74 ˚% at 5 years postoperatively. Postoperatively, patients often have varying degrees of lower limb soreness and swelling; subcutaneous petechiae along the venous itinerary, and even hard nodules with different ranges and sizes can be palpated, with pulling sensation when flexing and extending the lower limb, and edema in the lower leg and foot tread, and some patients still need elastic support. Once recurrence occurs, it is more difficult to operate again, which makes clinical treatment difficult. In our department, from March 2009 to December 2013, we applied Chinese herbal medicine to treat the recurrence and combined complications of varicose veins in the lower limbs after sclerotherapy with satisfactory results, which are reported as follows: 1. 35 to 80 years old, mean 72.2 years old; recurrence time ranged from 0.5 to 15 years. Superficial varicose veins of the lower extremities were seen in all patients, including 15 cases with small saphenous varicose veins. There were 37 limbs with swelling, 21 limbs with pain, 29 limbs with eczema, 52 limbs with varying degrees of hyperpigmentation, 9 cases with accessible subcutaneous hard nodes, 16 cases with ulcers, and 2 cases with healing. All patients underwent ultrasound examination of the deep veins of the lower limbs and had deep venous valve insufficiency in 12 limbs.  (2) Statistical methods SPSS17.0 statistical software was used for analysis. The measurement data were expressed as ±s, and paired t-test was used for comparison between groups. p < 0.05 indicated that the difference was statistically significant.  2. Treatment methods: (1) Internal formula No. 1: 60g of raw Astragalus, 30g of Poria, 15g of Atractylodes, 15g of Radix Codonopsis, 10g of Radix Aromaticus, 20g of Radix Angelicae Sinensis, 12g of Rhizoma Chuanxiong, 10g of Peach kernel, 15g of Radix Achyranthes, 10g of Radix Paeoniae, 30g of Salviae, 10g of Curcuma, 15g of Atractylodes, 40g of Zedoaria, 6g of roasted Boswelliae, 6g of roasted Myrrh (2) External formula No. 2. Peach kernel, safflower, Bai Xian Pi, Chuan Niu Knee, Angelica sinensis, Fang Qi, Red Peony 15g each, while warm (to maintain the temperature of about 38 degrees) fumigation of the affected area and soak the affected foot, 2 times / day, 15min / time. Take 10 doses as a course of treatment. Combined with ulcers to clean up and change medicine treatment.  3, efficacy criteria and results (1) efficacy assessment method using the prevailing chronic venous disease clinical severity score (VCSS) to objectively evaluate the efficacy of treatment methods. It included pain, varicose veins, venous edema, hyperpigmentation, inflammation, sclerosis, number of ulcers, duration, ulcer size and compression therapy. The circumference of each limb was also measured before treatment, 1 month after treatment, and 3 months after treatment 10 cm above the patella, 10 cm below the patella, and 10 cm above the ankle to determine the efficacy of edema treatment, respectively.  (2) Results Two patients (2 limbs) withdrew from the treatment regimen due to rash in the lower extremities from topical soaking medication, with an average follow-up of 6 months after treatment and deletion of 1 case (1 limb). The patients' VCSS scores were all improved in terms of pain, varicose veins, and ulcers. In particular, the swelling of the lower extremities improved significantly 3 months after treatment compared with the pre-treatment period, and all patients reported relief of pain, including 13 cases with occasional swelling. In the other two cases, the healed ulcers did not recur. No important complications such as skin necrosis, deep vein thrombosis and infection occurred during the follow-up period.  4.Discussion Varicose veins of the lower limbs are common diseases, and the name of the disease in Chinese medicine is "tendon tumor", and the formation of calf ulcers is called polyposis, which is a disease of lower limbs with bruised tendons due to long standing and stagnation of qi and blood stasis caused by holding weight. It is most common with the evidence of fatigue and qi stagnation and blood stasis. In cases of recurrence after sclerotherapy, it is more difficult to operate again by western medicine, and the patient's compliance with re-operation is poor. The pathogenesis of the disease is due to the congenital deficiencies of the cha, weak tendons and veins, coupled with prolonged walking and standing, excessive exertion, further damage to the tendons and veins, so that the meridians and veins do not fit, the flow of Qi and blood is not smooth, blood congestion in the lower, stasis of blood stagnation of the veins and veins expansion and filling. Day after day intertwined coiled and become, day after day similar to the shape of the tumor. After injection of sclerosing agent lower extremity qi blockage, qi does not work then blood is not smooth, long and qi stagnation and blood stasis, blood stasis blocking the meridians, not pass then pain. We use TCM holistic diagnosis, the use of Chinese medicine internal as well as external fumigation therapy, treatment of sclerotherapy injection after recurrence and the emergence of complications cases, the formula in the raw astragalus nourishes the middle to benefit the qi, remove sores and muscle, the aromatic herb for the qi in the blood, has the effect of moving qi and blood, poria, atractylodes, party ginseng to take the meaning of the four gentlemen soup, has the effect of strengthening the spleen and moving qi, the spleen is the main transport, the combination of the above drugs can provide power for the qi and blood to run. Radix Angelicae Sinensis, Rhizoma Chuanxiong, Rhizoma Peach, Radix Paeoniae Alba, Salviae Miltiorrhizae, Salviae Miltiorrhizae and Curcumae can invigorate the blood and open the veins, and the software disperses the knots. Atractylodes macrocephala and zedoary diuretic and subdue swelling. Fangji invigorates blood and subdues swelling. Boswellia and Myrrh relieve pain. This formula is based on the principle of "promoting Qi and Blood circulation, promoting blood circulation and relieving pain", and follows the principle of holistic concept of Chinese medicine and diagnosis and treatment, which fully reflects the principle of consolidating and clearing the source and treating both symptoms and root causes. Chinese medicine internal and external treatment of lower limb varicose veins after sclerotherapy injection cases with satisfactory results.