Veins of human body

1. Varicose veins
Raymond G Buick FRCS
Approx 12 minutes

2. Varicose veins
• Varicose veins are swollen and enlarged veins
• usually blue or dark purple
• Lumpy
• Bulging
• torturous
• twisted
Varicose-veins.jpg
Original uploader was Jackerhack at en.wikipedia
CC-BY-SA-2.5.

3. Varicose veins
• Legs
• Testicular veins
• Portal vein
• Ano-rectal
• Oesophageal
• umbilicus

4. Varicose veins
• common
– may be present in up to 30% of the UK adult
population
– 40,000 operations/year in England & Wales
– F>M

5. Varicose veins
• Long (great) saphenous vein in 50%
• Short (small) saphenous vein in 30%
• both saphenous veins in 20%.

6. Aetiology / Pathogenesis
• Aetiology unknown.
• Limb veins – valves

7. Aetiology / Pathogenesis
• Limb veins – valves
– Muscle pump

8. Venous drainage of the lower limb
• Limb veins – valves
• Superficial veins
– Great (long) saphenous vein
– Small (Short) saphenous vein
• Deep Veins
• Perforating veins

9. Aetiology / Pathogenesis
• Limb veins – valves
– Muscle pump
• Incompetent valves

10. Aetiology / Pathogenesis
• Limb veins – valves
– Muscle pump
• Incompetent valves

11. Aetiology / Pathogenesis
• Limb veins – valves
– Muscle pump
• Incompetent valves

12. Diagnosis
• The best diagnostic tool is the duplex ultrasound.
– Sensitivity 90 to 95%
– specificity 95 to 100%.

13. Risk Factors
• a positive family,
• increasing age,
• pregnancy.

14. Risk Factors
• a positive family,
• increasing age,
• pregnancy.
• Other controversial risk factors
• obesity,
• menopause
• standing for long periods of time,
• decreased mobility
• Injury / post phlebitis
• Abdominal straining
• Venous / arteriovenous malformations

15. Risk Factors
• a positive family,
• increasing age,
• pregnancy.
• Other controversial risk factors
• obesity,
• menopause
• standing for long periods of time,
• decreased mobility
• Injury / post phlebitis
• Abdominal straining
• Venous / arteriovenous malformations

16. Symptoms
• aching; heavy legs
• itching;
• leg cramps; (making a sudden move or standing up)
• restless legs (relieved by walking, symptoms worse during the evening and
night)
• Skin discolouration (brownish blue shinny skin)
• eczema-like skin changes
• swelling; ankles
• small reticular veins and varicosities

17. complications
• Injury
• Bleeding
• superficial thrombophlebitis (Blood clotting within affected
veins. - can extend into deep veins)
• Acute fat necrosis (ankle of overweight patients – lipodermatosclerosis)
• ulceration
• carcinoma or sarcoma (longstanding venous ulcers -malignant
transformation - rate 0.4% to 1%.)

18. complications
• Injury
• Bleeding
• superficial thrombophlebitis (Blood clotting within affected veins. -
can extend into deep veins)
• Acute fat necrosis
• (ankle of overweight patients – lipodermatosclerosis)
• ulceration
• carcinoma or sarcoma (longstanding venous
ulcers -malignant transformation - rate 0.4% to
1%.)

19. complications
• Injury
• Bleeding
• superficial thrombophlebitis (Blood clotting within affected
veins. - can extend into deep veins)
• Acute fat necrosis (ankle of overweight patients – lipodermatosclerosis)
• ulceration
• carcinoma or sarcoma (longstanding venous ulcers -malignant
transformation - rate 0.4% to 1%.)

20. complications
• Injury
• Bleeding
• superficial thrombophlebitis (Blood clotting within affected
veins. - can extend into deep veins)
• Acute fat necrosis (ankle of overweight patients – lipodermatosclerosis)
• ulceration
• carcinoma or sarcoma (longstanding venous ulcers -malignant
transformation - rate 0.4% to 1%.)

21. complications
• Injury
• Bleeding
• superficial thrombophlebitis (Blood clotting within affected
veins. - can extend into deep veins)
• Acute fat necrosis (ankle of overweight patients – lipodermatosclerosis)
• ulceration
• carcinoma or sarcoma (longstanding venous ulcers -malignant
transformation - rate 0.4% to 1%.)

22. Treatment
• asymptomatic - no treatment required.
Prophylactic treatment does not reduce the
progression of venous disease.
• Symptomatic patients
– to reduce symptoms
– cosmetic reasons (may be valid)

23. Treatment
• aim of treatment
– to reduce symptoms
– improve appearance

24. Treatment
• Conservative treatment
• Invasive Treatment

25. Treatment
• Conservative treatment
– compression
– Elevate leg
– Address risk factors

26. Treatment
• Invasive Treatment
• Surgery
• Endovenous Ablation Techniques

27. Treatment
• Invasive Treatment
• Surgery
– Surgical ligation
– Surgical stripping
– Cryostripping
– Subfascial Endoscopic Perforator vein Surgery – SEPS
– Transilluminated Powered Phlebectomy - TIPP

28. Treatment
• Invasive Treatment
• Endovenous Ablation Techniques
– Radiofrequency Ablation
– Endovenous Laser Treatment
– Sclerotherapy
• Liquid
• foam

29. Surgery
– Surgical ligation
– Surgical stripping
• Great Saphenous Vein
– Saphenofemoral disconnection + stripping
» Groin to ankle - unnecessary: increased risk of
Saphenous Nerve Injury
» Groin to knee – good initial results
- reduced recurrence rate
• Small Saphenous Vein
– Saphenopopliteal disconnection
» Stripping – damage to Sural Nerve

30. Risks of Treatment
• Problems arising from superficial venous
surgery are the most common reason for
litigation in the UK.

31. Risks of Treatment
• Problems arising from
superficial venous surgery are
the most common reason for
litigation in the UK.

32. Risks of Treatment
• Most settled claims result from a failure to
warn patients about nerve damage.

33. Risks of Treatment
• Most settled claims result
from a failure to warn
patients about nerve damage.

34. Risks of Treatment
• Conservative treatment - Very few
• Invasive Treatment

35. Risks of Treatment
• Invasive Treatment
– Long saphenous vein - saphenous nerve damage
– 8% to 40%

36. Risks of Treatment
• Invasive Treatment
– Long saphenous vein - saphenous nerve damage
– LONG STRIP(groin to ankle Level)
– SHORT STRIP (groin to knee level

37. Risks of Treatment
• Invasive Treatment
– Long saphenous vein - saphenous nerve damage
– LONG STRIP(groin to ankle Level) - saphenous
nerve damage 40%
– SHORT STRIP (groin to knee level)- saphenous
nerve damage 8%

38. Risks of Treatment
• Invasive Treatment
– Long saphenous vein - saphenous nerve damage
SHORT STRIP
more safe than
LONG STRIP

39. Risks of Treatment
• Invasive Treatment
– Short saphenous vein - Sural nerve damage
• 2.1%

40. • Problems arising from superficial
venous surgery are the most
common reason for litigation in
the UK.
• Most settled claims result from a
failure to warn patients about
nerve damage

41. Varicose veins
A more comprehensive presentation is
A more comprehensive presentation is
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available on Meducation Premium