varicose veins
TRANSCRIPT
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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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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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
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
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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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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Complications of varicose vein
surgery Saphenous neuralgia, sural nerve
injury
Infection
Hematoma formation
DVT
Recurrence
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