Vascular Surgery Stent Graft Plan: Fill & Download for Free

Varicose veins can be, and often are, treated in a diabetic patient. Treatment requires vascular surgical assessment before any intervention in a diabetic patient. Ideally the vascular surgeon is involved at every stage, even if not performing each procedure.Many extra considerations apply and it is wise to let the patient reflect on the available options in most cases. Some basic concepts and examples are:1. Mildly symptomatic, uncomplicated veins that are an appearance issue may be better left alone. Support stockings or socks can reduce symptoms and stabilise venous dermatitis.2. A review consultation and repeat vascular venous ultrasound exam should be part of the initial care plan. Varicose veins that worsen or develop complications may then be reconsidered for intervention (largely this means their removal or ablation).3. A conservative approach with specialist review is preferred because treating varicose veins may involve intervention on the long (greater) or short (lesser) saphenous veins. These long straight superficial veins are important potential autogenous graft options for the patient in the future. They are useful for these purposes even if moderately varicose.Despite the advent of stents and synthetic grafts for peripheral arterial disease and stents and arterial grafts for cardiac bypass operations, there remain a substantial number of diabetic patients in whom these veins may be life or limb saving grafts later in life.4. Conversely, varicose veins associated with complications often deserve intervention. Typically one is referred a diabetic patient with a leg ulcer. Assessment and treatment of the arterial circulation comes first. This involves the usual pathways: optimise diabetes control, start or review cholesterol lowering therapy, start or review anti-platelet therapy, an ultrasound exam, likely then an arteriogram, with or without angioplasty and stenting.Subsequently, one can apply compressive bandages or stocking over the ulcer with less risk of arterial compromise (causes pain, may prevent ulcer healing). In selected cases, it may be decided to treat (sacrifice) potential venous conduits to treat the ulcer.5. Diabetics have about twice the complication rate at surgery as non- diabetic patients so the move to operate needs to factor in: medical optimisation, operate in a larger hospital with appropriate backup facilities, involve the patient's endocrinologist (or a preferred substitute), consider if a lesser surgical procedure would suffice.6. Varicose vein surgery (ie operations by incision, generally removing the varicose veins, often called "vein stripping") remains a viable option to treat troublesome varicose veins in many countries, including Australia. It's effective, rapid, fairly safe, and fairly cheap or free to the patient.7. Newer venous ablative procedures (ultrasound guided sclerotherapy or UGS, phlebectomy under LA, endovenous laser ablation or EVLA) require local expertise and equipment but are generally preferred if accessible. Cost and availability vary widely. The avoidance of a hospital admission, no anaesthesia, and no surgical incisions are major advantages especially for the diabetic patient no matter how well controlled.7. There are still a group of patients for whom hospitalisation and surgery are advised in varicose vein treatment. Another small group may also require surgery for ulcer biopsy, debridement, or skin grafting.8. Smaller varicose veins may often be injected (sclerotherapy) in diabetic patients after the issues described above have been addressed by the doctor and canvassed with the patient (informed consent vs signing a consent form). Many diabetic patient have enough burdens in life without aching or unsightly varicose veins on their legs.9. The topic of varicose vein management in the diabetic patient is vast. This answer highlights some major considerations.10. Diabetic patients with any but the mildest of varicose veins require specialist surgical management, even if that amounts only to a review consultation every year or two. The diabetic patient might also need specialist input for arterial disease, a topic largely not addressed here.