Download - Case of Varicose Veins
Case of Varicose Veins
By: Anumeha Vashist
Introduction of the patient Raju32 yrs male Farmer by occupationResident of Village- Shikapura Distt. Karnal
Chief Complaints
Patient came with the chief complaints of Prominent veins in the right leg for past 2 yrs Swelling and pain right leg for 1 year
History of present illness
Patient was asymptomatic 2 yrs back when he noticed prominent veins in the right leg on the medial side. Gradually the prominence of veins went on increasing. The veins become more prominent on prolonged standing
He started having swelling in the Right leg and ankle region I yr back. The pain and swelling was more in the evening hours and on prolonged standing.
H/o itching and pigmentation in right leg and ankle region for the last 1 year. There is No H/o any ulceration and No H/o night cramps.
No H/o feverNo H/o urinary or bowel trouble
Past History:No History suggestive of Deep Vein Thrombosis(DVT)
in past No H/o TB, Diabetes mellitus, asthma, epilepsy, drug
allergy, Hypertension.
Personal History:VegetarianSmoker and non-alcoholic
Family History:No family history of varicose veins
Patient is conscious, cooperative, well oriented to time place and person,moderately built and nourished.
No Pallor, icterus, cyanosis, clubbing, Lymphadenopathy.No Pedal edema, JVP not raised.Vital Signs:Pulse Rate- 82/min, regular good volumeBlood Pressure- 130/80 mm Hg, right arm lying down
positionRespiratory Rate- 16/min Temperature- Normal
General Physical Examination
Inspection:Dilated veins on the medial side of right leg ,ankle and
foot extending upto thigh region ( Long Saphenous region)
Ankle flare present pigmentation present in the leg and ankle area and no
skin ulceration seen.No prominent veins in left leg
Palpation:Dilated vein palpable on medial side of leg and ankle
extending to mid thigh region.
Local Examination
Examination cont.Tredelenberg test : +vePerthes test : -veFegan’s test : +ve, 2 perforaters on medial side
of right leg.Peripheral pulsations in right
leg normal.Auscultation- No brue heard
over the prominent veins.Opposite leg no prominent
veins.
Inspection: abdomen is normal in shape, umbilicus is inverted and central in position.
Normal abdominal movements seen with respiration. Skin over the abdomen is normal. No mass visible Hernial sites normal.
Palpation: abdomen is soft, non tender
No mass is palpable. Hernial sites normal
Abdominal Examination
The diagnosis is Varicose Veins Clinical Grade 4With saphanofemoral incompetence with perforator
incompetence right side.
Diagnosis
InvestigationsWe will do colour dopler to find perforators which are
incompetent and to check incompetency of Saphenofemoral and saphenopopliteal junction.
Deep veins will be looked for any obstruction/DVTInvestigations will be done for pre-anaesthetic check up
and fitness of patient for surgery
Color Doppler showing Saphenofemoral incompetence
Surgery : High Saphenofemoral junction ligation with ligation of
all the tributaries with stripping of thigh portion of long saphenous vein and subfascial ligation of all the perforators with multiple superficial phlebectomies ( ligation of superficial prominent veins)
Alternatives: Endovenous laser treatment of varicose veins Radiofrequency ablation of varicose veins Foam Sclerotherapy (Ultrasound guided)
Treatment
Thank you