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