Varicose veins

VARICOSE VEINS

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Tortuous dilated veins

Reversal of blood flow though its faulty valves

Affect 5% of the adult population

Common sites

Lower limb

Pampiniform plexus of veins

Vulva

Sites of portosystemic anastomosis

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Anatomy of superficial and deep

veins of lowerlimb

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Types

Long saphenous vein varicosity

Short saphenous vein varicosity

Varicose vein due to perforator incompetence

Thread veins(dermal flares)-r small veins in the skin usually around the ankle which looks like dilated red or purple network of veins

Reticular varices-slightly larger varicesthan thread veins located in the s/c tissue

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Combination of any of the above

Small varicose vein is <3mm dia

Large varicose vein is >3mm dia

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Aetiology

Congenital incompetence or absence of valves

Familial-abnormalities in FOXC2 gene

Pts with post thrombotic limbs

Pts with congenital abnormalities like klippel-trenaunay syndrome or multiple arteriovenous fistulae

Pregnancy

Pelvic trs

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Other factors

Age

Sex

Race

Weight

Height

diet

Side(left > right)

Bowel habit

Occupation

Heridity

Erect stance

Recurrent

thrombophlebitis

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Clinical features

Symptoms Familial-begin in younger age group,

b/l, involves all veins including deep veins

Visible dilated vein

Aching in the veins at the end of the day after prolonged standing

Ankle swelling

Itching

Bleeding

Superficial thrombophlebitis9

Eczema

Lipodermatosclerosis

ulceration

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Signs

Brodie-Trendelenberg test

-Trendelenberg 1-saphenofemoral incompetence11

-Trendeleberg 11-perforator incompetence

Modified Perthe’s test-signifies DVT

three tourniquet test

Schwartz test

Morrissey’s cough impulse test

Fegan’s test 11

Complications of varicose

veins Haemorrhage

Eczema and dermatitis

Periostitis causing thickening of periosteum

Venous ulcer, marjolin’s ulcer

Lipodermatosclerosis

Deep vein thrombosis

Thrombophlebitis

Ankylosis of ankle joint, talipes equinovarus

calcification12

Venous ulcer

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Investigations

Standard venous dopplerexamination-a biphasic signal indicates forward and reverse flow and is indicative of blood refluxing down through incompetent valves

Duplex scan

Varicography

Venography

USG abd, PS, Plt count, other relvantinv depending on the cause of varicose vein

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Differential diagnosis

Lymphoedema

A-V malformation

Orthostatic oedema

Renal and cardiac disease

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Treatment

Consevative treatment

-elastic crepe bandage application

-diosmin therapy

-elevation of limb

-unna boots

-pneumatic compression method

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Injection sclerotherapy

-a detergent is injected directly into

superficial veins,commomly sodium

tetradecyl sulphate

-destroys the lipid membrane of

endothelial cells causing them to

shed,leading to thrombosis,fibrosis

and obliteration(sclerosis)

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Ultrasound guided foam

scleropathy

Contraindications

-SF incompetence

-varicose vein with venous ulcer

-DVT

Advantages

-OP proceedure

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Disadvantages

-inadvertant s/c inj can cause skin

necrosis or abscess formation

-anaphylaxis

-hyperpigmentation

-thrombophlebitis

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Surgical treatment

Trendelenburg operation Stripping Subfascial ligation of cocket and dodd Ligation of short saphenous vein Linton’s vertical approach Stab avulsion of varicose vein and

perforators VNUS closure method TRIVEX method Subfacial endoscopic perforator ligation

surgery

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Other methods

-radiofrequency ablation

-endovenous laser ablation

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Complications of varicose vein

surgery Saphenous neuralgia, sural nerve

injury

Infection

Hematoma formation

DVT

Recurrence

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