veerudental2-190429052318 (1).pptx varicose veins

CHRONIC VENOUS
INSUFFICIENCY-
Varicose veins

Anatomy
• The venous system
is comprised of:
– Deep veins
– Superficial veins
– Perforator veins
VN20-03-B 10/04

Superficial veins
• Great saphenous vein
 Begins from medial marginal vein on
the dorsum of foot
 Ascends in front of tibial malleolus
 In the medial aspect of leg(related to???)
 behind medial condyles of tibia and femur
posteromedial surface of the knee
 In anteromedial aspect of thigh
 Terminates into femoral vein at fossa ovalis
2.5cm below and lateral to pubic tubercle

Perforators
• Perforating veins connect the
deep system with the
superficial system
• They pass through the deep
fascia
• Guarded by valves-unidirectional
flow from superficial to deep
veins
VN20-03-B 10/04

ANY RISK FACTOR INCREASED VENOUS PRESSURE
DILATION OF VEIN WALLS
STRECHING OF VALVES-VALVULAR INCOMPETENCE
REVERSAL OF BLOOD FLOW
FAILURE OF MUSCLES TO PUMP BLOOD
VEINS DISTEND,ELONGATE,TORTOUS,POUCHED,INELASTIC
AND FRIABLE

Telangectasias
• Small(0.5-1mm) widened blood vessels in
skin-small intradermal varicosities
“SPIDER VEINS”/”venulectasias"
• In anywhere on the body esp-leg
• Usually no severe symptoms
• Rarely heamorhagic
• “corona phlebectatica”-blue
spiderveins on medial aspect ankle below
malleolus

Reticular veins
• Subcutaneous dilated veins-enter
tributaries of main axial/trunk
veins
(1-3mm)
• Size >spider veins
<varicose vein
• “feeder veins”-
refluxing reticular veins spider veins
• Cause discomfort and is cosmetically
undesirable

Varicose veins
• Dilated,tortuous and elongated veins
with reversal of blood flow mainly
due to valvular incompetence
• Only in humans
• Includes
varicose veins in
legs Hemorrhoids
Varicocele
Oesophageal varices

Risk factors
Age
Gender
Height
left>right
Heredity
Pregnancy
Obesity and overweight
Posture

Aetiology
• More common in lower limb due to erect posture
• Primary varicosities
 Congenital incompetence/absence of valves
 Weakness or wasting of muscles
 Stretching of deep fascia
 Inheritance with FOXC2 gene
 Klippel-trenaunay syndrome

• Secondary varicosities
recurrent thrombophlebitis
Occupational
Obstruction to venous return
Pregnancy
Iatrogenic-in AV fistula
Deep vein thrombosis

 Dilated tortuous veins
 Dragging pain worsening on prolonged standing/sitting
 Bursting pain on walking
 Swelling of the ankle
 Ithcing,oedema,thickening.eczema of feet
 Night cramps
 Appearance of spider veins in affected leg.
 Discoloration/ulceration
 Skin above ankle may shrink (lipodermatosclerosis) b/c fat
underneath skin becomes hard.
 Bleeding blow outs
 Local gigantism
Symptoms

Champagne bottle sign
• Inverted beer bottle look
• Contraction of ankle skin and s/c tissue
with prominent edematous calf

2. Tourniquet test
 Uses a tourniquet to control the junction rather than fingers
 Advantage of moving the tourniquet lower (mid-thigh region)
 Test is unreliable below the knee
3. Perthes Test
 Empty the vein as above, place a tourniquet around the thigh,
stand the patient up.
 Ask them to rapidly stand up and down on their toes – filling of
the veins indicated deep venous incompetence. This is a painful
and rarely used test.
4. Schwartz test
 In standing position,tap the lower part of vein
 Impulse felt on saphenofemoral junction

5.Pratt’s test-
 Esmarch bandage applied on the leg from below upward with tourniquet
on saphenofemoral junction
 Release of bandages
 Perforators seen as blow outs
6.Morrissey’s cough impulse test
 limb elevated and veins emptied
 Patient is asked to cough
 Expansile impulse in saphenofemoral junction
7.Fegan’s test
 Line of varicosities marked
 Site where perforators pierce deep fascia-bulges on standing
circular depressions on lying

 Hemorrhage
 Ulcerations
 phlebitis
 Pigmentations
 Eczema
 lipodermatosclerosis
 Periostitis
 Calcification of vein
 Equinus deformity
 Acute fat necrosis can occur, esp: at ankle
 Deep vein thrombosis

VARICOSE ULCER MARJOLIN’S ULCER

Thrombophlebitis
•Thrombosis with infammation of superfiacial veins
•Occur spontaneously/due to minor trauma
•Can occur durin injection of sclerosing fluid for
treatment

Eczema in varicose vein
lipodermatosclerosis

C. (Clinical class):
- Class 0: No visible or palpable signs of
venous disease.
- Class I : Telangiectasis or reticular
veins.
- Class 2: Varicose veins.
- Class 3: Edema.
- Class 4: Skin changes e.g. venous
eczema,
pigmentation and
lipodermatosclerosis.
- Class 5: Skin changes with healed
ulceration
- Class 6: Skin changes with active
Classiffication-CEAP

E. (Etiology):
Congenital.
Primary (undetermined cause).
Secondary:- Post-thrombotic - Post-traumatic
A. (Anatomic distribution of veins):
Superficial.
Perforator.
Deep.
P
.
(Pathophy
siologicme
chanism):
Reflux.

Investigations
• Venous doppler
• Duplex scan
• Venography/phlebography
• Plethysmography
• AVP-ambulatory venous pressure
• Varicography
• Arm foot venous pressure
• Routine investigations

Management
• Conservative treatment
Elevation of limb
Support hosiery-elastic crepe bandage /unna boots
drugs-dioxmin,toxerutin
N’S TECHNIQUE)
sodium tetradecyl sulphate
of endothelial cells
• Injection-s
Inje
dest
shed
thro
clerotherapy(FEGA
cting sclerosants into vein –
ruction of lipid
membranes ding of
endothelial cells
mbosis,fibrosis,obliteration
of veins

• Surgical treatment- Trendelenburg procedure
(High tie and strip)
1. High saphenous ligation
2. Long saphenous strip
3. Avulsion of varicosities-multiple ligation

 Endovascular occlusion of Saphenous veins
using VNUS ClosureTM Catheter

veerudental2-190429052318 (1).pptx varicose veins

veerudental2-190429052318 (1).pptx varicose veins

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veerudental2-190429052318 (1).pptx varicose veins