Varicose Veins

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Varicose veins are the veins that have become elongated, dilated, tortuous, pouched and thickened, due to continuous dilatation under pressure.

Causes

Causes are different for primary and secondary varicose veins.
Primary varicose veins:

  • intrinsic valvular defect
  • sapheno-femoral incompetence
  • defect in connective tissue and smooth muscle of vessel wall
  • No apparent underlying cause

Secondary varicose veins:

  • obstruction to venous outflow due to pregnancy, ovarian cysts, fibroids, pelvic malignancy, abdominal lymphadenopathy or retroperitoneal fibrosis
  • Valve destruction due to deep venous thrombosis
  • Arteriovenous fistula -mostly traumatic

Formation-of-varicose-veins
Clinical features

Clinical features include dull aching pain in the calf and lower legs, feeling of pressure or heaviness in the leg, swollen ankle and feet and itching of skin near the damaged veins.

Complications

Complications include venous eczema, venous pigmentation, lipodermatosclerosis, superficial thrombophlebiltis and venous ulcers

Investigations

Common investigations include standard doppler scan, venous duplex scan, venography and varicography.

Management

Management indications include cosmetic reasons, relief of symptoms, for avoiding complications and aid ulcer healing.

Sclerotherapy

Microinjection sclerotherapy
Ultrasound-guided foam sclerotherapy

Radiofrequency ablation

Laser ablation

Varicose vein surgery

Saphenofemoral junction ligation and greater
Saphenous ligation
Saphenopopliteal junction ligation and lesser
Saphenous stripping

VNUS

Subfascial endoscopic perforator surgery

Indications of sclerotherapy include telangiectasias, reticular varicosities, isolated varicosities, below knee varicosities, recurrent varicosities, aged-infirm varicosities and candidates not fit for surgery

Complications of surgery
Bruising, recurrence, haemorrhage and sensory nerve damage may occur.