Ancient Greek Heroes Modern Interpretation.

1. VARICOSE VEIN ,VARICOSE
ULCER AND MANAGEMENT
SUBMITTED BY. – RUCHIKA (46)
GENERAL SURGERY

2. DEFINITION > VARICOSE VEINS ARE DEFINED AS DILATED,
ELONGATED, TORTUOUS AND PALPABLE SUPERFICIAL VEINS
AS A RESULT OF VENOUS HYPERTENSION.

3. VARICOSE VEIN
• More common in males in India
• Left lower limb more commonly involved
• Long saphenous system affected in 2/3 rd of cases
veins
• It is common – may be present in up to 30% of the
population – 40,000 operations/year in England &

4. VENOUS SYSTEM OF LOWER LIMBS
Consists of
•Deep system of veins which lies
below the deep fascia.
•Superficial system of veins which
lies outside the deep fascia (carry
10% blood)
•Perforating veins which pass
through the deep fascia joining
the superficial to the deep system
of veins.

5. FACTORS HELPING IN VENOUS
. RETURN
1. Negative pressure in thorax during inspiration to
-6 mm.
2. Calf muscle pump.
3. Vis a tergo.
4. Competent valves
5. Venae commitants.

6. TYPES
1. Primary ( idiopathic)
• More common in women
• Lower extremities
• Strong family history
2.SECONDARY
PREVIOUS DVT other identifiable obstruction Also occur in
esophagus
• Haemorrhoids
• arterivenous malformation

7. ETIOLOGY
1. Long hours of standingwhich increase the hydrostatic
pressure of gravity,
2. • Family history
3. • Pregnancy
4. • Ageing
5. • Deep vein thrombosis
6. • Oral contraceptives
7. • obesity

8. PATHOPHYSIOLOGY

9. VARICOSE ULCER

10. VARICOSE ULCERS VENOUS ULCERS, STASIS ULCERS, ULCUS CRURIS .
. A VENOUS LEG ULCER IS THE MOST COMMON TYPE OF LEG ULCER, ACCOUNTING FOR 80-
85% OF ALL CASES. VENOUS LEG ULCERS DEVELOP WHEN PERSISTENTLY HIGH BLOOD
PRESSURE IN THE VEINS OF THE LEGS (VENOUS HYPERTENSION) CAUSES DAMAGE TO THE
SKIN, WHICH EVENTUALLY BREAKS DOWN AND FORMS AN ULCER.

12. Symptoms
 a chronic non-healing wound with broken skin and exposed tissue.
 -usually found on the inside of the leg, just above the ankle .
 painful, particularly when
infected .
 pitting oedema .
 lipodermatosclerosis .
 atrophie blanche .

13. DIAGNOSIS
Gp : diagnosis based on symptoms and a physical examination.
Look for symptoms of a venous leg ulcer and feel your pulse at
ankles (check arteries) .
 Doppler study.
Colour duplex ultrasound Test.

14. TREATMENT
 70% of small ulcers will heal within 12 weeks. -Larger ulcers may
take longer to heal.
 Treatment involves cleaning and dressing the wound and using
compression bandages to control blood pressure inside the legs.
 4E’s: education, elevation, elastic compression and evaluation.
 Active movement -Leg elevation -Emollient use -Treating the
underlying condition -Treatment of any infection

15. COMPLICATIONS
1. Unless underlying risk factors such as immobility,
obesity and varicose veins are addressed, there is a high
risk of a venous leg ulcer reoccurring.
1. > Loss of mobility - infection (rarely infection could lead
to more serious conditions such as osteomyelitis or
sepsis)

16. Conservative management
Avoiding prolonged standing
 Crepe bandaging and elastic stockings
from toe to thigh, which causes
decreased edema, venous volume and
reflux and increases venous return.
 Limb elevation above the level of heart
while lying down

17. Sclerotherapy
 A chemical is injected into the
vein, irritating the venous
endothelium and producing
localized phlebitis and fibrosis,
thereby obliterating the lumen of
the vein • Under Ultrasound
guidance.
 hypertonic sodium chloride
solution • Sodium morrhuate •
Ethanolamine oleate •
Polidocanol.
 Spread of foam monitored under
USG guidance as it spreads. •
Apex of saphenous opening
compressed by probe to prevent
foam entering deep veins. • Leg
also elevated • After leg is

18. SURGICAL MANAGEMENT
 Surgical management High end ligation and stripping • Ligation of
entire vein and dissection and removal of its tributaries
 Laser fiber produce endoluminal heat that destroy the vascular endothelium

19. NURSING MANAGEMENT
Bed rest is maintained for 24 hours, after which the patient begins walking every 2
hours for 5 to 10 minutes.
• Elastic compression stockings are used to maintaincompression of the leg.They are
worn continuously for about 1 week after vein stripping .
•The foot of the bed should be elevated, Standing still and sitting are discouraged
• Usually, the patient may shower after the first 24 hours.
The patient is instructed to dry the incisions well with a clean towel using a patting
technique rather than rubbing.

20. Thankyou 