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PATHOPHYSIOLOGY OF VARICOSE VEINS

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About physiology of venous return from lowerlimb , pathology behind varicosity and classification of varicose vein disease. ( Reference : Bailey and Love)

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PATHOPHYSIOLOGY OF VARICOSE VEINS

  1. 1. PROF.S.P.GAYATHRE.M.S ASSISTANT PROFESSORS: Dr.G.KARTHIKEYAN,M.S Dr.R.SYED RAJ,M.S S4 UNIT
  2. 2. PATHOPHYSIOLOGY OF VENOUS DISEASES
  3. 3. 1.What are the two major veins of hand? 2.Have you ever seen varicose veins of hands? Ulnar and radial vein 3.Do you know why?
  4. 4. To overcome the effect of GRAVITY LOWER LIMB has some special mechanism
  5. 5. PRESSURE GRADIENT
  6. 6. HIGH PRESSURE LOW PRESSURE
  7. 7. PERIPHERAL PUMP Calf , Thigh & Foot pump UNIDIRECTIONAL NONREFLUXING VALVES NEGATIVE INTRATHORACIC PRESSURE VIS-A-TERGO VENA COMITANTES SYMPATHETIC ACTIVITY FACTORS RESPONSIBLE FOR NORMAL VENOUS RETURN
  8. 8. MOTOR PIPE TANK SOLEUS MUSCLE VEINS HEART 1.MUSCLE PUMP
  9. 9. STRUCTURE
  10. 10. DURING MUSCLE RELAXATION, PRESSURE WITHIN CALF COMPARTMENT FALLS BLOOD FROM SUPERFICIAL VEINS ENTER DEEP VEINS SUPERFICIAL VENOUS pressure cont. To fall TILL THRESHOLD IS REACHED THRESHOLD IS APPROX. 30mmHg VENOUS INFLOW NOW KEEPS PACE WITH EJECTION FROM DEEP VEINS Patency of veins Competent valves RELAXATION PHASE
  11. 11. RELAXATION CONTRACTION
  12. 12. DURING MUSCLE CONTRACTION, PRESSURE WITHIN CALF COMPARTMENT RISES TO 200-300mmHg BLOOD FROM DEEP VEINS ENTER IVC VALVES OF PERFORATOR VEINS CLOSED TO PREVENT REFLUX CONTRACTION PHASE
  13. 13. AMBULATORY VENOUS HYPERTENSION REFLUX OBSTRUCTIVE
  14. 14. 2. NON REFLUXING VALVES
  15. 15. 3.NEGATIVE INTRATHORACICPRESSURE
  16. 16. 4.VIS-A-TERGO 12mmHg 32 mmHg
  17. 17. 5.VENAE COMITANTES
  18. 18. PATHOGENESIS ChangesinVeinWall Smooth Muscle Proliferation Increased MMP Collagen deposition Decreased elastin content
  19. 19. Changes in vein wall over stretching of veins increase in size of veins but valve leaflets don’t expand Secondary valvular Incompetence Backflow( reflux) Pooling and further dilation of veins Varicosity – Dilated Tortuous Veins
  20. 20. COMPETENT VALVE INCOMPETENT VALVE
  21. 21. PRIMARY:  Congenital weakness in vessel wall  Congenital absence of valves  Congenital Valvular incompetence  Familial (FOX C2 gene)  Lysosomal enzyme activity(Haardt)  Chronic inflammatory process(Class II MHC & Macrophages) ETIOLOGY
  22. 22. SECONDARY : OBSTRUCTION TO FLOW: DESTRUCTION OF VALVES: 1.Pregnancy 2.Pelvic tumor: Ovarian ca Fibroid uterus 3.Ascites 4.Retroperitoneal fibrosis 5.Iliac vein thrombosis 1.Deep vein thrombosis HIGH PRESSURE FLOW: 1.AV fistula KLIPPEL TRENAUNAY SYNDROME
  23. 23.  Gender  Age  Ethnicity  Body mass index&height  Family history  Pregnancy  occupation and lifestyle factor;  smokers,  constipation  occupations which involve prolonged standing.  Traffic police  Bus conductors  Sports man  Nurses  Surgeons  hair stylists  Factory workers OTHER RISK FACTORS
  24. 24. • C = CLINICAL CLASSIFICATION • E = ETIOLOGICAL CLASSIFICATION • A = ANATOMICAL CLASSIFICATION • P =PATHO-PHYSIOLOGICAL CEAP CLASSIFICATION
  25. 25. TELANGECTASIA : <1 mm Spider veins, thread veins, hyphen webs RETICULAR VEINS: Dilated, subdermal veins 1-3mm in diameter CLASS 1
  26. 26. VARICOSE VEINS: Varicose veins are defined as dilated, usually tortuous, subcutaneous veins 3 mm in diameter measured in the upright position with demonstrable reflux. CLASS 2
  27. 27. CLASS 3 DEPENDENT PITTING EDEMA: Result of increase in volume of fluid Elevation/compression bandaging
  28. 28. CLASS 4A PIGMENTATION: Brownish Discolouration Hemosiderin deposition ECZEMA : Erythematous dermatitis Progress to blistering, weeping or scaling eruption of the skin
  29. 29. CLASS 4B LIPODERMATOSCLEROSIS: Localised chronic inflammation and fibrosis of skin and subcutaneous tissue Severe stage of chronic venous disease ATROPHIE BLANCHE: Localized white atrophic skin - dilated capillaries and hyperpigmentation site
  30. 30. CLASS 5 HEALED ULCER:
  31. 31. CLASS 6 ACTIVE ULCER: epidermal defect gaiter area
  32. 32. IDENTIFIED
  33. 33. IDENTIFIED
  34. 34. SAPHENA VARIX: Large groin varicosity Painless lump standing recumbent Cough impulse
  35. 35. CORONA PHLEBECTASIA: Fan shaped patterns of small intradermal veins Site Malleolar or Ankle Flares

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