Presentation about varicoose veins, symptoms, etiology treatment, surgical complications and more

1. By,
Dr.Srinivasan Raman,
Tbilisi state medical university,
Georgia.
VARICOSE VEINS

2. VEINS ANTERIOR VIEW

3. VENOUS SYSTEM OF THE LOWER EXTREMITY

4. Superficial veins of lower extremity

6. 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.

7. CAPILLARY DYNAMICS

8. 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

9. CLASSIFICATION:
• CEAP classification(clinical-etiology-anatomy-pathophysiology)
Clinical classification:
Co: no signs of venous disease
C1: telengiectasia or reticular veins
C2: varicose veins
C3: edema
C4: pigmentation of eczema
C4b: lipodermatosclerosis or atrophie
blanche
C5: healed venous ulcer
C6: active venous ulcer
each clinical class is further divided as
symptomatic(S) and asymptomatic(A), e.g.
C2S
Etiologic classification:
Ec: congenital
Ep: primary
Es: secondary
En: no venous cause identified
Anatomical classification:
As: superficial veins
Ap: perforator veins
Ad : deep veins
An: no venous locations identified
Pathophysiological
classification:
Pr: reflux
Po: obstruction
Pr,o: reflux and obstruction
Pn: no venous pathophysiology identifiable

12. 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

14. 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

15. 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.

16. Duplex Ultrasound- Normal valve

17. Incompetent valve

18. Duplex ultrasound: incompetent valves

19. MANAGEMENT
• Compression hosiery
• Ultrasound guided foam sclerotherapy
• Endovenous laser ablation
• Radiofrequency ablation

20. SCLEROTHERAPY
• Sclerosant used in u.k is sodium
tetradecyl sulphate

21. Endovenous laser ablation

22. MANAGEMENT

23. SURGERY
• Saphenofemoral ligation and long
saphenous stripping
• Saphenopopliteal junction ligation and
lesser saphenous stripping
• Perforator ligation
• Phlebectomies

24. 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)

25. Saphenofemoral
ligation

26. Ligation and stripping

27. Saphenopopliteal junction ligation

28. 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

29. 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

30. 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.

31. 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