About physiology of venous return from lowerlimb , pathology behind varicosity and classification of varicose vein disease. ( Reference : Bailey and Love)
13. 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
15. 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
22. 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
26. 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
27. 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
28.
29. • C = CLINICAL CLASSIFICATION
• E = ETIOLOGICAL CLASSIFICATION
• A = ANATOMICAL CLASSIFICATION
• P =PATHO-PHYSIOLOGICAL
CEAP CLASSIFICATION
30. TELANGECTASIA :
<1 mm
Spider veins, thread veins,
hyphen webs
RETICULAR VEINS:
Dilated, subdermal veins
1-3mm in diameter
CLASS 1
31. 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
32. CLASS 3
DEPENDENT PITTING EDEMA:
Result of increase in
volume
of fluid
Elevation/compression
bandaging
arterioles into the capillaries, which have a
pressure of about 32 mmHg at their arterial ends. This pressure is
reduced along the course of the capillaries and is approximately
12 mmHg at the venular end of the capillary.