varicose veins

1. VIDULA SHEVADE
GROUP 603

2.  Definition:
Varicose veins are veins that have
become distended over time. Long,
tortuous and dilated veins of the
superficial varicose system due to
the pooling of blood in the lower
extremities.

3. Legs are made of network of veins
that carry blood to heart.
The venous system is comprised of –
1 Superficial veins
long saphenous vein
short saphenous vein

4. 2 Deep veins
femoral vein
Popliteal vein
Peroneal vein
Anterior tibial vein
Posterior tibial vein
3 perforating veins
90% of blood is returned by deep veins
and not by superficial veins.

5. Direct perforating veins :
These directly connect superficial
veins with deep veins

6. In thigh : Adductor canal perforator
connects long saphenous with
femoral vein in lower part of
adductor canal. (hunterian’s
perforator)
In the lower thigh on medial aspect
Long SV connect femoral vein via
DODD’s Perforator
Below knee :
Perforator connects long SV or
post-Arch vein with posterior tibial
vein knows as BOYD’S Perforator.

7.  In leg :
1.Lateral perforator is presented at the
junction of
mid & lower third of leg .It connect SSV with
peroneal vein.
2. Medially there are three perforator which
connect posterior arch vein with posterior
tibial vein , know as COCKETT’S Perforator

8. Upper medial perforator lies at the
junction of middle and lower third
of leg.
Middle medial perforator lies 4Inch
above the medial malleolus .
Lower medial perforator lies
posterio-inferior to the medial
malleolus .

10. Indirect perforating veins:
 These consist of small superficial
veins which penetrate the deep
fascia to connect with vessel in
muscle and in turn end in Deep
vein.

11. Blood is drained from superficial to
deep veins of legs through
perforating veins .
And through deep veins it is carried
to heart.
Back flow of blood is impossible.
But due to defect in valve of blood
flows in opposite direction .

13. The venous valves are abundant in the
distal lower extremity and number of
valves decreases proximally, with no
valves in superior and inferior vena
cava
Delicate structures
Prevent reverse flow in the veins
Ensure that the blood is pumped from
the superficial to the deep system and
back towards the heart when the patient
is walking

14. PRIMARY VARICOSE VEINS
Defect in saphanofemoral valve
Defect in saphanopoplitial valve
Defect in valve of perforators

15. Anything that increases intra-abdominal
pressure
Or raises pressure in superfical or deep
veins
Pregnancy
Obesity
Abdominal or pelvic mass
Old age
Long standing
Thrombosis of leg veins

16. Arteriovenous fistulas

17. Heaviness in the legs
Night time cramps
Dragging pain, postural discomfort
Oedema, itching
Discolouration
Ulceration

19. Anoxia
Hyperviscosity or red cells
Chronic venous hypertension
Platelet aggregation
Capillary functional disorder
Altered cuteneous microcirculation

20. Hemorrhage
Pigmentation/ eczema
Periostitis
Venous ulcer
Lipodermatosclerosis
DVT
Tromboplebitis

23.  C0 no visible or palpable signs of venous
disease
 C1 telangectacia or reticular veins
 C2 varicose veins (without symptoms)
 C3 edema
 C4a skin changes due to venous disorders:
pigmentation, eczema
 C4b skin changes due to venous
disorders: lipodermatosclerosis
 C5 as C4 but with healed ulcers
 C6 skin changes with active ulcers (venous
insufficiency ulceration)

24. Venography
Venous doppler
Trendelenburg test
Tourniquet test
Cough impulse test
Perthe test

26. 3 tourniquets are tied.
1st at thigh
2nd at below knee
3rd above knee
Now patient is asked to stand and
appearance of varicosity is looked
for,within 30 sec in each segment
If the veins above the tourniquet fill up
,it indicates incompetence of
communicating veins above tourniquet.

27. If veins below tourniquet fill up
rapidly ,it indicates communicating
veins below tourniquet are
incompetent.

28. Patient is asked to elevate the limb .
Then patient is asked to cough
forcibly.
The impulse is felt on long
saphenous vein.
This indicates the incompetent of
sapheno-femoral valve.

29. A tourniquet is tied around the
upper thigh.
Then patient is asked to walk.
If veins get dilated ,it indicates the
presence of incompetence.

30. Elastic crepe bandage – stockings
Elevation of limbs
Graded compression
Excercise
Avoidance of prolonged standing

31. Compression methods
 Reduce ambulatory venous
pressure
Improve cutaneous micro
circulation

32.  Injection of sclerosant (ethanolamine
oleate) into an varicose vein causes
sclerosis.
 Leading to complete obliteration of vein.

33. INDICATION
LSV /SSV incompetency .
Perforating vein incompetency.
CONTRAINDICATION
DVT
Pregnancy
Thrombophlebitis
Peripheral vascular disease

34. After anesthesia proper position is
given.
The whole table is tilted head down
to an angle of about 10 degree.
(trendelenberg position)

35. Incisions :
1. Hockey stick incision
2. Oblique incision
Incision is kept at groin
at Saphenous opening 3-4 cm below
and lateral to pubic tubercle.

37. Then stripper is passed down the
saphenous vein and directed
downward by finger .
Vein is tied with stripper and then
stripper is slowly and steadily pulled
out through lower wound

39. Vein valve tranplantation