Varicose Veins

Varicose Veins

• Definition :
• Varicose Veins Are Dilated, Tortuous Superficial Veins
• They Can Occur As An Isolated FIndings Or Can Be A Manifestation Of Underlying Venous Insufficiency

• Epidemiology :
• Prevalence : 15 - 20 % Of Adults
• Sex : 2 - 3 Times As Frequent In Women As In Men
• Risk Factors :
• Positive Family History Of Varicose Veins
• Positive In Half Of Patients With Primary Varicose Veins
• If Both Parents Have Varicose Veins, The Risk Is Around 90%
• Female Sex
• Increasing Age
• Pregnancy
• Obesity
• Prolonged Standing
• Etiology :
• Various Causes Including :
• Defective Structure And Function Of The Valves Of The Saphenous Veins
• Intrinsic Weakness Of The Vein Wall
• High Intraluminal Pressure
• Arteriovenous Fistulae (RARELY)

• Classification :
• Primary Varicose Veins
• Originate In The Superficial System
• Secondary Varicose Veins
• Deep Venous Insufficiency And Incompetent Perforating Veins
• Deep Venous Occlusion Causing Enlargement Of Superficial Veins Serving As Collaterals
• Diagnosis :
• Sign & Symptoms :
• Asymptomatic - MOST COMMON
  
• Dull Ache Or Pressure Sensation In The Legs After Prolonged Standing, Which Relieved With Leg Elevation
• Legs Feel Heavy
• Cramping
• Muscle Fatigue
• Pruritus
• Mild Ankle Edema
• Visible, Palpable, Dilated, Tortuous, Superficial Veins
• Mainly In The Lower Extremities
• Generally > 3 mm In Diameter
• Imaging :
• Duplex Ultrasonography
• Non Invasive Imaging Often Used Prior To Ablative Or Operative Procedure
• Magnetic Resonance Venography
• Most Sensitive And Specific Test To Locate Anatomic Obstruction
• Reserved For Difficult Cases, Rarely Required
• Treatment :
• Supportive :
• Purpose : Alleviation Of Symptoms
• Weight Loss, Elevate Legs Periodically, Avoid Prolonged Standing,
  
• Wear Elastic Support Hose
• Start With Low Pressure Stockings (Class I, 20 - 30 mmHg)
• And Progress To Higher Pressure Stockings Only If Symptoms So Dictate
• Main Side Effects : SKIN IRRITATION & CONTACT DERMATITIS
• Ablative Procedures :
• Sclerotherapy
• Generally Used To Treat Small, Symptomatic Varicose Veins
• Procedure Is Done With No Or Only Local Anesthesia
• Sclerosing Solution Is Injected Into The Involved Varicose Vein
• Solution Damages The Endothelium Leading To Thrombosis And Inability Of The Vein To Fill
• A Compression Bandage Is Applied
• Contraindications :
• Varicosities Of More Than 6 mm, Arterial Insufficiency Of The Legs, Anticoagulation, Hypercoagulable States, Phlebitis, Pregnancy, Any Disease That Will Hamper Post Surgical Ambulation, Morbid Obesity
• Endovenous Radiofrequency Or Laser Ablation
• Percutaneous, Endovenous Delivery Of Radiofrequency Or Laser Energy Can Be Used To Treat Incompetent Greater Saphenous Veins

• Surgical Therapy
• Usually Involves Extensive Ligation And Stripping Of The Greater And Lesser Saphenous Veins

• Complications :
• Pigmentation
• Skin Ulceration
• Superimposed Infection
• Superficial Venous Thrombosis
• Rupture WIth Bleeding / Hemorrhage (Rare)
• Prognosis :
• Course Is Chronic
• Recurrence May Occur After Treatment
• Over 5 Years, About 2 / 3 Of Patients WIll Experience Recurrence After Sclerotherapy
• Recurrence Rate Is Lower After Ligation And Striping
• Prevention :
• NO KNOWN PRIMARY PREVENTION