Vascular Surgery

DVT — deep vein thrombosis — is a blood clot in the deep veins of the leg, and its symptoms are dangerously easy to ignore or mistake for a muscle problem. What makes DVT particularly serious is not the clot in the leg itself — it is what happens when a fragment breaks off and travels to the lungs. That is a pulmonary embolism, and it can be fatal within minutes. Dr. Ved Prakash, Director of CTVS and Vascular Surgery at Yatharth Super Speciality Hospitals, Greater Noida, explains DVT deep vein thrombosis symptoms, who is most at risk, and what treatment involves. What Is DVT — Deep Vein Thrombosis? Deep veins are the major vessels that carry blood from the legs back to the heart. When a clot forms in one of these deep veins — most commonly in the calf, thigh, or pelvis — blood cannot drain normally from the affected leg. The result is the swelling, pain, and warmth that characterise DVT deep vein thrombosis symptoms. And because the deep veins are connected directly to the pulmonary circulation, a piece of the clot can detach and reach the lungs at any time. DVT Deep Vein Thrombosis Symptoms — What to Look For Unilateral (One-Sided) Leg Swelling DVT almost always affects one leg. Swelling of both legs together is rarely caused by DVT — it more commonly indicates heart failure or low albumin. If one calf or thigh is noticeably larger than the other and this developed over hours or a few days, DVT must be ruled out urgently. Calf Pain and Tenderness Aching or tenderness in the calf — often mistaken for a muscle strain or cramp. The pain is typically worse when walking and when the foot is flexed upward (Homan’s sign — though this is not reliable as a standalone test). Many patients describe it as a persistent heaviness or soreness that does not improve with rest the way a muscle injury would. Warmth and Redness The skin over the clotted vein may feel warm to the touch and appear reddish or purplish — caused by the inflammatory response to the clot. This can look similar to cellulitis, which is a skin infection. DVT and cellulitis require completely different treatments, so a duplex ultrasound — not antibiotics alone — is always needed when the diagnosis is uncertain. Distended Surface Veins When the deep vein is blocked, blood reroutes through the surface veins — which then become visibly distended. This is different from pre-existing varicose veins and appears more suddenly. If you have sudden breathlessness, sharp chest pain, or are coughing blood — go to a hospital emergency immediately. These are pulmonary embolism symptoms and require urgent treatment. Who Is at Risk of DVT? Recent surgery — particularly orthopaedic surgery (hip or knee replacement), abdominal or pelvic surgery. Post-surgical DVT prevention with anticoagulants is standard practice in all major hospitals. Prolonged immobility — long-haul flights over 4 hours, extended bed rest, or a limb in plaster cast. Economy class travel over 8 hours increases DVT risk 2–3 fold. Cancer — many cancers activate the clotting system. DVT is sometimes the first sign of an undetected malignancy. Pregnancy and postpartum period — DVT risk is 5–10 times higher in pregnant women, particularly in the third trimester and the 6 weeks after delivery. Oral contraceptive pills or hormone replacement therapy — oestrogen increases clotting factor levels, particularly when combined with smoking. Inherited clotting disorders — Factor V Leiden, Protein C or S deficiency, antiphospholipid syndrome. Recurrent DVT without an obvious trigger should prompt testing for these. Post-COVID — COVID-19 infection causes a significant pro-thrombotic state. DVT incidence is elevated in patients recovering from COVID-19, particularly those who were hospitalised. Obesity and varicose veins — both impair venous return from the legs and increase background DVT risk. How Is DVT Diagnosed? Duplex Ultrasound The primary test. Non-invasive, painless, and highly accurate. Shows the clot location, how far it extends, and whether it is freely floating (mobile clots carry a higher embolism risk). This is the test that confirms or rules out DVT — not clinical examination alone. D-Dimer Blood Test A negative D-dimer in a low-probability patient effectively rules out DVT without needing an ultrasound. A positive D-dimer is not diagnostic on its own — it only means something is causing clotting activity (which could be DVT, infection, pregnancy, or many other conditions). Duplex ultrasound confirms. Wells Score A clinical scoring system that estimates DVT probability before imaging, based on symptoms, risk factors, and whether an alternative diagnosis is more likely. A high Wells score plus a positive D-dimer means DVT until proven otherwise by ultrasound. DVT Treatment Anticoagulation: The cornerstone of treatment. Blood thinners prevent the clot from growing and allow the body to dissolve it gradually. Modern DOACs — rivaroxaban or apixaban — are used in most cases and do not require regular INR blood monitoring, unlike warfarin. Duration is 3 months for provoked DVT (surgery, flight), 6 months or longer for cancer-related DVT or unprovoked recurrent episodes. Compression stockings: Reduce leg swelling and significantly lower the risk of post-thrombotic syndrome — the long-term venous damage that can follow an unresolved DVT clot. Catheter-directed thrombolysis: Reserved for large, limb-threatening DVTs causing severe swelling and circulatory compromise — a catheter delivers clot-dissolving drugs directly into the thrombosed vessel. IVC filter: A filter placed in the inferior vena cava to catch clots before they reach the lungs — used when anticoagulation is contraindicated (recent surgery, active bleeding). For patients with varicose veins and DVT — both conditions affecting the venous system — Dr. Ved Prakash treats both simultaneously at Yatharth Hospital to address the root cause of recurrent venous disease. Frequently Asked Questions — DVT Deep Vein Thrombosis Symptoms What are the classic DVT deep vein thrombosis symptoms? Unilateral leg swelling, calf pain and tenderness (worse on foot flexion), warmth and redness over the affected calf, and distended surface veins. More than 50% of DVTs are symptomless — which

Peripheral artery disease symptoms are one of the most under-recognised warning signs in Indian medicine — and in the diabetic population, which is enormous across UP, Delhi NCR, and the surrounding regions, peripheral artery disease often presents with no warning at all until the disease is critical. Dr. Ved Prakash, Director of CTVS and Vascular Surgery at Yatharth Super Speciality Hospitals, Greater Noida, explains what peripheral artery disease is, the stages of symptoms from mild to limb-threatening, and when intervention is urgently needed. What Is Peripheral Artery Disease? Peripheral artery disease (PAD) is atherosclerosis — plaque buildup — affecting the arteries that supply blood to the legs. It is the same disease process as coronary artery disease in the heart, occurring in a different location. As the arteries narrow, the leg muscles do not receive enough blood during exercise — and as the disease progresses, not even at rest. PAD affects approximately 200 million people worldwide and is significantly underdiagnosed in India. PAD is not the same as deep vein thrombosis or varicose veins. Those are venous (vein) problems. PAD is an arterial (artery) problem — it is about blood not reaching the leg, not blood failing to drain from it. The distinction matters because the symptoms, investigations, and treatments are completely different. For comparison, read about deep vein thrombosis. Peripheral Artery Disease Symptoms — Stage by Stage Stage 1 — Claudication The hallmark PAD symptom. Cramping, tightness, or aching in the calf, thigh, or buttock that comes on after a predictable walking distance — say, 300 metres — and stops you in your tracks. After 5–10 minutes of standing still, the pain disappears completely. You can then walk again — until the same distance is reached. The location of the pain tells you the level of arterial disease: calf claudication means disease in the superficial femoral artery (mid-thigh level); thigh and buttock claudication means disease in the iliac arteries of the pelvis. Claudication is often written off as arthritis, age-related muscle weakness, or sciatica — none of which share its specific pattern of predictable onset with walking and complete relief with rest. Stage 2 — Worsening Claudication As peripheral artery disease progresses without treatment, the claudication distance shortens. A patient who could walk 500 metres two years ago now manages 100. This reflects worsening arterial narrowing and is the signal that intervention should be considered before the next stage develops. Stage 3 — Rest Pain When peripheral artery disease becomes severe enough, the foot no longer receives adequate blood even lying in bed. The patient experiences burning or aching pain in the foot and toes — classically worse at night, and relieved slightly by hanging the foot over the edge of the bed (gravity assists blood flow). Rest pain is a medical emergency. Without treatment, tissue loss — gangrene — follows within weeks. Stage 4 — Tissue Loss (Ulceration or Gangrene) The most advanced peripheral artery disease symptom. Wounds on the foot or toes that do not heal despite weeks of dressing, or areas of blackened, dry or wet gangrene. In diabetic patients, this is often the first and only presentation of peripheral artery disease — because diabetic neuropathy has eliminated the earlier pain warning signals entirely. Peripheral Artery Disease in Diabetic Patients — The Silent Crisis This is the most important section for a significant proportion of readers across western UP and Delhi NCR, where diabetes rates are among the highest in the country. Diabetic neuropathy — nerve damage from chronic high blood sugar — destroys the pain sensation in the feet and lower legs. A diabetic patient with PAD advanced enough to cause rest pain may feel nothing. A small cut on the foot from a tight shoe may go unnoticed for days. A wound that should heal in a week sits open for months — because the blood supply needed for healing is not arriving. By the time a diabetic patient presents to a vascular surgeon with a non-healing foot wound, they often have severe, critical peripheral artery disease that has been silently progressing for years. Annual ABI (Ankle-Brachial Index) measurement is recommended for all diabetic patients over 50. It takes five minutes, is completely painless, and can detect PAD before any symptoms develop. How Is Peripheral Artery Disease Diagnosed? ABI (Ankle-Brachial Index): Blood pressure cuff at the ankle compared to the arm. A ratio below 0.9 confirms PAD. Below 0.5 indicates critical ischaemia. Fast, painless, available in any vascular clinic. Duplex Doppler ultrasound: Maps the arterial anatomy and identifies narrowings without radiation or dye. CT angiography: Detailed 3D imaging from the aorta to the foot — essential before planning angioplasty or bypass surgery. Conventional angiography: Catheter-based — performed in the interventional suite when treatment is planned immediately. Peripheral Artery Disease Treatment Medical management: Antiplatelet drugs (aspirin or clopidogrel), statin therapy, strict blood pressure and blood sugar control, and smoking cessation. Supervised walking exercise programmes — counterintuitive but effective — can increase the claudication distance by 50–100% in 3 months. Endovascular treatment (angioplasty/stenting): A catheter opens the narrowed artery and a stent holds it open. Minimally invasive, 1–2 day hospital stay, faster recovery. Peripheral bypass surgery: For long or multiple blockages not amenable to angioplasty — a vein or synthetic graft bypasses the blocked arterial segment. More invasive but durable, with recovery of 4–6 weeks. For patients with critical limb ischaemia or a non-healing diabetic foot wound, peripheral vascular disease treatment in Delhi NCR at Yatharth Hospital is available on an urgent basis — WhatsApp your clinical photos and report to +91-9355255106 for a rapid pre-assessment. Frequently Asked Questions — Peripheral Artery Disease Symptoms What is the most common symptom of peripheral artery disease? Claudication — leg cramping that starts after a predictable walking distance and disappears completely with 5–10 minutes of rest. It affects about 50% of PAD patients; the other half are asymptomatic, particularly diabetics. Why are diabetic patients at higher risk? Diabetes doubles PAD risk and eliminates the pain signals (via neuropathy)

EVLT — Endovenous Laser Treatment — is a walk-in, walk-out procedure that closes varicose veins permanently from the inside using laser energy, with no surgical incision, no stitches, and no general anaesthesia. It has replaced surgical stripping as the first-choice treatment for most varicose veins. Dr. Ved Prakash, Director of CTVS and Vascular Surgery at Yatharth Super Speciality Hospitals, Greater Noida, explains exactly what EVLT laser treatment involves, who it works for, and what recovery looks like day by day. How Does EVLT Work? To understand EVLT, you first need to understand the problem it solves. Varicose veins are caused by valve failure in the long saphenous vein — the main superficial vein that runs from the foot to the groin. When this vein’s valves stop working, blood pools and the branches feeding off it become the visible varicose veins on the surface. EVLT targets the root cause directly. A laser fibre is inserted into the long saphenous vein through a needle puncture — no cut, no incision. As the fibre is slowly withdrawn along the length of the vein, it delivers controlled laser energy to the vein wall, causing it to collapse and seal permanently. Within 4–8 weeks, the sealed vein is absorbed by the body. Blood that previously pooled in the diseased vein automatically reroutes through the healthy deep veins — relieving symptoms and collapsing the visible surface varicosities. What Happens on the Day of EVLT Duplex Ultrasound Mapping First Before the laser is inserted, a duplex ultrasound scan is performed to map the incompetent saphenous vein — its length, diameter, and the location of the incompetent junction at the groin. This guides precisely where the laser fibre will be placed and how long it needs to run. Access Under Ultrasound Guidance A fine needle puncture — usually at the knee — is made into the saphenous vein under ultrasound vision. No incision, no stitch. A thin sheath is introduced through which the laser fibre is threaded up to the level of the groin junction. Tumescent Anaesthesia A dilute local anaesthetic solution is injected around the vein using very fine needles along its entire length. This is called tumescent anaesthesia. It numbs the vein completely — so the laser is painless — and also acts as a heat buffer protecting the surrounding tissue from thermal injury. This step takes 10–15 minutes and is the only mildly uncomfortable part of the procedure. Laser Activation The laser is switched on and the fibre is slowly pulled back along the vein at a controlled rate. You feel nothing. The procedure takes 15–25 minutes per leg. Compression and Walking A compression bandage is applied immediately. Patients are asked to walk for 20–30 minutes in the corridor before leaving the hospital. Walking straight away activates the deep veins and prevents clot formation. You then go home — same day, every time. Recovery After EVLT — Day by Day Day of procedure: Walk 20–30 minutes before leaving. Go home. Mild tightness along the treated vein is normal — this is the vein sealing. Not painful. Days 1–3: Bruising develops along the vein track. This is expected and not a complication. Continue walking 30 minutes daily. Compression stocking on throughout the day, off at night. Days 3–5: Most desk-work patients return to work. The vein feels like a cord under the skin — the sealed vein being absorbed. This resolves over 4–6 weeks. Week 1: Avoid hot baths, saunas, swimming. Shower normally. No prolonged standing for more than 2 hours at a stretch. Week 2: Bruising fades significantly. Compression stocking continues for the full 2 weeks post-procedure. Week 4–6: Follow-up duplex ultrasound confirms the vein is fully closed. Any residual smaller tributary veins visible at the surface are treated with sclerotherapy injection at this visit if needed. EVLT vs Surgical Stripping — Why EVLT Is Now the Standard Feature EVLT Laser Surgical Stripping Anaesthesia Local (tumescent) General or spinal Incisions None — needle puncture only 2–3 small incisions Same-day discharge Yes — every time Usually day procedure or overnight Return to desk work 1–2 days 2–3 weeks Post-procedure pain Mild tightness only Wound pain for 5–10 days 5-year closure rate >90% >85% — similar Who Qualifies for EVLT? EVLT is suitable for most patients with symptomatic varicose veins from great or small saphenous vein incompetence. A duplex ultrasound assessment beforehand confirms suitability — specifically, the vein must be large enough to accept the laser fibre and accessible by needle puncture. Very large or tortuous veins may require surgical stripping. Active DVT in the affected leg is a contraindication. To understand more about the underlying condition EVLT treats, read about how varicose veins develop. For more on all treatment options — including sclerotherapy and surgical alternatives — visit our varicose vein treatment page. Frequently Asked Questions — EVLT Laser Varicose Vein Treatment Is EVLT laser treatment for varicose veins painful? No — the tumescent anaesthesia numbs the vein completely before the laser activates. Patients feel no pain during the procedure. Mild tightness and bruising along the treated vein is normal for 3–7 days after and is not painful. How long does recovery take after EVLT? Desk-work patients return within 1–2 days. Walking from the same day. Compression stockings for 2 weeks. Physically demanding work — prolonged standing or heavy lifting — avoided for 2 weeks. Full activity by week 3. How long does EVLT last? The treated vein is permanently closed. Closure rates exceed 90% at 5 years. The treated vein does not reopen. New varicose veins can develop from other branches over subsequent years but the treated vein stays sealed. Can both legs be treated with EVLT on the same day? Yes — bilateral EVLT on the same day is safe and commonly performed. Post-procedure walking is required. Most patients tolerate bilateral EVLT well under tumescent anaesthesia. Dr. Ved Prakash | Director, CTVS — Yatharth Super Speciality Hospitals, Greater Noida 📞 +91-9355255106  | 📧 drvedprakash@gmail.com  | Book Appointment →

Varicose veins causes symptoms: Varicose veins are not just a cosmetic concern — they are a progressive condition caused by damaged vein valves, and without treatment they tend to worsen over time. Many patients visit a vascular specialist only after years of ignoring early warning signs, assuming them to be a normal part of ageing. Dr. Ved Prakash, Director of CTVS and Vascular Surgery at Yatharth Super Speciality Hospitals, explains what causes varicose veins, how symptoms appear at different stages, and when the condition becomes medically serious. What Are Varicose Veins? Your leg veins carry blood from the feet back up to the heart — against gravity. To stop blood from flowing backwards between heartbeats, veins contain one-way valves that open as blood flows upward and snap shut as soon as the heartbeat stops pushing. When these valves weaken or are damaged, blood pools in the vein between beats. The pooled blood stretches the vein wall — and over time the vein enlarges, twists, and becomes visibly distorted under the skin. This is a varicose vein. It is always caused by valve failure — not by the pressure of standing, not by diet, and not by crossing your legs. Varicose Veins Causes — Why They Develop Prolonged Standing or Sitting The most significant occupational risk factor. Teachers, nurses, surgeons, security guards, factory floor workers, and retail staff who stand for 6 or more hours daily put sustained pressure on their leg vein valves. Over years this weakens the valves. Desk workers who sit for long periods face a different but related problem — pelvic vein compression impairs drainage from both legs. Family History If one parent has varicose veins, your lifetime risk is approximately 40%. If both parents do, it rises to 90%. Valve weakness is largely inherited — it is not something you caused. Pregnancy Multiple mechanisms combine during pregnancy: blood volume increases by 40–50%, the hormone progesterone relaxes vein walls, and the growing uterus compresses the pelvic veins — all increasing the pressure on leg vein valves. Varicose veins from a first pregnancy often improve partially after delivery. They typically worsen with subsequent pregnancies. Obesity Increased intra-abdominal pressure from excess body weight continuously impairs blood return from the legs — accelerating valve deterioration. Age Valve elasticity decreases naturally with age. Most symptomatic varicose veins present in patients over 40. Previous DVT A past episode of deep vein thrombosis can permanently damage vein valves — causing post-thrombotic varicose veins that are more difficult to treat and more likely to cause skin complications. Common Symptoms of Varicose Veins  Varicose veins are usually visible on the legs, but they can also make your legs feel uncomfortable. Common signs include: Visible VeinsYou may notice enlarged veins that look blue or dark purple. These veins often appear twisted, raised, or bulging under the skin, mainly on the legs. Leg Pain or HeavinessYour legs may feel tired, sore, or heavy, especially after standing or sitting for a long time. SwellingMild swelling can develop around the feet, ankles, or lower legs, particularly by the end of the day. Skin Irritation or ChangesThe skin around the veins may itch, burn, or feel warm. If not treated, the skin color may slowly become darker. Leg CrampsSome people experience muscle cramps or tightening in the legs, often during the night while sleeping. Varicose Veins Symptoms — Staged by Severity Varicose veins progress through a clinically recognised staging system called CEAP classification. Understanding where you are in this progression determines urgency of treatment. C1 — Spider Veins (Telangiectasia) Small, thread-like red or purple veins visible very close to the skin surface. No symptoms — purely cosmetic. Common in women from their 20s onward. C2 — Varicose Veins Bulging, rope-like veins visible under the skin — typically on the calf, back of the knee, or inner thigh. May or may not cause symptoms at this stage. Many patients live with C2 disease for years before seeking help. C3 — Swelling (Oedema) Ankle and lower leg swelling that builds through the day and does not fully resolve overnight. This indicates significant venous hypertension — the vein pressure has risen to the point where fluid is being pushed out into the surrounding tissue. At this stage, symptoms include leg heaviness, aching after standing, and cramping at night. C4 — Skin Changes Brown pigmentation (haemosiderin staining) around the ankle, eczema over the varicose veins, or a hardening and tightening of the skin above the ankle (lipodermatosclerosis). These are signs of longstanding venous hypertension damaging the skin. This stage requires treatment — it is no longer purely cosmetic. C5 — Healed Venous Ulcer A venous ulcer near the inner ankle that has previously healed but left a scar. These patients are at high risk of recurrence without treatment of the underlying varicose veins. C6 — Active Venous Ulcer An open wound near the inner ankle that does not heal despite weeks of dressing. This is a medical emergency in vascular terms — it will not close without treating the underlying varicose veins driving the venous hypertension. Referral to a vascular surgeon is urgent. Primary Causes and Risk Factors of Varicose Veins Varicose veins develop when the tiny valves inside your veins stop working properly. These valves normally help blood flow upward toward the heart. When they weaken or get damaged, blood flows backward and collects in the veins, making them swollen and visible.  Main Causes and Risk Factors Age (Getting Older)As we age, veins naturally lose strength and flexibility. The valves become weaker, increasing the chance of varicose veins. PregnancyDuring pregnancy, the body produces more blood to support the baby. Hormonal changes and pressure from the growing uterus put extra strain on leg veins, causing them to stretch. Gender (Women at Higher Risk)Women develop varicose veins more often than men. Hormonal changes during pregnancy, menopause, or while using birth control pills can affect vein health. Obesity or Excess WeightExtra body weight puts additional pressure on leg veins, making it harder for blood to