varicose veins are elongated,b dilated tortuous veins which may occur due to perforator incompetence or due to congenital reasons. various tests are performed before going for surgery. the presentation gives an idea of what is to be done pre-operatively.
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Treatment for Varicose Veins
1. Varicose veins
Dr Avijit Banerjee, 2nd year surgery resident,
Dr Ashwani Kumar Malhotra, Chief Surgeon,
South Eastern Railway Hospital, Kolkata
2. HISTORY
53 years old gentleman, constable by profession presented with chief
complaint of swelling along the veins of left lower limb for last 15 years
There is dull-aching pain in left calf for last 1 year
Pigmentation of skin over the medial aspect of left lower leg for last 1
year
3. The swelling is insidious in onset and is prominent on standing up and
walking and reduces on lying down.
The pain is dull aching in nature and aggravates on prolonged standing.
There is presence of skin pigmentation in left lower limb for last 1 year.
There is no associated night cramps
There is no history of ulceration or bleeding.
There is no history suggestive of DVT
4. General survey
Patient is alert, conscious and cooperative.
Patient is of average built and nutrition
Decubitus of choice
P0I0CCE
P- 78/min
BP- 110/70mm Hg
RR- 16/MINUTE
Temp- Normal
Neck veins are not engorged ,neck glands are not palpable.
5. Physical Examination
On inspection , the right lower limb is essentially normal
There is dilatation and tortuosity along the course of GSV of left lower
limb from dorsum of foot to upper thigh.
There is no visible deformity or local gigantism
There is pigmentation in the Gaiter’s area without any ulceration or
eczema.
Morrissey’s cough impulse is present
6. Palpation
Cough impulse present at the sapheno-femoral junction
Trendelenberg test suggests incompetence of the sapheno-femoral
junction as well as perforator.
Multiple tourniquet test reveals perforator incompetence at 10 and
15cms above the medial malleolus.
Fegan’s test reveals fascial defects at the level of incompetent
perforators.
Swartz test is positive revealing reflux of blood.
Modified Perthes test is negative revealing there is no associated DVT
7. All peripheral pulses are normally palpable
There was no bruit heard upon auscultation
Examination of other limb was normal
8. Summary
53 years old constable presented with swelling of veins along the inner
aspect of left leg and thigh for last 10 years. There is associated dull
aching pain in the calf along with pigmentation in the Gaiter’s area.
On examination there is varicosity involving GSV of left lower limb due to
SFJ and perforator incompetence at 10 and 15cms from medial malleolus.
9. This is a case of varicose vein affecting great saphenous system in left
lower limb with SFJ incompetence and perforator incompetence at 10 and
15 cms above the medial malleolus without any clinical evidence of DVT.
As per CEAP classification – CS4aEPASPPR