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THE WHITE ARMY-VARICOSE VEINS.pdf
- 2. VARICOSE VEINS - Dr.Kishan Rao
- 5. Great saphenous vein: • It is formed on the dorsum of foot by the union of the medial end of the dorsal venous arch of the foot and medial marginal vein of the foot. The vein runs upward about 2.5 cm in front of the medial malleolus, crosses obliquelythe medial surface of the lower third of tibia, and then ascends a littlebehind the medial border of tibia to reach the knee, where it lies on the posteromedial aspect of the knee joint, about one hand-breadth posteriorto the patella;it is accompanied by saphenousnerve. • From here it runs upward along the medial side of the thigh to reach the saphenous opening(fossa ovalis). • It passes through the saphenousopening after piercing the cribriform fascia and drains into the femoral vein after piercing the femoral sheath.
- 6. Small saphenous vein • It is formed below and behind the lateral malleolus by the union of the lateral end of the dorsal venous arch, and the lateral dorsal digital vein of the little toe. It runs upward behind the lateral malleolus, along the lateral edge of tendocalcaneus, and is accompanied by the sural nerve on its lateral side. • Thereafter it runs in the middle of the back of the leg, pierces the deep fascia, and undergoes a subfascial course between the two heads of the gastrocnemius until it reaches the middle of the popliteal fossa. Here it turns inward to terminate into the popliteal vein.
- 9. • Permanently dilated (>3mm) and tortuous leg veins with reflux of blood caused by incompetent valve closure, which results in venous congestion and vein enlargement • Usually affects the saphaenous vein and its branches
- 10. Types of varicose vein Primary varicose veins
- 14. Varicocele
- 15. Risk factor • Genetics • Age • Gender • Pregnancy • Overweight and obesity • Posture
- 16. Causes • Congenital absent or defective venous valves. • Elevation of venous pressure • Incompetent venous valves • Chronic systemic disease • Infections and trauma
- 17. Pathophysiology Any risk factor/cause ↓ ↑ed venous pressure ↓ Dilation of veins ↓ Valves stretched ↓ Incompetent valve ↓ Reverse blood flow ↓ Calf muscles fail to pump blood ↓ Venous distention
- 18. Clinical manifestations • Enlarged veins that are visible on skin • Mild swelling of ankles and feet • Painful, achy, or “heavy” legs • Throbbing or cramping in legs • Itchy legs, especially in the lower leg and ankle • Discoloration of skin surrounding the varicose veins
- 22. Telangiectasia and reticular veins. Advanced skin changes – lipodermatosclerosis, eczema and atrophie blanche. Pigmentation (haemosiderosis) and mild eczema. Severe eczema. venous ulcer.
- 23. Clinical Signs 1.Brodie-trendelenberg’s test I -Saphenofemoral incompetence 2.Brodie-trendelenberg’s test II -Perforator incompetence 3.Perthe’s test / modified perthe’s – DVT 4.Tourniquet’s test - Perforator incompetence 5.Schwartz test - Valvular incompetence 6.Fegan test -Perforator site localisation 7.Pratt’s test - Blow outs = perforators
- 24. CEAP Classification for varicose veins
- 26. Diagnostic Evaluation • Appearance • Hand held Doppler examination
- 27. Diagnostic Evaluation • Appearance • Hand held Doppler examination • Duplex Ultrasonography
- 28. Treatment Conservative management - Elevation of the legs - Avoid prolonged sitting & standing - Compression stockings - Exercise - Lose weight
- 29. Sclerotherapy Sclerosant agent: sodium tetradecyl sulphate dose: 0.25 - 1ml at one site and maximum can be 4 ml at 4 different sites in superficial vein. Action: irritation to the intima of the vein wall, causes hardening of vein so that they no longer fill with blood. Blood that would normally return to the heart through these veins returns to the heart by way of other veins. The veins that received the injection will eventually shrivel and disappear. The scar tissue is absorbed by the body.
- 31. Surgery Vein stripping and ligation: involves tying off all varicose veins associated with the leg's main superficial vein and removing it from the leg. The removal of veins from the leg will not affect the blood circulation in the leg as deeper veins will be able to take care of the increased blood circulation
- 33. Perforator incompetence –Subfascial ligation of perforators –Linton’s method –Stab avulsion method
- 34. Laser treatment: This procedure uses no incisions or injections. Light energy from a laser is used to make the vein fade away. Laser surgery is typically used to treat smaller varicose veins.
- 35. Endovenous ablation therapy: A tiny incision is made in the skin & small catheter is inserted into the vein. A device at the tip of the catheter heats up inside the vein, which causes it to close off.
- 37. SEPS • Subfascial endoscopic perforator surgery • Minimally invasive method
- 41. • Venous eczema
- 42. THANK YOU