Varicose vein surgery presentation

2. VARICOSE VEINS
- Dr.Kishan Rao

5. Great saphenous vein:
• It is formed on the dorsum of foot by the
union of the medial end of the dorsal
venous arch of the foot and medial
marginal vein of the foot. The vein runs
upward about 2.5 cm in front of the medial
malleolus, crosses obliquelythe medial
surface of the lower third of tibia, and then
ascends a littlebehind the medial border of
tibia to reach the knee, where it lies on the
posteromedial aspect of the knee joint, about
one hand-breadth posteriorto the patella;it is
accompanied by saphenousnerve.
• From here it runs upward along the medial
side of the thigh to reach the saphenous
opening(fossa ovalis).
• It passes through the saphenousopening
after piercing the cribriform fascia and
drains into the femoral vein after piercing
the femoral sheath.

6. Small saphenous vein
• It is formed below and behind the lateral
malleolus by the union of the lateral end of
the dorsal venous arch, and the lateral
dorsal digital vein of the little toe. It runs
upward behind the lateral malleolus, along
the lateral edge of tendocalcaneus, and is
accompanied by the sural nerve on its
lateral side.
• Thereafter it runs in the middle of the back
of the leg, pierces the deep fascia, and
undergoes a subfascial course between the
two heads of the gastrocnemius until it
reaches the middle of the popliteal fossa.
Here it turns inward to terminate into the
popliteal vein.

9. • Permanently dilated (>3mm)
and tortuous leg veins with
reflux of blood caused by
incompetent valve closure,
which results in venous
congestion and vein
enlargement
• Usually affects the saphaenous
vein and its branches

10. Types of varicose vein
Primary varicose veins

11. Secondary varicose veins

12. of varicose vein
Hemorrhoids

13. Esophageal varices

14. Varicocele

15. Risk factor
• Genetics
• Age
• Gender
• Pregnancy
• Overweight and obesity
• Posture

16. Causes
• Congenital absent or defective venous
valves.
• Elevation of venous pressure
• Incompetent venous valves
• Chronic systemic disease
• Infections and trauma

17. Pathophysiology
Any risk factor/cause
↓
↑ed venous pressure
↓
Dilation of veins
↓
Valves stretched
↓
Incompetent valve
↓
Reverse blood flow
↓
Calf muscles fail to pump blood
↓
Venous distention

18. Clinical manifestations
• Enlarged veins that are visible on skin
• Mild swelling of ankles and feet
• Painful, achy, or “heavy” legs
• Throbbing or cramping in legs
• Itchy legs, especially in the lower leg and ankle
• Discoloration of skin surrounding the varicose veins

22. Telangiectasia and
reticular veins.
Advanced skin changes –
lipodermatosclerosis, eczema
and atrophie blanche.
Pigmentation (haemosiderosis) and mild
eczema. Severe eczema.
venous ulcer.

23. Clinical Signs
1.Brodie-trendelenberg’s test I
-Saphenofemoral incompetence
2.Brodie-trendelenberg’s test II
-Perforator incompetence
3.Perthe’s test / modified perthe’s – DVT
4.Tourniquet’s test - Perforator incompetence
5.Schwartz test - Valvular incompetence
6.Fegan test -Perforator site localisation
7.Pratt’s test - Blow outs = perforators

24. CEAP Classification for varicose veins

25. Diagnostic Evaluation
• Appearance

26. Diagnostic Evaluation
• Appearance
• Hand held Doppler examination

27. Diagnostic Evaluation
• Appearance
• Hand held Doppler examination
• Duplex Ultrasonography

28. Treatment
Conservative management
- Elevation of the legs
- Avoid prolonged sitting & standing
- Compression stockings
- Exercise
- Lose weight

29. Sclerotherapy
Sclerosant agent: sodium tetradecyl sulphate
dose: 0.25 - 1ml at one site and maximum can be 4 ml at 4
different sites in superficial vein.
Action: irritation to the intima of the vein wall, causes
hardening of vein so that they no longer fill with blood.
Blood that would normally return to the heart through
these veins returns to the heart by way of other veins. The
veins that received the injection will eventually shrivel
and disappear. The scar tissue is absorbed by the body.

31. Surgery
Vein stripping and ligation:
involves tying off all varicose veins associated
with the leg's main superficial vein and
removing it from the leg. The removal of
veins from the leg will not affect the blood
circulation in the leg as deeper veins will be
able to take care of the increased blood
circulation

33. Perforator incompetence
–Subfascial ligation of perforators
–Linton’s method
–Stab avulsion method

34. Laser treatment:
This procedure uses no incisions or injections. Light
energy from a laser is used to make the vein fade
away. Laser surgery is typically used to treat smaller
varicose veins.

35. Endovenous ablation therapy:
A tiny incision is made in the skin & small
catheter is inserted into the vein. A device at the
tip of the catheter heats up inside the vein, which
causes it to close off.

37. SEPS
• Subfascial endoscopic perforator surgery
• Minimally invasive method

38. Complications
• Superficial thrombophlebitis

39. • Lipodermatosclerosis

40. • Venous ulceration

41. • Venous eczema

42. THANK YOU