varicose veins
TRANSCRIPT
![Page 1: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/1.jpg)
By, Dr.Srinivasan Raman,Tbilisi state medical university,Georgia.
VARICOSE VEINS
![Page 2: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/2.jpg)
VEINS ANTERIOR VIEW
![Page 3: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/3.jpg)
VENOUS SYSTEM OF THE LOWER EXTREMITY
![Page 4: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/4.jpg)
Superficial veins of lower extremity
![Page 5: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/5.jpg)
![Page 6: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/6.jpg)
PHYSIOLOGY
• Fluid Movements: Bulk Flow (Starlings Law of the Capillary)
• Hydrostatic pressure (HP) is the force of a fluid against a membrane.
• Colloid osmotic pressure (OP), the force opposing hydrostatic pressure, is created by the presence of large, nondiffusible molecules that are prevented from moving through the capillary membrane.
• Fluids will leave the capillaries if net HP exceeds net OP, but fluids will enter the capillaries if net OP exceeds net HP.
![Page 7: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/7.jpg)
CAPILLARY DYNAMICS
![Page 8: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/8.jpg)
EPIDEMIOLOGY
• Adult prevalence of visible varicose veins are 25-30 % in women and 15% in men factors affecting prevalence as per edinburgh vein study include,
• Gender: women > men• Age: increases with age• Body mass index and height: increased BMI and height
increases prevalence• Pregnancy: Increase risk• Family history: familial susceptibility present• Occupation and lifestyle factors: smoking, constipation
increases prevalence and occupations with prolonged standing also increases
![Page 9: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/9.jpg)
CLASSIFICATION:• CEAP classification(clinical-etiology-anatomy-pathophysiology)
Clinical classification:Co: no signs of venous disease C1: telengiectasia or reticular veinsC2: varicose veinsC3: edemaC4: pigmentation of eczemaC4b: lipodermatosclerosis or atrophie blancheC5: healed venous ulcerC6: active venous ulcereach clinical class is further divided as symptomatic(S) and asymptomatic(A), e.g. C2S
Etiologic classification: Ec: congenitalEp: primaryEs: secondaryEn: no venous cause identified
Anatomical classification:As: superficial veinsAp: perforator veinsAd : deep veinsAn: no venous locations identified
Pathophysiological classification:Pr: refluxPo: obstructionPr,o: reflux and obstructionPn: no venous pathophysiology identifiable
![Page 10: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/10.jpg)
![Page 11: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/11.jpg)
![Page 12: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/12.jpg)
Clinical feature:• Symptoms:• More commonly: aching and heaviness,
which typically increases throughout the day or with prolonged standing and is relieved by elevation or compression hosiery.
• Less commonly: ankle swelling and itching • Complications like bleeding, superficial
thrombophlebitis, eczema, lipodermatosclerosis and ulceration
![Page 13: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/13.jpg)
![Page 14: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/14.jpg)
SIGNS• Tortuous dilated superficial veins, mostly they are confined to long and
short saphenous systems in 20 to 60 % of cases• By distribution of varicosities we can determine which superficial system
is defective, medial thigh and calf varicosities suggest long saphenous incompetence posterolateral varicosities indicate short saphenous incompetence and anterolateral thigh and calf varicosities indicate isolated incompetenceof proximal anterolateral long saphenous tributory
• Other signs commonly found are,• Telengiectasia• Reticular veins are dilated • Atrophie blanche• Corona phlebectasia• Pigmentation• Eczema• Dependent pitting edema• Lipodermatosclerosis• Ulceration
![Page 15: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/15.jpg)
INVESTIGATION• Doctors often diagnose varicose veins based on a physical exam alone. Sometimes tests or
procedures are used to find out the extent of the problem or to rule out other conditions.• Specialists Involved• If a patient have varicose veins, he/she may see a vascular medicine specialist or vascular
surgeon. These doctors specialize in blood vessel conditions. He/she also may see a dermatologist. This type of doctor specializes in skin conditions.
• Physical Exam• To check for varicose veins in your legs, the doctor will just look at patients legs while
he/she is standing or sitting with their legs dangling. He or she may ask you about your signs and symptoms, including any pain you're having.
• Diagnostic Tests and Procedures• Duplex Ultrasound• Your doctor may recommend duplex ultrasound to check blood flow in your veins and to
look for blood clots. Duplex ultrasound combines traditional with Doppler ultrasound.• Angiogram• Although it is not very common, your doctor may recommend an angiogram to get a more
detailed look at the blood flow through your veins.• For this procedure, dye is injected into your veins. The dye outlines your veins on x-ray
images.• An angiogram can help your doctor confirm whether you have varicose veins or another
condition.
![Page 16: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/16.jpg)
Duplex Ultrasound- Normal valve
![Page 17: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/17.jpg)
Incompetent valve
![Page 18: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/18.jpg)
Duplex ultrasound: incompetent valves
![Page 19: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/19.jpg)
MANAGEMENT
• Compression hosiery• Ultrasound guided foam sclerotherapy• Endovenous laser ablation• Radiofrequency ablation
![Page 20: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/20.jpg)
SCLEROTHERAPY• Sclerosant used in u.k is sodium
tetradecyl sulphate
![Page 21: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/21.jpg)
Endovenous laser ablation
![Page 22: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/22.jpg)
MANAGEMENT
![Page 23: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/23.jpg)
SURGERY
• Saphenofemoral ligation and long saphenous stripping
• Saphenopopliteal junction ligation and lesser saphenous stripping
• Perforator ligation• Phlebectomies
![Page 24: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/24.jpg)
Ligation and stripping
• To treat varicose veins in the leg, the saphenous vein may be removed by ligation and stripping (A). First an incision is made in the upper thigh, and the saphenous vein is separated from its tributaries (B). Another incision is made above the foot (C). The lower portion of the vein is cut, and a stripper is inserted into the vein (D). The stripper is pulled through the vein and out the incision in the upper thigh (E)
![Page 25: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/25.jpg)
Saphenofemoral ligation
![Page 26: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/26.jpg)
Ligation and stripping
![Page 27: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/27.jpg)
Saphenopopliteal junction ligation
![Page 28: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/28.jpg)
Phlebectomies • Performed for
junctional competencies under local anaesthetic in patients with isolated tributary incompetencies
• During phlebectomies, small stab incisions using small mosquito forceps or phlebectomy hooks which is more superior in terms of bruising, pain and genetic quality of life than transilluminated powered phlebectomy
![Page 29: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/29.jpg)
Surgical complications
• Vein stripping is a surgical procedure, and there are always risks associated with surgeries. They include:
• allergic reaction to anesthesia• breathing problems• bleeding• bruising• infection at cut site• scarring• nerve injury• reoccurrence of varicose veins• temporary severe pain
![Page 30: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/30.jpg)
Surgical complications
• Serious complications are possible with any kind of procedure, although extremely rare with ambulatory phlebectomy.
• However, inconveniences such as blister formation, wound infection, visible scars, bruising or hematomas along the course of the removed varicose vein, and loss of sensation in small areas, may occur.
• Most of the time, these events run a limited course and resolve without any long-term problems.
![Page 31: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/31.jpg)
Reference • http://www.medscape.com/viewarticle/778728_2• http://www.mayoclinic.org/diseases-conditions/
varicose-veins/basics/complications/con-20043474• http://www.surgeryencyclopedia.com/St-Wr/Vein-
Ligation-and-Stripping.html• http://www.healthline.com/health/varicose-vein-
stripping#Purpose2• http://www.emedicinehealth.com/varicose_veins-
health/page3_em.htm• http://www.medicalnewstoday.com/articles/
182793.php• Bailey and love short practice of medecine• http://www.sigvaris.com/global/en/ceap-classification
![Page 32: Varicose veins](https://reader033.vdocuments.us/reader033/viewer/2022042819/55cdf0d3bb61eb04538b47eb/html5/thumbnails/32.jpg)