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| | Venous
Disease > Varicose Veins | |
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Varicose veins affect: |
| |
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20-25% of adult
females |
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10-15% of adult
males |
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Assessment
of varicose veins
| | History |
| |
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Poor correlation exists between symptoms and signs | |
| Cough,
tap and thrill tests are inaccurate | |
| Important
to identify those with history of DVT or lower limb fracture | |
| If
history of DVT need preoperative investigation with duplex scanning |
| | | Examination |
| |
|
Identify distribution of varicose veins - long saphenous (LSV) vs short saphenous
(SSV) | | | Confirm
with tourniquet testing and hand held-doppler probe (5 MHz) | |
| Recurrent
varicose veins need duplex ultrasound | |
Causes of Varicose Veins
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Primary |
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Cong. abs. of
valves |
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Weakness/wasting
of muscles. |
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Calf muscle pump
failure. |
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Secondary |
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Obstruction of
venous return due to DVT, Tumours, Pregnancy, etc. |
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Klippel Trenauney Syn.-
Cong. A-V fistula. |
Signs & Symptoms
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Pain in the calf. |
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Swelling. |
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Skin colour changes. |
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Cosmetic. |
Investigations
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Brodie-Trendelenburg
test. |
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Hand held doppler. |
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Venous duplex scan. |
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Plethysmography. |
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Venogram. |
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Ankle-Brachial index. |
Treatment
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Conservative |
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Class II compression
stockings. |
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Daflon/Trental/Venusmin |
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Surgical
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Ligation of SFJ/SSPJ
+ Stripping of LSV upto knee+ multiple avulsions. |
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Subfascial Endoscopic
Perforator Surgery |
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Valvuloplasty |
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Endovenous Laser |
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Injection Sclerotherapy |
Indications for surgery
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Primary Varicocities. |
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Perforator Incompetance. |
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Deep venous Reflux |
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Secondary Varicocities |
Contraindications
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Acute infective thrombophlebitis. |
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Deep vein thrombosis. |
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Pregnancy. |
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Tumours. |
Complications
|
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Thrombophlebitis |
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Ulceration |
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Lipodermatosclerosis |
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Rupture |
Indications for SEPS
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Incompetent perforator
veins |
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Lipodermatosclerosis |
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Ulceration |
Advantages of SEPS
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Accurate localization
of perforator veins in the subfascial compartment |
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Minimally invasive surgery
done as day care |
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Morbidity from wound
complications is eliminated |
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Ulcer healing rates
are improved |
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