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1. Varicose Veins
Dr. Nikhil Talwar

2. Venous Anatomy of lower limbs
• Superficial venous system
• Deep venous system
• Perforator veins

3. Venous Valves
• Abundant in lower extremity, number
decreases proximally
• Prevent retrograde flow
• Delicate Structures
• Aid in the venous pump to make blood
flow from superficial to deep veins

4. Perforator veins
• Connect superficial to dep veins
• Travel through openings in deep
fascia
• Direction of flow: superficial to deep
veins
• Valves: ensure unidirectional flow
• Incompetent perforators: reversal of
flow into superficial veins leading to
varicose veins

5. Perforator veins
• Ankle Perforators
• Lower leg: Cocket perforators
• Boyd’s
• Dodd
• Hunterian

6. Risk Factors

9. CEAP Classification

10. Clinical Features
• Heaviness in legs
• Dragging pain
• Postural discomfort
• Night cramps
• Edema, Itching
• Discoloration
• Ulceration

12. Causes of pain in varicose veins
• Chronic venous hypertension
• Anoxia
• Hyperviscosity of RBCs
• Platelet Aggregation
• Capillary dysfunction
• Altered cutaneous microcirculation

13. Complications
• Hemorrhage
• Pigmentation/ eczema
• Venous Ulcer
• Lipodermatosclerosis
• DVT
• Talipes equinovarus
• Recurrent thrombophlebitis

15. Other examniation
• Abdomen
• Ulcer
• Lymph Nodes

16. Investigations
• Localise the anatomical location
• Long or short system
• DVT
• SFJ, SPJ competent?
• Perforators

17. Venous Doppler
• DUPLEX SCAN
• B mode USG + Doppler
• Normal: uniphasic signal
• Reversal of flow: Biphasic signal
• DVT
• Anatomical information

18. Treatment
• Conservative Treatments
• Injection Sclerotherapy
• Surgical Treatment
• Endovascular Management