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Varicose veins:A never ending problem if mistreated!
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Varicose veins:A never ending problem if mistreated!

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Varicose veins is one of the most distressing disorders affecting the lower limbs. It is commonly seen in individuals who stand for prolonged hours thus causing immense pain and discomfort. These days ...

Varicose veins is one of the most distressing disorders affecting the lower limbs. It is commonly seen in individuals who stand for prolonged hours thus causing immense pain and discomfort. These days it is also found in individuals who sit for prolonged periods as seen in computer professionals. Proper treatment based on good understanding of the pathophysiology underlying the disease is pivitol for a successful outcome. the presentation outlines the approach to the problem for practitioners

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Varicose veins:A never ending problem if mistreated! Varicose veins:A never ending problem if mistreated! Presentation Transcript

  • Varicose Veins By Dr. Ketan Vagholkar MS, DNB, MRCS, FACS. Professor of Surgery & Consultant General Surgeon.
  • Surgical anatomy of veins of the lower limb
    • Structure of the vein wall
      • Adventitia
      • Media
      • Intima
    • Superficial veins
      • Long saphenous vein
      • Short saphenous vein
      • Tributaries
  • Surgical anatomy of veins of the lower limb
  • Surgical anatomy of veins of the lower limb
    • Deep veins
    • Muscular sinuses
    • Calf pump
  • Surgical anatomy of veins of the lower limb
    • Valves
      • Location in deep veins
      • Location in the superficial veins
  • Surgical anatomy of veins of the lower limb
    • Perforators
    • Types
      • Direct(few, large in size,constant in position)
      • Indirect(small,irregularly distrubuted throughout the muscular part of the limb)
    • Sites
    • LSV
    • SSV
  • Definition
    • Veins which are dilated, elongated and tortuous are called varicose.
  • Classification
    • Primary
      • Congenital paucity of valves
      • Stretching of valve rings
      • Weakness or wasting of muscles
      • Stretching of deep fascia
    • Secondary
      • Deep vein thrombosis
      • Pelvic tumours
      • Pregnancy
      • Fistula varicosity(Klippel Trenauney syndrome)
  • Clinical features
    • History
      • Complaints of tortuous swellings in the lower extremity
      • Complications
      • Associated pathology
      • Etiology
      • Treatment taken
    • Clinical examination
      • Inspection
      • Which venous system is affected(lsv/ssv)
      • Extent of disease
      • Skin complications
      • Ankle flare
  • Clinical cases
  • Clinical cases
  • Clinical tests (technique,interpretation,inference)
    • Brodie Trendelenberg test
    • Oschner Mahoner multiple tourniquet test
    • Cough impulse test
    • Schwartz tapping test
    • Pratt’s test for perforator incompetance
    • Fegan’s method for marking perforators
    • Tests for status of deep veins
      • Perthe’s test
      • For acute DVT
        • Homan’s Test
        • Moses test
  • Other clinical examinations
    • Differentiate between primary and secondary varicose veins
    • P/A examination
    • Dilated veins over the abdomen(Harvey’s test)
    • Lymph node examination
    • Scrotal swelling(varicocele)
    • PR/Proctoscopic examination
  • Diagnosis
    • Primary/secondary
    • Complicated/uncomplicated
    • Side R/L
    • LSV/SSV
    • Status of perforators
    • Etiology(if secondary)
  • Investigations
    • Doppler ultrasound
      • Principles
      • Applications in venous disorders
      • Advances (colour doppler)
  • Investigations
    • Laboratory
      • CBC
      • BS f/pp
      • Urine R/M
      • Blood grouping and cross matching
    • Radiology
      • X ray chest
      • USG abdomen to search for intraabdominal cause for secondary varicosities
      • Venography (no longer done)
  • Treatment (Principle)
    • Surgical treatment is contemplated only after ruling out deep vein thrombosis that is having ensured that the deep veins are absolutely normal
  • Surgical options
    • For LSV disease
      • Trendelenberg’s operation
      • Stripping of LSV trunk
      • Subfascial ligation of incompetant perforators
      • Endovascular techniques
      • Laser ablation
    • For SSV disease
      • Flush ligation of SP junction
      • Subfascial ligation of incompetant external ankle perforator
  • Trendelenberg’s operation
    • Principle
    • Technique
    • Complications
  • Stripping of long saphenous vein trunk
    • Principle
    • Extent of stripping
    • Technique and instrumentation
  • Subfascial ligation of incompetant perforators(Dodd & Cockett)
    • Why subfascial ligation?
    • Technique
    • Intraop test for perforator incompetance
    • (Backbleed test)
    • Complications
  • Surgical options for short saphenous vein disease
    • Flush ligation of SP junction
    • Subfascial ligation of incompetant external ankle perforator
  • Surgical aftercare
    • Elastocrepe bandage support
    • Early ambulation
    • Avoid prolonged standing or sitting
    • Advocate the use of venous stockings
  • Treatment of secondary varicose veins
    • Identify and treat the underlying cause
    • There is no role of surgery whatsoever
    • Conservative treatment of varicosities
      • Elastocrepe bandage
      • Care of the leg
      • Avoid prolonged standing