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What is One of the following is a contraindication for surgical intervention in varicose veins? and explain in detail?
Ans: D (Deep venous thrombosis) Ref : Scibiston Text Book of Surgery, 19th edition. 2012. Page 1811Explanation:Deep venous thrombosis (DVT) should be ruled out before intervention in varicose veins.Indications for intervention in varicose veins:CosmesisSymptoms refractory to conservative therapyBleeding from a varixSuperficial thrombophlebitisLipodermatosclerosisVenous stasis ulcerIndications for IVC filter:Recurrent thromboembolism despite adequate anticoagulationChronic pulmonary embolism and resultant pulmonary hypertensionDeep venous thrombosis in a patient with contraindications to anticoaguiationPropagating iliofemoral venous thrombus in anticoagulationComplications of anticoagulationIndications for retrievable IVC filter:Prophylactic placement in a high-risk trauma patientShort-term contraindication to anticoagulationProtection during venous thrombolytic therapyExtensive ilio-caval thrombosisAnticoagulation for DVT:Treatment of DVT utilises heparin to maintain the aPTT at 60 to 80 seconds, followed by- warfarin to obtain an international normalized ratio (INR) of 2.5to 3.0. If unfractionated heparin is used, use a nomogram-based dosing therapyRecurrent venous thromboembolism increases if time to therapeutic anticoagulation is prolonged. Hence it is important to reach therapeutic levels within 24 hoursAn initial bolus of 80 U/kg or 5000 units IV bolus is administeredMaintenance 18 U/kg/hrThe rate is dependent on a target PTT corresponding to anti-factor.Xa level of 0.3 to 0.7 unifmL.PTT is to be checked 6 hours after change in heparin dosingWarfarin is started on the same day.There is no recommended duration of anticoagulant therapyMinimum treatment time: 3 months in most cases (Recurrence rate is the same with 3 versus 6 months of warfarin)Known hypercoagulable state or venous thrombosis: Lifetime anticoagulation if not contraindicatedThe accepted INR range is 2.0 to 3.0