Varicose veins

Definition:

These are dilated tortuous veins due to abnormality of the valves mainly occurring in the lower limbs.

Causes:

Primary causes:

A.      Congenital deficiency of valves

B.      Pregnancy in which there is increase in estrogen, progesterone which increases the laxity in veins.

Secondary causes:

A.      Deep vein thrombosis

B.      A tumor which hampers the flow of blood

Clinical features:

·         Pain in legs

·         Restlessness in leg

·         Swelling of leg (swollen calf muscles)

·         Champagne bottle leg

·         Dilated tortuous veins are visible

Diagnosis:

1.     Clinical tests:

These are done to investigate varicose veins.

A.      Trendelenburg test:

Pressure is applied on SFJ (sapheno-femoral junction) or SPJ (sapheno-popliteal junction) to identify the site of incompetency of valves.

B.      Tourniquet test:

A tourniquet is applied on the leg to identify the site of incompetent valves.

2.     Doppler ultrasound of leg:

It will tell us about blood flow and if there is thrombus in the leg veins.

3.     Venography:

A dye is injected into vein which will highlight the whole vein and can identify the site of incompetency.

A.      Ascending Venography:

Dye is injected in the dorsum of the foot (normally it flows upward).

B.      Descending Venography:

Dye is injected into femoral vein.

Management:

1.     Compression stockings:

Graduated stockings are used to apply pressures. They will prevent the further formation of varicose vein and they also prevent further dilatation. But they don’t cure the disease.

2.     Sclerosing agents used in varicose vein:

The lumen of superficial vein is destroyed by introducing sclerosing agent (Na tetradecayl), which is followed by compression.

3.     Surgical removal of superficial veins (Phlebectomy):

Sometimes the great saphenous vein is mobilized from the affected leg and connected with inferior vena cava. If sapheno-femoral or sapheno-popliteal junction is incompetent then they are repaired.