Varicose Veins
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Teaching presentation on diagnosis and management of varicose veins.
![Sarantos Kaptanis [email_address] Airedale General Hospital Department of Surgery Teaching Session 27 August 2009](https://image.slidesharecdn.com/skaptanisvaricoseveins-12554111412036-phpapp03/85/Varicose-Veins-1-320.jpg)
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Varicose Veins
- 1. Sarantos Kaptanis [email_address] Airedale General Hospital Department of Surgery Teaching Session 27 August 2009
- 22. Images: Mr Neeraj Bhasin
Editor's Notes
- Chronic Venous Insufficiency (CVI) is the general term for a group of disorders including varicose veins (VVs), skin changes (corona phlebectatica, lipodermatosclerosis, varicose eczema, atrophie blanche), and chronic venous ulceration (CVU).
- It has been noted that men are less troubled by the cosmetic appearance, so they present less often with the problem. However population-based studies also indicate that varicose veins are more common in women, about 2:1. Chronic venous disorders are an important cause of discomfort and disability that is widespread in the industrialized countries and that result in a substantial medical and economic problem. The health care demand is massive, ranking in France as the seventh most often declared reason for consulting a general practitioner. Edinburgh vein study reported a higher prevalence of mild disease in men.
- Yes, you must know this!!! Part of the examination involves identifying which vein is involved and level of incompetence . Three paired stem veins (no valves): Posterior tibial, Anterior tibial, Peroneal. Two muscular veins (with valves): Soleal, Gastrocnemius. Join with short saphenous vein in popliteal fossa to form popliteal vein, which becomes femoral vein and joins with long saphenous vein in saphenofemoral junction, then becomes iliac vein. Note mid-thigh perforator + 3-4 middle-calf perforators.
- Corona phlebectatica (ankle/malleolar flare): One of the earliest skin manifestations of CVI comprises dilated intra/subdermal veins at or just below the medial malleolus. Overlying skin is thin and fragile leading to a blue-bleb appearance. Trauma frequently leads to hemorrhage and ulceration. Lipodermatosclerosis: The skin is brown (red or purple) and indurated due to hemosiderin and plasma protein deposition, leading to dermal fibrosis. Atrophie blanche: Thin and pale skin due to the thrombotic obliteration of papillary capillaries; often at the site of previous ulceration. Varicose eczema: Scaly dry (or weeping) skin that is often intensely pruritic and can demonstrate blanching erythema (mimicking cellulitis). Edema: A common presentation in patients with CEAP class 3 or greater CVI. Chronic venous insufficiency may coexist with other diseases that cause edema, such as congestive heart failure, and must be considered when evaluating CVI patients . Hemorrhage: Can be alarming, even life threatening,may be spontaneous or follow trauma. Direct pressure and elevation always arrest venous hemorrhage. As recurrent bleeding is almost inevitable, the patient should be hospitalized for definitive treatment. Ulceration: Most CVUs can be easily differentiated from other forms of ulceration.
- Localized discomfort in the leg: Usually at the site of the visible VV, particularly after prolonged standing. Prominent varices may be tender, particularly in menstruating w omen. Pain: Severe pain is unusual and suggests infection or arterial insufficiency. Swelling: A feeling of swelling is common. Venous claudication: This is unusual and due to extensive postthrombotic iliofemoral venous occlusion. There is bursting pain in the calf on walking, which is relieved only by elevating the leg. In addition, patients often complain of heaviness in the calf with ambulation. Itching: This is common and may lead to scratching, infection, and ulceration. heaviness, tension, aching, itching commonly after standing
- Fortunately, major complications following VV surgery are relatively rare. However, up to 20% of patients may suffer some form of minor morbidity, such as hematoma, lymphatic leak, pain, saphenous neuritis, and venous thrombosis. In the U.K., VV surgery is the commonest cause of litigation against general and vascular surgeons. This not a field for the unsupervised, inexperienced surgeon and it behooves surgeons who undertake VV surgery to carefully audit their management, techniques, and outcomes. Surgery is for recurrence in 20% of patients.