This document describes a 32-year-old male farmer who presented with prominent veins in his right leg for 2 years along with swelling and pain in the right leg for 1 year. On examination, dilated veins were visible on the medial side of the right leg, ankle, and foot extending to the thigh. Tests showed saphenofemoral and perforator incompetence on the right side. The diagnosis was clinical grade 4 varicose veins. Color doppler ultrasound was recommended to further evaluate the perforators and veins, and pre-anaesthetic tests were ordered prior to a planned surgery involving high saphenofemoral junction ligation and stripping of the long saphenous vein along with ligation of perforators and

1. By: Anumeha Vashist

2. Introduction of the patient
Raju
32 yrs male Farmer by occupation
Resident of Village- Shikapura Distt. Karnal
Chief Complaints
Patient came with the chief complaints of
 Prominent veins in the right leg for past 2 yrs
 Swelling and pain right leg for 1 year

3. History of present illness
Patient was asymptomatic 2 yrs back when he noticed
prominent veins in the right leg on the medial side.
Gradually the prominence of veins went on increasing.
The veins become more prominent on prolonged
standing
He started having swelling in the Right leg and ankle
region I yr back. The pain and swelling was more in the
evening hours and on prolonged standing.
H/o itching and pigmentation in right leg and ankle
region for the last 1 year. There is No H/o any
ulceration and No H/o night cramps.
No H/o fever
No H/o urinary or bowel trouble

4. Past History:
No History suggestive of Deep Vein Thrombosis(DVT)
in past
No H/o TB, Diabetes mellitus, asthma, epilepsy, drug
allergy, Hypertension.
Personal History:
Vegetarian
Smoker and non-alcoholic
Family History:
No family history of varicose veins

5. Patient is conscious, cooperative, well oriented to time
place and person,moderately built and nourished.
No Pallor, icterus, cyanosis, clubbing, Lymphadenopathy.
No Pedal edema, JVP not raised.
Vital Signs:
Pulse Rate- 82/min, regular good volume
Blood Pressure- 130/80 mm Hg, right arm lying down
position
Respiratory Rate- 16/min
Temperature- Normal

6. Inspection:
Dilated veins on the medial side of right leg ,ankle and
foot extending upto thigh region ( Long Saphenous
region)
Ankle flare present
pigmentation present in the leg and ankle area and no
skin ulceration seen.
No prominent veins in left leg
Palpation:
Dilated vein palpable on medial side of leg and ankle
extending to mid thigh region.

7. Tredelenberg test : +ve
Perthes test : -ve
Fegan’s test : +ve,
2 perforaters on medial side
of right leg.
Peripheral pulsations in right
leg normal.
Auscultation- No brue heard
over the prominent veins.
Opposite leg no prominent
veins.

8. Inspection: abdomen is normal in shape, umbilicus is
inverted and central in position.
Normal abdominal movements seen with respiration.
Skin over the abdomen is normal. No mass visible
Hernial sites normal.
Palpation: abdomen is soft, non tender
No mass is palpable. Hernial sites normal

9. The diagnosis is Varicose Veins Clinical Grade 4
With saphanofemoral incompetence with perforator
incompetence right side.
We will do colour dopler to find perforators which are
incompetent and to check incompetency of
Saphenofemoral and saphenopopliteal junction.
Deep veins will be looked for any obstruction/DVT
Investigations will be done for pre-anaesthetic check up
and fitness of patient for surgery

11. Surgery :
 High Saphenofemoral junction ligation with ligation of
all the tributaries with stripping of thigh portion of long
saphenous vein and subfascial ligation of all the
perforators with multiple superficial phlebectomies
( ligation of superficial prominent veins)
Alternatives:
 Endovenous laser treatment of varicose veins
 Radiofrequency ablation of varicose veins
 Foam Sclerotherapy (Ultrasound guided)