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Clinical Presentation of Varicose Veins

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• Published: 25 May 2021
• Volume 85 , pages 7–14, ( 2023 )

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• Shantonu Kumar Ghosh   ORCID: orcid.org/0000-0002-2842-9023 1 ,
• Abdullah Al Mamun 2 &
• Alpana Majumder 3  

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Varicose vein is one type of venous insufficiency that presents with any dilated, elongated, or tortuous veins caused by permanent loss of its valvular efficiency. Destruction of venous valves in the axial veins results in venous hypertension, reflux, and total dilatation, causing varicosities and transudation of fluid into subcutaneous tissue. The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens. Evidence of surgical intervention was found in the 1860s. However dramatic advances of varicose vein management occurred in the latter half of twentieth century. Varicose veins affect from 40 to 60% of women and 15 to 30% men. Multiple intrinsic and extrinsic factors including age, gender, pregnancy, weight, height, race, diet, bowel habits, occupation, posture, previous DVT, genetics, and climate are considered to be the predisposing factors for formation of varicose vein. Other reported factors are hereditary, standing occupation, chair sitting, tight underclothes, raised toilet seats, lack of exercise, smoking, and oral contraceptives. Common symptoms are unsightly visible veins, pain, aching, swelling, itching, skin changes, ulceration, thrombophlebitis, and bleeding. The signs of varicose vein disease are edema, varicose eczema or thrombophlebitis, ulcers (typically found over the medial malleolus), hemosiderin skin staining, lipodermatosclerosis (tapering of legs above ankles, an “inverted champagne bottle” appearance), and atrophie blanche. Varicose vein is classified according to CEAP classification, the components of which are clinical, etiological, anatomy, and pathophysiology. The revised CEAP classification was published on 2020 based on four principles which were preservation of the reproducibility of CEAP, compatibility with prior versions, evidence-based medicine, and practicality.

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Introduction

Varicose veins constitute a progressive disease, and remission of the disease does not occur, except after pregnancy and delivery. During its course, the disease produces complication; most frequent are superficial thrombophlebitis, acute bleeding originating in one of the thin-walled varices, eczema, and, finally, skin ulceration [ 1 ].

The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens [ 2 ]. First patient who underwent operation for his varicose vein appears to be Canus Marius, the Roman tyrant. Greek philosopher Hippocrates (460–377 B.C.) described the use of compressive bandages and was advisor of small punctures in varicose veins. Aurelius Cornelius Celsus 25 B.C.–A.D.50) used linen bandages and plasters for leg ulcers. He treated them by exposure followed by avulsion with a blunt hook. Claudius Galen (A.D. 130–200) developed a method of bandaging which held the wound edges together. Galen’s theory of circulation remained standard theory for next 1400 years. William Harvey (1578–1657) proposed the theory of unidirectional blood circulation [ 3 ]. Giovanni Rima (1777–1843) introduced midthigh ligation of the saphenous vein.

The era of vascular intervention for varicose veins was modernized by Friedrich Trendelenburg, in the 1860s, who not only popularized his eponymous Trendelenburg test for saphenous reflux but also performed great saphenous vein (GSV) ligation by making a transverse upper thigh incision to ligate and divide the proximal GSV [ 1 ]. William Moore, an Australian surgeon, moved the site of ligation cephalad to the sapheno-femoral junction [ 1 ]. Ligation of the sapheno-femoral junction as it is practiced today was first described by John Homans in his paper in 1916 [ 1 ]. The Mayo Brothers, postulating that there would be additional benefit in removing the saphenous vein, pursued excision of the GSV through an incision extending from the groin to below the knee. This technique was initially improved by the use of an external “ring vein enucleator” [ 1 ]. The final technologic leap was introduction of the intraluminal stripper by Babcock [ 1 ]. The latter half of the twentieth century saw dramatic advances in diagnostic testing; however, surgical treatment of varicose veins benefited from only modest refinements after this innovation.

The twenty-first century has begun with a resurgence of interest and innovation in venous disease. Although sclerotherapy and endovenous thermal ablation occupy preeminent roles in the contemporary management of superficial venous disease, surgical approaches remain relevant when applied appropriately and executed expertly [ 4 ].

Epidemiology

It is generally agreed that varicose veins affect from 40 to 60% of women and 15 to 30% men [ 5 ]. In a study published on 1994, it was found that half of the adult population had minor stigmata of venous disease (women 50–55%; men 40–50%), but fewer than half of these will have visible varicose veins (women 20–25%; men 10–15%) [ 6 ]. However, more recently, large population studies such as Edinburgh Vein Study demonstrated an age-adjusted prevalence of truncal varices of 40% in men and 32% in women [ 7 ].

Varicose vein is one type of venous insufficiency which falls under the broad heading superficial venous disease [ 8 ]. In Western populations, the incidence of varicose veins varies with the definition applied. Most investigators favor the definition of Arnoldi, who said that varicosities are “any dilated, elongated, or tortuous veins, irrespective of size” [ 9 ] (Fig. 1 ).

Development of varicose veins: healthy vein (1) and varicose vein (2)

The definition of Arnoldi is particularly useful because it presents a unifying concept for reticular varicosities, telangiectasias, and major varicose veins. Since all three are elongated, dilated, and have incompetent valves, they probably have a common origin and respond to the same physical forces and acquired influences [ 5 ]. The dilation and elongation implies that these abnormal veins have been responsive to effects of pressure. The dilation of a vein and valve annulus stretches beyond the capability of its leaflets to close together. Dodd and Cockett defined varicose veins, saying “a varicose vein is one which has permanently lost its valvular efficiency” [ 10 ] (Fig. 2 ). It was pressure over a course of time that causes a varix to become elongated, tortuous, pouched, and thickened.

Varicose veins develop from valvular incompetence, resulting in dilation of the superficial venous system

Risk Factors

Among the theories that have been proposed to explain the cause of varicose veins is the hypothesis regarding weakness in the vein wall. Significantly reduced vein wall elasticity has suggested that the role of venous valves in development of varicose veins is secondary to changes in the elastic properties of the vein wall [ 11 ]. Estrogens, progestogens, or their associative action facilitate varicose vein development in individuals with factors which predispose them to vascular disorders (familial history, prolonged standing, obesity, and sedentary). They also aggravate the superficial venous state in these patients [ 12 ]. Wearing of tight undergarments produces proximal limb venous hypertension. A low-fiber diet predisposes to constipation and increased abdominal straining. Raised toilet seats prevent squatting during defecation. All these theories are related to venous hypertension, which itself is linked to development of venous insufficiency.

Common Predisposing Factors for Formation of Varicose Vein

Multiple intrinsic and extrinsic factors including age, gender, pregnancy, weight, height, race, diet, bowel habits, occupation, posture, previous DVT, genetics, and climate are the predisposing factors for formation of varicose vein [ 2 ]. Other factors documented in various studies are hereditary, standing occupation, chair sitting, tight underclothes, raised toilet seats, lack of exercise, smoking, and oral contraceptives.

Pathogenesis

Destruction of venous valves in the axial veins results in venous hypertension, reflux, and total dilatation, causing varicosities and transudation of fluid into subcutaneous tissue [ 2 ].

Development of Varicose Vein

All leg veins are equipped with valves at regular intervals. Together with the leg muscles and the pump function of the heart, these valves ensure that blood flows back to the heart against the force of gravity. Activating the leg muscles, for example by walking, compresses the deep veins lying between the muscles and forces the blood out of them. Healthy valves ensure that the blood flows in only one direction towards the heart and prevent any backflow to the feet. Most of the blood returns to the heart in the deep vein system. The superficial veins merely have a supporting role in blood transport, although they often develop into varicose veins. When superficial veins enlarge because of hereditary connective tissue weakness, the valves do not expand at the same time. This disrupts valve function, as the valves are no longer big enough to close the dilated vein (Fig. 2 ). As a result, there is a constant backflow to the feet that causes the vein to enlarge even further and varicose veins to develop (Fig. 3 ).

Overview of the positions of the different types of varicose veins in and under the skin

Saphena Varix

A saphena varix is a dilatation of the saphenous vein at the sapheno-femoral junction in the groin. As it displays a cough impulse, it is commonly mistaken for a femoral hernia; suspicion should be raised in any suspected femoral hernia if the patient has concurrent varicosities present in the rest of the limb. These can be best identified via duplex ultrasound and management is via high saphenous ligation.

Classifications

Ceap classification—creation.

CEAP was suggested by John Porter in 1993 at the American Venous Forum. A consensus conference was held at the Sixth Annual Meeting of AVF in February, 1994. An international ad hoc committee chaired by Andrew Nicolaides with representatives from Australia, Europe, and the USA developed the first CEAP consensus document in 1994—“CEAP classification” [ 13 ]. It was accepted around the World by venous authorities of Europe, America and Asia. It was published in 11 languages in 5 continents. CEAP was updated in 1996 and revised in 2004 [ 13 ] (Table 1 and Table 2 ).

Since its introduction, CEAP has been demonstrated to be an excellent discriminative instrument and has become an accepted reporting standard for CVD research [ 14 ]. With time management of venous diseases has progressed, and many new modalities have been introduced which became popular in many fields. Over the years, criticisms of the instrument have included a lack of precise definitions resulting in a lack of reproducibility in assigning patients to specific clinical classes [ 15 , 16 ]. In the 16 years since the last revision, an enhanced understanding of aspects of venous disease has identified gaps in the ability of CEAP to separately group patients with unique clinical attributes [ 17 ]. The necessity of further revision of CEAP was due with the advancement of phlebology. To address these advances, a taskforce was created for necessary revisions of CEAP classification. This task force comprised an international group of experts, as well as an advisory group of those who were involved in the creation and previous revision of the CEAP classification. Following a modified Delphi process, the task force adopted the following four “guiding principles”: preservation of the reproducibility of CEAP, compatibility with prior versions, evidence based medicine, and practicality. The revised CEAP remains a descriptive classification [ 18 ].

Changes in CEAP 2020

The CEAP 2020 taskforce adopted the following changes [ 19 ] (Table 3 ).

Clinical Domain

Revision in the “C” domain was done for the better understanding of the natural history between the subclasses. Corona phlebectatica appears to be a predictor of venous ulcer similar to other advanced skin changes and was placed as a subclass C4c in the class C4. The tendency of recurrence of varicose vein and venous ulcer was reflected by “r” in the revised CEAP. C2r indicates recurrent varicose vein, and C6r indicates recurrent venous ulcer.

Etiology Domain

Previously those patients who had no venous abnormality were classified as “En” (none). According to the modified CEAP, patients with clinical signs typically associated with venous disease will come under this subclass, if no other typical venous etiology is found. After the last revision of CEAP, the diverse of causality and development of newer treatment techniques raised the necessity to revise the secondary chronic venous disease (CVDs). To make it easily understandable, “Es” was separated into intravenous (Esi) and extravenous (Ese). The subclass “Esi” includes post-thrombotic changes, traumatic arteriovenous fistulas, primary intravenous sarcoma, or other luminal changes inside the vein. Unlike “Esi,” “Esc” does not reflect on conditions due to venous wall or valve damage, rather due to conditions affecting venous hemodynamics. It may be systemic (e.g., obesity and congestive heart failure) or locally by extrinsic compression (e.g., extravenous tumor and local perivenous fibrosis), or, at a distance, by muscle pump dysfunction due to motor disorders (paraplegia, arthritis, chronic immobility, and frozen ankle) [ 18 ].

Anatomy Domain

Previously 18 numerical designations were used to describe the venous segments of abdomen, pelvis, and lower extremities. Now it has been described by abbreviations which is more practical and easier for professional communication and publications. Anterior accessory saphenous vein was also included in the list of anatomical segments.

Pathophysiology Domain

The “P” component of CEAP was kept unchanged.

Venous Severity Scoring

The CEAP scoring was limited by several factors and was not popular. Rather it was found that severity scoring system based on CEAP was more desirable for research and daily practice. In 2000, the American Venous Forum (AVF), Ad Hoc Committee on Venous Outcomes Assessment, proposed the three-part Venous Severity Score: Venous Clinical Severity Score (VCSS), Venous Segmental Disease Score (VSDS), and Venous Disability Score (VDS)—a modification of the original CEAP disability score [ 20 ]. These scorings had been used to evaluate the severity of venous disease and to provide standardized evaluation of treatment effectiveness.

Venous Clinical Severity Score

The VCSS system includes 10 clinical descriptors (pain, varicose veins, venous edema, skin pigmentation, inflammation, induration, number of active ulcers, duration of active ulceration, size of ulcer, and compressive therapy use), scored from 0 to 3 (absent, mild, moderate, severe; total possible score, 30) that may be used to assess changes in response to therapy [ 21 ]. The revised VCSS score was published in 2010 and is currently being evaluated in studies for its validity and reliability.

Venous Segmental Disease Score

Venous Segmental Disease Score combines the anatomic and pathophysiologic components of CEAP. Major venous segments are graded according to presence of reflux and/or obstruction. It is entirely based on venous imaging, primarily duplex scan but also phlebographic findings. This scoring scheme weights 11 venous segments for their relative importance when involved with reflux and/or obstruction, with a maximum score of 10 [ 20 ].

Venous Disability Score

This modification to the original CEAP disability score substitutes prior normal activity level for the patient rather than ability to complete an 8-h workday.

Clinical Features

The common symptoms of varicose veins are unsightly visible veins, pain, aching, swelling (often worse on standing or at the end of the day), itching, skin changes, ulceration, thrombophlebitis, and bleeding. Edema, varicose eczema or thrombophlebitis, ulcers (typically found over the medial malleolus), hemosiderin skin staining, lipodermatosclerosis (tapering of legs above ankles, an “inverted champagne bottle” appearance), and atrophie blanche are common signs. Treatment should be considered when the patient is complaining of aching pain, leg heaviness, easy leg fatigue, superficial thrombophlebitis, external bleeding, ankle hyperpigmentation, lipodermatosclerosis, atrophie blanche, and venous leg ulcer.

Complications

Most common complications of varicose vein include aching pain, leg heaviness, and easy leg fatigue. Other complications are superficial thrombophlebitis, ankle hyperpigmentation, lipodermatosclerosis, atrophie blanche, and venous ulcer. Complications that require urgent management are superficial bleeding and superficial venous thrombosis. Rarely superficial venous thrombus may propagate to deep venous system.

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Shantonu Kumar Ghosh

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Ghosh, S.K., Al Mamun, A. & Majumder, A. Clinical Presentation of Varicose Veins. Indian J Surg 85 (Suppl 1), 7–14 (2023). https://doi.org/10.1007/s12262-021-02946-4

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Received : 16 April 2021

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Published : 25 May 2021

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DOI : https://doi.org/10.1007/s12262-021-02946-4

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A Comprehensive Review on Varicose Veins: Preventive Measures and Different Treatments

Affiliations.

• 1 Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India.
• 2 Department of Biotechnology, Chandigarh group of Colleges Landran, Mohali, Punjab, India.
• 3 Indian Institute of Food Processing Technology, Thanjavur, Tamilnadu, India.
• 4 Department of Pharmacy, Goa College of Pharmacy, Panaji, Goa, India.
• PMID: 34242131
• DOI: 10.1080/07315724.2021.1909510

The purpose of this article was to review the different preventive measures and treatments for varicose veins disease. Varicose veins are tortuous, enlarged veins that are usually found in the lower extremities damages blood vessels leading to its painful swelling cause's blood clots, affecting people over increasing prevalence with age and affects the proficiency, productivity, and life quality of a person. Prolonged standing and obesity are the major reason for varicose vein disease. The mechanisms, prevention, risk factors, complications, and treatment of varicose veins are explained in this review. Various types of treatments such as endovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veins. Besides these methods of treatments, varicose vein disease can be prevented by doing regular yoga/exercise and consumption of several fruits and vegetables such as Grapes, blackberries, avocados, ginger, and rosemary. Typically, varicose veins can be a benign process with several problems that can influence the life quality of an individual that can lead to potentially life-threatening complications. However, there are numerous surgical, endovascular, and chemical treatments that improve quality of life and decrease secondary complications of varicose veins. Patients with varicose veins should take an antioxidant medicament from the flavonoid groups to reduce the arterial blood pressure value, risk of atherosclerosis development, prevent thrombotic incidents.Key teaching pointsChronic venous disease is a pathological state of vein circulatory systems of the lower limbsProlonged standing and obesity are the major reason for varicose vein diseaseEndovascular, surgical, and herbal treatments improve quality of life and reduce the secondary complications of varicose veinsVenoactive drugs such as flavonoids, saponins, and others have a therapeutic effect on chronic venous disordersPhlebotropic drugs are semi-synthetic substances widely used in different states of chronic venous insufficiencyFood rich in phytoconstituents are more effective in varicose veins.

Keywords: Varicose vein; foam sclerotherapy; herbs.

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Varicose veins : epidemiology and outcomes

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• Varicose veins are among the most prevalent medical conditions in western populations, with a prevalence estimated at 25--35% in women and 10--20% in men. Until now, few studies have regarded varicose veins as a distinct clinical entity and have investigated specific risk factors. Their consequences for the patients have not been adequately investigated. The main objective of this thesis was to examine the association between varicose veins and specific risk indicators and outcomes, taking into account the effects of more severe venous disorders often found in combination with varicose veins. This work is based on the VEnous INsufficiency Epidemiological and economical Study (VEINES), a one-year cohort study on venous disorders carried out in Belgium, France, Italy and Quebec. It included 1531 patients sampled among 5688 consecutive patients consulting a physician for a venous disorder. A sub-sample of 150 patients were referred to specialists for clinical examination and duplex investigation of venous incompetence. This study illustrated the problems of the diagnosis and classification of varicose veins, with a specificity of 45% for the diagnosis made by general practitioners. In a case-control analysis, the strongest risk indicators of varicose veins were pregnancy, age and family history. No association was found with other hypothesised determinants (obesity, smoking, history of thrombophlebitis, blood group A). Results of duplex studies support the hypothesis of a distal onset of venous reflux and varicose veins. Using a classification of varicose veins proposed to take account the concomitant presence of other signs of venous disease, varicose veins alone had no impact on a symptom score and on generic (SF-36) and disease-specific quality of life scores. The results suggest that symptoms and presence of varicose veins are independent outcomes, which has implications for clinical practice. A detailed analysis of health service utilisation performed in Belgium also showed that both are independent predictors of resource use.
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Varicose veins: a clinical study

2017, International Surgery Journal

Background: Varicose veins are a common condition affecting the lower limbs. Apart from being a cosmetic problem, it can have some serious complications if not treated in time. Multiple modes of surgical management exist for the disease. Complications of the surgery are troublesome and difficult to treat.Methods: This is a prospective study done in inpatients of SDM college of Medical Sciences, Dharwad, Karnataka, India. A total of 70 patients were included in this study and various general, demographic, clinical and surgical data outcomes were studied over a period of 4 years.Results: In our study of 70 patients we found the mean age of the study population to be 45.6% with a range of 21 to 70 years. Male patients (80%) outnumbered the females (20%). Among the 70 limbs studied, 30 (42.85%) patients had the involvement of GSV and communicating system, 6 (8.57%) had involvement of GSV and SSV systems, whereas SSV and CS were affected in 2 (2.85%) patients. 2 (2.85%) had all the three...

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Background and objectives: Venous diseases of lower limb remain commonaffecting 20% of adult population. Objective of this study is to identify cases with primary varicose veins, evaluate with appropriate investigations, collect data and establish the clinical spectrum of complications in this population. Methods: Study was conducted on 50 consecutive patients with primary varicoseveins at Govt. thiruvarur medical college, thiruvarur. All cases of varicose veins presenting to the OPD were subjected to duplex scan to rule out secondary causes. Patients admitted with varicose veins who satisfied the inclusion and exclusion criteria were included in the study.. Patients who presented with bilateral disease got their symptomatic limb operated first while the other limb was treated conservatively Patients with saphenofemoral incompetence were treated with saphenofemoral junction ligation and stripping of long saphenous vein. Patients with saphenopopliteal junction incompetence were treated with saphenopopliteal junction ligation with or without stripping of short saphenous vein. Patients with perforator incompetence were treated with subfascial ligation of perforators Results: Out of 50 patients studied, 39 (78%) patients were agriculturists, whoadmitted of having been exposed to prolonged hours of standing .Among the 50 cases studied, 70 limbs showed varicose veins, of which 32 limbs had long saphenous vein and communicating system involvement (45.7%). 20 limbs had long saphenous vein involvement (28.5%) alone. Among 32 limbs with long saphenous and communicating system involvement, 24 had pain (75%), 7 had oedema (21.8%), 18 had disfigurement (56.2%), 8 ulcers (25%). Among 20 limbs with only long saphenous involvement 10 had pain (50%), 3 had oedema (15%), 4 had disfigurement (20%), 2 had ulcer (10%).Of the 48 limbs that underwent surgery 26 (54.1%) underwent saphenofemoral flush ligation with stripping of LSV and subfascial ligation of perforators Conclusion: Definite relationship exists between occupation involving prolongedstanding and primary varicose veins.The involvement of long saphenous and communicating system together is commonest followed by long saphenous involvement alone. Patients with involvement of long saphenous and communicating system or long saphenous and short saphenous system were more symptomatic than others Complications of varicose veins were responded well to operative treatment. Results of surgical treatment are good

Journal of Evidence Based Medicine and Healthcare

Venkat Vineeth

Scholar Science Journals

Varicose veins and their associated symptoms and complications constitute the most common chronic vascular disorders leading to surgical treatment. Though considerable advances in understanding of venous patho physiology and modern imaging techniques have revolutionized the concept of management of varicosity of lower limb, whether these inferences hold good for our population is a pertinent question. The objective of the study is: 1) Analysis of the clinical features of varicose vein. 2) To know the various treatment modalities adapted for the management of varicose veins. Varicosity of the lower limb is a common clinical entity with, age group of 31-40 being commonly affected. The involvement of long saphenous vein is the commonest. Clinical examination has a high predictive accuracy. The use of color Doppler is a valuable supplement to clinical examination for effective treatment of varicose veins. Operative line of treatment is a primary procedure in the management of varicose veins of lower limbs. LSV stripping up to mid calf is associated with less morbidity so also non-stripping of SSV. The present procedures enable the patient to lead almost normal life after surgery and the mortality rate is very negligible.

Gundavajhula Laxmana Sastry

Varicose veins constitute a progressive disease that becomes steadily worst. IntheINDIAN subcontinent,anestimated 23%ofadultshave varicose veins, and6%havemoreadvancedchronicvenous disease(CVD), includingskinchangesandhealedoractive venousulcers. The study has been taken up to know the distribution & severity of varicose veins of lower limbs & modalities of treatment in prevention of complications.

The aim of study is to study the clinical presentations, surgical management and its outcome and complications associated with varicose veins in lower limbs. Patients and methods:This randomized prospective study includes 50 patients with primary varicose veins admitted in surgical units of SiddharthaMedicalcollege/ Govt. general hospital VijayawadafromOctober 2015toSeptember 2017.Results:In the study, it was noted that the varicose veins more commonly affect the young adult and middle age population (20-60yrs). Most of the patients were males (88%). Long saphenous vein involvement was seen in 88% of patients. A great number of patients had perforator incompetence. Sapheno-femoral flush ligation with stripping appears to be best option for LSV truncal involvement with no recurrence in followup. Conclusion: Majority of the patients with varicose veins associated with complications and surgical management with stripping of path of incompetence (i.e., LSV trunk) with incompetent perforator ligation appear to be best option for lower limb varicose veins under our settings.

International Surgery Journal

VIVEK CHAUDHARI

Background: Varicose veins are common problem and are present in at least 10% of the general population. So far as the aetiology is concerned varicose veins mostly occur due to incompetence of their valves. Risk factors for varicose veins include obesity, female sex, inactivity, and family history. Varicose veins do not threaten life and are seldom disabling, but it causes a considerable demand on medical care.Methods: The study was prospective observational single center study. 30 patients were selected for the study which fit in the selection criteria laid down at the beginning of the study. Informed consent was obtained from each patient before any investigations and treatment.Results: The study revealed that the varicose veins of lower limbs are a disease of younger age group, occurring more commonly during third and fifth decades of life. The involvement of long saphenous system was more common.Conclusions: Results of our study are comparable with various other studies in liter...

International Journal of Surgery Science

Pradeep Tenginkai

Varicose veins are a common encounter in a surgical out-patient department. The vivid range of presentations can leave the surgeon perplexed about the approach to be taken.Despite this, little epidemiological research has been carried out on venous disease, perhaps partly because of society’s perception that venous disease is not a major problem and it is not normally a cause death. More recently however, efforts have been made conduct structural epidemiological studies to identify risk factors and to clarify the geographical variations suggested in the past by anecdotal the prevalence of varicose veins and presents evidence for an against the different theories of causation. The study emphasizes on a sample of the society presented to us, who were diagnosed with varicose veins and patterns with respect to their age, sex, social status, occupations, recurrence, and involvement of the limbs were assessed. The outcomes based on the time of presentations, improvement in the quality of life including conservative regimens were briefed. The ultimate aim of the study being to assure a life of normal quality.

Abhilash Vemula

Background: Disorders of veins which are chronic in nature and very common are the varicose veins. Surgery is required at any one stage of the disease. There have been considerable advances that took place in the diagnostics of the varicose veins, but the treatment outcomes may not be good in many cases. To study the management and outcome of lower limbs varicose veins. Methods: This was a hospital based follow up study. Patients who presented with varicose veins signs and symptoms were included. During the study period it was possible to include 40 patients who were willing to get included in the present study. Various presentations, complications and treatments were noted and finally followed up for minimum of 3 months. Results: Most commonly affected age group was 36-45 years. Males were four times more affected than females. Most commonly affected limb was left side in 48%. Long saphenous system was involved in 55%. The predominant symptom was dilated and tortuous veins (32%) followed by pain (25%). 65 incompetent perforators identified by clinical examination and 130 by Doppler with above ankle being the commonest incompetent perforator. With the mean follow up of six months, no serious complications were noted. It was found that the sensitivity of the clinical examination was 82% when doppler scan was taken as gold standard. On follow up no one developed deep vein thrombosis. Incompetence recurrence rate at SFJ was 8% and at SPJ was 18%. Conclusions: We conclude that surgery is the first line of management and if done accurately, complications are minimal.

https://www.ijhsr.org/IJHSR_Vol.11_Issue.8_Aug2021/IJHSR-Abstract.02.html

International Journal of Health Sciences and Research (IJHSR)

Introduction: Varicose veins are part of the spectrum of chronic venous diseases and include dilated, tortuous veins of lower limbs, spider telangiectasia and reticular veins. Varicose vein disease is a very common problem of the western world and mostly their patients come for treatment because of cosmetic reasons. Indian scenario is different as mostly patients from lower socioeconomic strata of the society come for complications like ulceration, dermatitis etc. of varicose veins come for treatment. This problem sometimes results in chronic absenteeism from work, economic losses and change of occupation in many individuals. Methods: This observational study was carried out from 1 st January 2017 to 30 th June 2018 in Sri Aurobindo Medical College and Postgraduate Institute, Indore. Clinical profile of 52 patients of varicose vein disease was studied. All the patients were thoroughly examined and the pertaining data recorded. This data was tabulated and compared with the available literature on this subject. Results: Fifty two cases of varicose vein disease were studied. The commonest age group affected with the disease was between 41 to 50 years. Male patients were more and comprised of 84.6% of total number. Sapheno femoral junction valve was incompetent in 73.1 % cases as compared to saphenopopliteal junction[34.6%].Obesity was an important factor in causation of varicose vein disease. Flush ligation at SFJ with stripping was the commonest surgical procedure carried out our center. Conclusion: It is found that varicose vein disease with its associated sequelae brings the patient for treatment in our scenario. Long saphenous vein is the commonly affected part of the superficial venous system because of incompetency of the valve at SFJ. Although various etiological factors can be attributed to varicose vein disease but occupation and obesity remain the main factors. Accurate assessment of problem and adequate surgery will prevent recurrence.

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CLINICAL STUDY AND MANAGEMENT OF LOWER LIMB VARICOSE VEINS

• ASSOCIATE PROFESSOR, DEPT.OF GENERAL SURGERY,RIMS,KADAPA.
• DEPT.OF GENERAL SURGERY, RIMS, KADAPA.
• Cite This Article as
• Corresponding Author

Background: Varicose veins of the lower limb are the most common peripheral vascular disease. A clinical study and surgical management of varicose vein was conducted to study the age, sex and occupational distribution of varicose veins of lower limb. Evaluations of clinical features and surgical methods of treatments that were in practice in the management of varicose veins in terms of recurrence and symptoms improvement were alsostudied. Methods: A prospective study was carried out between July 2013 to June 2015. During this period 50 cases of varicose veins of lower limbs were admitted to our hospital and were studied in detail. After thorough clinical examination and relevant investigation they are all subjected to surgical management. Results: Out of 50 cases studied, 35 (50%) had long saphenous vein involvement, 6 (12%) had short saphenous vein involvement and in 5 (10%) cases both short and long saphenous system were involved. In addition to long saphenous vein involvement, incompetent perforators were present in 4 (8%) cases. Among them prominent veins and pain were the main complaints in 36 (72%) patients. Itching and pigmentation were present in 7(14%) patients. Ankle edema was present in 4(8%) patients. Pain and ulceration of lower leg were present in 3(6%) patients. After clinical assessment appropriate surgical procedures were followed for each of patients. Conclusions: This study reveals that the disease is more prevalent during the active adult life in their 3rd and 4th decades and males were more affected. Definite relationship exists between the occupation and the incidence of varicose veins. The patients were in the occupation which required standing for long time had the higher chances of varicose vein. Severity of the symptoms is not proportional to the duration of varicose veins. The involvement of long saphenous vein is more common than the short saphenous vein. Since our study shows very low percentage of recurrence and symptoms related to varicose vein the surgical line of treatment is an ideal treatment for varicose vein. If cases are selected properly with good operative technique the complications are negligible.

• Varicose vein
• long and short saphenous veins

[ K. VANI and D. REDDY PRASAD (2015); CLINICAL STUDY AND MANAGEMENT OF LOWER LIMB VARICOSE VEINS Int. J. of Adv. Res. 3 (Oct). 1778-1784] (ISSN 2320-5407). www.journalijar.com

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> Author: Tutor: School: Course: Keywords:   CLC: Type: Master's thesis Year: 2005 Downloads: 115 Quote: 3 Read: Objective: by measuring the severity of the two groups of patients with varicose veins in different parts of the MDA concentration , SOD activity to explore the role of and antioxidant enzymes in varicose veins pathogenesis . Materials and Methods : The subjects were randomly select our hospital from 2004.5 to 2004.11 after lower extremity deep venous angiography , Doppler ultrasound diagnosed patients with varicose veins 40 cases were treated by surgery , the middle of the cut - and calf -steps Da hidden venous specimens of 95 cases . Including seven men and 33 women , mean age 46.9 ± SD8.7 years old ( 32-70 years old) . Based on the following criteria are divided into A ( mild ) , B ( illness heavier ) two groups: ( 1 ) a longer course (10 years ) ; ② have limbs heavy , swelling, and pain ; the ③ Treads area skin nutritional changes or ulcer formation . Subject to more than two or more than two , or only in line with the first ③ divided into Group B , and the remaining patients were divided into Group A . Group A for varicose vein specimens 52 , 26 shares of Central varicose vein specimens , denoted by A group ; small leg varicose vein 26 denoted by A group. Group B achieved varicose vein specimens 43 , 24 shares of Central varicose vein specimens , denoted as B group ; small leg varicose veins 19 denoted as B group . All patients had no treatment history of thrombophlebitis and injection sclerotherapy . 2, specimen collection : surgery , respectively , from the middle of the shares exfoliation of the great saphenous vein and the removal of a small leg varicose veins cut the appropriate length of the vein samples were flushed with saline into the paste a good label the test tubes , stored in -20 ° C refrigerator . 3 Reagents and Methods : SOD kit , MDA kit and total protein assay kit was purchased from Nanjing Institute of Biology , albumin , the SOD determination and MDA were measured strictly in accordance with the kit instructions . Related Dissertations Clinical Study on the Kidneys and Stepdown Particlesin Elderly Hypertensive Kidney Disease of Free Radical Metabolism ,R285 Rat hepatic ischemia-reperfusion injury of oleanolic acid on oxygen free radicals ,R657.3 Study of Neuroprotective Effects of Antioxidant Gin Senoside Rg1 on the Parkinson Rats ,R285.5 Using atomic force microscopy study of cell elasticity ,R318.01 Experimental Study of Renal Injury after Skeletal Muscle Ischemia/reperfusion Injury ,R692 Adriamycin induced myocardial cells release of oxygen free radicals ,R541 Xuebijing rats with severe acute pancreatitis in rats ,R285.5 Study on Preparation Technology of Yiganzhuanyin Granules ,R283 Protective Effect of YiganZhuanyin Granules on Acute Chemical Liver Injury in Mice ,R285.5 The Protective Effect and Mechanism of Pseudo-Ginsenoside GQ on Myocardial Infarction in Rats ,R285 The Effect and Mechanisms of Chronic Intermittent Hypobaric Hypoxia on Vascular Functions in Rats ,R543 Liuyueqing polysaccharide purification and anti-liver injury research ,R284 Potentilla butanol fraction on EAHY926 endothelial cells injured by hypoxia and mechanisms of the protective effect ,R285.5 Experimental Study on the Role of Phosphorylated Smad3 on Apoptosis Related to Lung Ischemia-reperfusion Injury ,R655.3 Causes of Recurrence of Great Saphenous Vein after Varicotomy in Lower Extremities ,R654.3 Viscosity antithrombotic piece Ⅲ, on cerebral ischemia-reperfusion injury mechanism ,R743.3 The Change and the Role of Heme Oxygenase-1/Carbon Monoxide in Hypoxic-Ischemic Brain Damage of the Neonatal Rats ,R722.1 Pituitary adenylate cyclase activating polypeptide (PACAP) in neonatal rats with hypoxic -ischemic brain injury in rats ,R722.121 Cisplatin -induced apoptosis in Hela cells after ultra- weak luminescence with changes in the level of oxygen free radicals ,R737.33 Experimental Study on the Protective Effects of Ulinastatin Against Paraquat-Induced Acute Lung Injury in Rats ,R965 The Clinical Study of Drug Therapy in Cirrhotic Patients for the Prevention of Esophageal Variceal Rebleeding ,R575.2 An official website of the United States government The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site. The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Publications Account settings Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now . Advanced Search Journal List v.333(7562); 2006 Aug 5 Varicose veins and their management Bruce campbell. 1 Royal Devon and Exeter Hospital and Peninsula Medical School, Exeter EX2 5DW [email protected] Varicose veins are tortuous, widened veins in the subcutaneous tissues of the legs and are often easily visible. Their valves are usually incompetent so that reflux of blood occurs, and the resulting venous hypertension can cause symptoms. Varicose veins are widely seen as medically unimportant and deserving low priority for treatment. They are common, affecting nearly a third of adults in Western societies, and few people with varicose veins are ever harmed by them. However, they cause concern and distress on a large scale, most of which can be dealt with by good explanation and reassurance, or by a variety of treatments which are evolving rapidly at present. Patients can now be referred for more precise assessment and a greater range of therapeutic options than ever before. Who gets varicose veins? A large UK population study has shown age adjusted prevalences of 40% in men and 32% in women, although women more often present for treatment. 1 The age of onset varies; some people develop varicose veins in their teens, but prevalence rises with age. Varicose veins often appear first in pregnancy, and further pregnancies can make them worse. A family history is common, 1 but people should be reassured that having close relatives with severe symptoms from varicose veins or ulcers does not confer any great likelihood that they will have similar problems. Data sources and selection criteria This review is based on three main sources: A personal archive of publications accumulated over 20 years of special interest, studies, and writing on varicose veins Conversations with specialist vascular colleagues—particularly about the potential advantages and disadvantages of the newer treatments, indications for their use, and their place in the management of varicose veins A Medline search for important recent publications. Summary points Most people with varicose veins are never harmed by them—good explanation and reassurance are fundamental Ultrasound techniques (hand held Doppler and duplex) have replaced traditional tourniquet tests for assessing varicose veins before treatment Conventional varicose vein surgery is a clinically and cost effective treatment Laser and radiofrequency treatment simply replace one part of the traditional operation for varicose veins (“stripping”), and most varicosities still need to be treated by removal (phlebectomies) or by sclerotherapy Traditional sclerotherapy works well for smaller veins below the knee: foam sclerotherapy can be used to treat larger and extensive varicose veins and is becoming increasingly popular The place of newer treatments is not yet clear, and more information is needed What problems can varicose veins cause? Cosmetic concern. For the great majority of people varicose veins cause no symptoms and never cause harm. Dislike of their appearance is a common complaint, particularly for women. Cosmetic concern may increase the emphasis that patients place on other symptoms. Fears about future harm A questionnaire study found that many people are worried about the possible harm their varicose veins might cause, but these fears are usually inappropriate—particularly in relation to bleeding, ulcers, and deep vein thrombosis. 2 Varicose veins can cause a variety of symptoms of discomfort in the legs, but it is important to try to differentiate these from the many other reasons for leg pains. The Edinburgh vein study found that the symptoms significantly associated with varicose vein were itching, heaviness, and aching, but the relation of these with varicose veins was inconsistent, particularly in men. 3 Traditional pointers to symptoms being caused by varicose veins include worsening of symptoms after prolonged standing or walking and towards the end of the day, relieving symptoms by elevating the legs or wearing support hosiery, and tenderness over the veins. Leg swelling This is an uncommon symptom of varicose veins—other causes are much commoner. Unilateral swelling of a leg with big varicose veins is the most typical presentation. Thrombophlebitis Superficial thrombophlebitis (“phlebitis”) can complicate varicose veins. The risk of deep vein thrombosis is remote, but in a case series it occurred very occasionally if phlebitis extended above the knee. 4 Veins may sometimes remain permanently occluded. Treatment of the varicose veins may be appropriate if phlebitis is recurrent or severe, or if the veins also cause other symptoms. Note that thrombophlebitis is not caused by infection, and treatment with antibiotics is unnecessary: drug treatment should be limited to anti-inflammatory analgesics. Bleeding, skin changes, and ulcers These are the complications of varicose veins that mandate consideration of treatment. They are all associated with high venous pressure in the upright position, as a result of incompetent venous valves. Bleeding is uncommon and usually occurs from a prominent vein on the leg or foot with thin, dark, unhealthy skin overlying it. “Skin changes” range from eczema, through brown discoloration, to florid lipodermatosclerosis with induration of the subcutaneous tissues ( fig 1 ). Sometimes this can become painfully inflamed—“inflammatory liposclerosis”—which is often misdiagnosed as phlebitis or infection. If neglected, lipodermatosclerosis can lead to ulceration, which can be chronic and troublesome: treatment of ulcers will not be considered in this review. Skin changes (lipodermatosclerosis) caused by venous hypertension. Recognition of skin damage is fundamental in examination of varicose veins What other conditions can varicose veins be confused with? Many people have telangiectases on their legs—often called thread, spider, or broken veins. Small dark blue reticular veins are also common. All of these are of cosmetic importance only. They are not the same as varicose veins, though they often occur in association with them. Many people with varicose veins worry about deep vein thrombosis, but the superficial veins of the legs that become varicose are separate and distinct from the deep veins where deep vein thrombosis occurs. Varicose veins pose no proved risk of deep vein thrombosis during people's normal daily lives. Varicose veins occurring as a result of a deep vein thrombosis are uncommon. However, varicose veins may coexist with deep vein incompetence, particularly in people with complications such as lipodermatosclerosis or ulcers, which makes treatment more difficult. How should varicose veins be assessed? Examination should be done with the patient standing in good light, when the extent and size of varicose veins and the presence of other venous blemishes (such as telangiectases) will be clear. The distribution of varicose veins may well suggest that they are related to the long or short saphenous system. Sometimes a large varix with a palpable defect in the fascia beneath provides clinical evidence of an incompetent perforating vein. The most important medical issue is the presence or absence of skin damage resulting from venous hypertension. Tourniquet tests (such as the Trendelenberg test) have been abandoned by vascular specialists: they are inaccurate and have been superseded by the use of ultrasonography. Knowledge of the principle of tourniquet tests seems to persist in professional examinations as a test of the understanding of venous incompetence and the usual sites where it occurs. Incompetence at the saphenofemoral junction in the groin is by far the commonest: less common sites are the saphenopopliteal junction behind the knee, various perforating veins, and the deep veins ( fig 2 ). Main superficial veins of the legs commonly affected by varicose veins. Incompetence at the saphenofemoral junction in the groin is the commonest cause of reflux from the deep to superficial systems, but there are many other potential sites. Incompetence of calf perforators is not (as was once believed) a common and important problem, and when present it is often corrected by long saphenous vein surgery. (The long and short saphenous veins are also called the great and small saphenous veins 5 ) Sites of venous incompetence are best diagnosed by duplex ultrasound scanning, 6 which is being done increasingly during initial specialist assessment. 7 Duplex scanning shows both venous anatomy and blood flow and is essential for assessing more complex cases ( fig 3 ). Use of a hand held Doppler machine provides a quick screening test for selecting those who need duplex scanning. 8 The main indications for a duplex scan are Duplex ultrasound scan of varicose veins showing the short saphenous vein (SSV) joining the popliteal vein (PV) with the popliteal artery (PA) adjacent. The patient is standing, and the calf has just been squeezed and released: the colour indicates reflux down the short saphenous vein as a result of an incompetent valve at the saphenopopliteal junction Reflux in the popliteal fossa Recurrent varicose veins Complex or unusual varicose veins History of deep vein thrombosis. The accuracy of all Doppler tests is operator dependant, and venous Doppler examination is not a skill most doctors should expect to practise (unlike hand held Doppler assessment of arterial pressures for limb ischaemia). What should people with varicose veins be told? Good explanation is fundamental. Most patients need reassurance that their varicose veins are unlikely ever to cause them harm and that treatment is not essential. For those who need or want treatment, a variety of options is now available. In discussing these, it is important to specify the potential complications, especially for patients who want treatment for cosmetic reasons or minor symptoms. Medicolegal action against specialists for varicose vein treatments is relatively common. 9 Patients should be told that varicose veins may recur—but this is less common after carefully planned treatment. Patients for whom discomfort is the main problem should be advised that wearing support hosiery can provide good relief. 10 Elevation of the legs may relieve symptoms. Advice about regular exercise sounds sensible but is not supported by any evidence. For people who are obese, weight loss may reduce symptoms and would make any intervention easier and safer (but losing a lot of weight may make varicose veins more visible). Referral guidance for varicose veins from the National Institute for Health and Clinical Excellence (NICE) 11 Emergency—Bleeding from a varicosity that has eroded the skin Urgent—Varicosity that has bled and is at risk of bleeding again Soon—Ulcer that is progressive or painful despite treatment Routine— Active or healed ulcer or progressive skin changes that may benefit from surgery Recurrent superficial thrombophlebitis Troublesome symptoms attributable to varicose veins, or patient and doctor feel that the extent, site, and size of varicosities are having a severe impact on quality of life Referral for specialist advice Guidelines from the National Institute for Health and Clinical Excellence (NICE) provide a good summary of the usual indications for referral, including the degrees of urgency for those with complications such as bleeding (see box). 11 Operations for varicose veins For patients with symptomatic veins and substantial venous incompetence, surgery has been the optimal treatment for many years. Inadequate assessment and operations done to mediocre standards gave varicose vein surgery a suspect reputation, but in recent years thorough treatment by interested specialists has become more widespread. Evidence from a recent UK based randomised controlled trial has shown that varicose vein surgery is both clinically and cost effective (within the normal parameters of the National Health Service). 12 , 13 Nevertheless, varicose veins may gradually recur by a process of neovascularisation (regrowth and enlargement of veins) even after thorough surgery, or they may develop elsewhere in the legs. 14 Conventional surgery This usually means saphenofemoral ligation (not just a “high tie” but ligation of the long saphenous vein flush with the femoral vein) with stripping of the long saphenous vein and phlebectomies (stripping is supported by evidence from randomised controlled trials). 14 Precise technique varies, mostly with the aim of reducing postoperative bruising. Patients with obese legs or big varicose veins may have considerable post-operative bruising, but many patients have little discomfort and recover quickly, requiring no further intervention and being completely rid of all their varicose veins. Radiofrequency and laser ablation These are alternatives to stripping of the long saphenous vein. If done without any other kind of treatment they may cause some varicose veins to disappear, but usually varicose veins need to be dealt with by phlebectomies or sclerotherapy. Radiofrequency and laser ablation each involve passing a probe up the long saphenous vein from knee level to the groin under ultrasound guidance and then ablating the vein in sections. This avoids a groin incision and may lead to less bruising and quicker recovery. These benefits have been documented in small randomised studies for radiofrequency ablation 15 , 16 and by large case series for both methods, 17 - 20 but the scale of the advantages remains uncertain. Some surgeons use these techniques under local anaesthetic infiltration rather than general anaesthesia. Most major studies of varicose veins are concerned with treatments for venous ulcers Randomised studies on the clinical and cost effectiveness of foam sclerotherapy, and of radiofrequency and laser ablation compared with conventional surgery, are needed to establish the proper place of these treatments in the management of varicose veins Data on long term outcomes (at least five years and preferably 10 years after treatment) are important because varicose veins may return gradually in the years after treatment Information about large numbers of patients having foam sclerotherapy would be useful, with comprehensive data on adverse events to address concerns about the possible risk of stroke The precise place of laser and radiofrequency ablation remains uncertain. They require dedicated equipment and use of intraoperative duplex ultrasonography, and they take longer to do than conventional surgery in experienced hands. The amount of benefit for patients is variable: obvious varicose veins still need to be treated, and phlebectomies of large veins are often the main cause of bruising and discomfort after the operation—not the groin incision. Varying longer term results (two to three years) have been reported, but in general outcomes seem similar to those of surgery. 15 It has been suggested that endovenous ablation techniques may lead to less neovascularisation in the groin than surgical dissection, so reducing this cause of recurrence of varicose veins. Sclerotherapy Conventional sclerotherapy. This involves injection of a sclerosant—commonly sodium tetradecyl (STD) or polidocanol—into varicosities, followed by a period of compression bandaging and/or compression hosiery. There is little good evidence on how long compression needs to be worn and advice varies from a few days to three or four weeks. The main risk of sclerotherapy is injection outside the vein, which can result in local tissue necrosis and scarring. Further reading Medline Plus. Varicose veins. www.nlm.nih.gov/medlineplus/varicoseveins.html Clinical Evidence. Varicose veins. www.clinicalevidence.com/ceweb/conditions/cvd/0212/0212.jsp Michaels JA, Campbell WB, Brazier JE, MacIntyre JB, Palfreyman SJ, Ratcliffe J, et al. Randomized clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial). Health Technol Assess 2006; 10 (13). [ PubMed ] ( www.hta.ac.uk/fullmono/mon1013.pdf )—This Health Technology Assessment monograph includes reviews of the epidemiology, assessment, and treatment of varicose veins, as well as a study on clinical and cost effectiveness of surgery and sclerotherapy Information resources for patients There are a lot of websites set up by clinicians and clinics treating varicose veins, which provide variable information. Some are objective and informative but many are quite brief and others are biased towards the particular treatments they are offering. Most give a reasonable basic description of varicose veins and the problems they can cause. The Medline Plus and Clinical Evidence web pages cited above Best Treatments. Varicose veins. www.besttreatments.co.uk/btuk/conditions/15366.html MayoClinic.com . Varicose veins overview. www.mayoclinic.com/health/varicose-veins/DS00256 Campbell B. Understanding varicose veins . Poole: Family Doctor Publications, 2006 Tips for GPs People with varicose veins often present because of fears about possible future harm: these fears are usually inappropriate and can be allayed by explanation and reassurance Many patients with varicose veins have leg symptoms for other reasons: a few questions will often identify a different problem The most important medical reason to refer is recognition of complications such as bleeding or skin damage due to venous hypertension Referral for symptoms of discomfort or for cosmetic reasons is often influenced by local guidelines, but clear criteria are elusive and decisions can be difficult There is no need to assess the precise sites of venous incompetence: clinical tests are inaccurate, and Doppler ultrasound assessment can be done after referral. Simple observation of the size and distribution of the varicose veins and recognising skin damage from venous hypertension are the important issues Superficial thrombophlebitis is not an infective condition and does not require antibiotic treatment. A hard, red, tender area just above the ankle is often inflammatory liposclerosis and not thrombophlebitis Conventional sclerotherapy is a clinically and cost effective treatment for smaller varicose veins, particularly those that are not subject to upstream incompetence and those below the knee. 12 , 13 However, its results are not long lasting in the presence of saphenofemoral reflux (the most usual situation for varicose veins with troublesome symptoms): a randomised controlled trial found that most varicose veins recur within five years. 21 Sclerotherapy became popular in the 1970s, but its use then declined because so many varicose veins recurred. Foam sclerotherapy This involves mixing sclerosant with a small quantity of air (or other gas) to produce a foam that spreads rapidly and widely through the veins, pushing the blood aside and causing the veins to go into spasm. This is believed to increase the effectiveness of sclerosant in obliterating long segments of superficial veins. Duplex ultrasonography is used to guide placement of the injecting cannula in the chosen vein and to monitor spread of sclerosant through the veins ( fig 4 ). The treated leg is bandaged, and compression hosiery is advised for up to a month after treatment. After treatment, larger varicose veins are commonly hard and prominent for many weeks before they gradually shrivel. Further sessions of foam treatment may be required for extensive or bilateral varicose veins. Foam sclerotherapy: the short saphenous vein is being cannulated under duplex ultrasound guidance before injection of foam A recent randomised controlled trial found that foam treatment (combined with saphenofemoral ligation) had short term advantages compared with conventional surgery. 22 Evidence for the longer term effectiveness of foam sclerotherapy is mostly from large case series, which show obliteration of varicose veins for up to three years. 23 There has been concern about the possibility of foam entering the deep veins and causing venous thromboembolism, but this seems rare. Visual disturbances have been reported, particularly in individuals prone to migraine, and these may be due to vasospasm. Of greater concern is the possibility of foam passing through a patent foramen ovale (present in many people) to enter small arteries in the eye or brain. A recent report of a stroke attributed to foam treatment, albeit after injection of an unusually large volume of foam, must sound a note of caution. 24 Nevertheless, the popularity of foam sclerotherapy continues to increase among both patients and specialists, and it looks set to become an important treatment for varicose veins. Which treatment should patients choose for their varicose veins? It is not yet clear just how the various treatments will fit into the management of varicose veins. It may well be that some are more suitable for certain kinds of patients (for example, those with large varicosities or obese legs), and patients may have personal preferences. It is unlikely that most specialists will offer all the possible treatment modalities, but they ought to be able to give good advice about treatment choices and to provide a range of options. The table shows some of the considerations that may guide the choice of treatment. Features of the various treatments now available for varicose veins * Anaesthesia required General General or extensive infiltration of local Local or none Postoperative pain and discomfort Variable—many patients have minimal discomfort, but others are very bruised Avoids a groin incision and causes less thigh bruising in many patients No incisions or bruising, but veins may be lumpy and tender for weeks Need for compression (bandaging or stocking) Usually advised for up to 10 days but not essential Usually advised for several days (like surgery), sometimes longer Usually advised for about two weeks, but up to four weeks Can both legs be treated at a single procedure? Yes Yes under general anaesthesia No, usually not Further procedures required for clearance of varicose veins? No Frequently, unless done under general anaesthesia with conventional phlebectomies (or sclerotherapy) Yes, frequently Long term freedom from varicose veins A few varicose veins reappear in many patients: about a third have troublesomerecurrence at 10 years Similar to surgery up to three years. Longer term results not known Probably similar to surgery up to three years, but may need further treatments. Longer term results not known Uncertainties and the need for further research The most important studies required are randomised comparisons of the different treatments with good long term follow up—in particular, comparison of foam sclerotherapy with conventional surgery. It will be several years before long term (≥ 10 years) data are known for the newer treatments. Studies need to include economic modelling which will help to guide the way services are delivered: for example, are repeated outpatient treatments with foam sclerotherapy more cost effective than a single operation under general anaesthesia for bilateral varicose veins? Meanwhile, specialists will need to advise patients as objectively as they are able about choices of treatment and to audit their own results as thoroughly as they can. I thank Georgios Lyratzopoulos, consultant in public health medicine, David Kernick, general practitioner, and Andrew Cowan, consultant vascular surgeon, for their critical and helpful advice during the preparation of this review. I also thank the Medical Photography Department of the Royal Devon and Exeter Hospital and the Clinical Measurements Department for preparing the figures. Funding. None Competing interests. None declared. Dissertations & Theses Collections EliScholar > Medicine > Medicine Thesis Digital Library > 3656 Yale Medicine Thesis Digital Library Dissertation on varicose veins. Andrew Judson White , Yale University. Date of Award Document type. Open Access Thesis Degree Name Medical Doctor (MD) Recommended Citation White, Andrew Judson, "Dissertation on varicose veins" (1846). Yale Medicine Thesis Digital Library . 3656. https://elischolar.library.yale.edu/ymtdl/3656 This Article is Open Access Since May 26, 2020 Included in Medicine and Health Sciences Commons Advanced Search Notify me via email or RSS Disciplines Researcher Profiles Author Help Copyright, Publishing and Open Access Terms & Conditions Open Access at Yale Yale University Library Yale Law School Repository Home | About | FAQ | My Account | Accessibility Statement Privacy Copyright Early warning signs in legs could be symptom of painful condition says doctor There are several early signs of varicose veins, said Dr Mark Bratby 12:16, 24 Jun 2024 Updated 17:54, 24 Jun 2024 A vein expert has revealed the five common warning signs you are developing varicose veins - and when to consider wearing compression socks daily. Varicose veins are very common, affecting one in three people at some point in their lives. Identifying early warning signs and taking proactive steps can be crucial in managing this condition. Hot weather , such as that set for the UK this week, can exacerbate these symptoms by increasing vein dilation and blood pooling. Dr Mark Bratby, medical director of Veincentre , has explained how to spot the subtle signs that indicate you might benefit from daily compression sock use. He said: "Varicose veins can often start as a minor issue but, if left unchecked, they can lead to more serious complications such as skin ulcers or deep vein thrombosis. Early intervention with compression socks can help to manage symptoms and improve overall leg health." Early signs of varicose veins Persistent leg fatigue Experiencing leg fatigue that persists throughout the day is one of the early indicators of poor blood circulation, according to Dr Bratby. "If you often find your legs feeling heavy or tired, especially after long periods of standing or sitting, it could be a sign that your veins are struggling to pump blood efficiently," he said. Swelling in the lower legs and ankles Swelling, particularly in the lower legs and ankles, is another key sign. "When the veins are not functioning properly, fluid can leak into the surrounding tissues, causing swelling," Dr Bratby said. "Wearing compression socks can help reduce this swelling by encouraging blood flow back towards the heart." Discomfort or pain Leg discomfort or pain is often overlooked but can be an early symptom of varicose veins. "Many people dismiss aching or throbbing pain in their legs, attributing it to other factors like exercise or long work days. However, persistent pain can be an indicator that your veins are under strain," Dr Bratby advised. "Compression socks can alleviate some of this discomfort by supporting your veins and improving circulation." Visible vein abnormalities "Noticeable changes in the appearance of your veins, such as bulging or darkening, should not be ignored," Dr Bratby warned. "These visible abnormalities often suggest that your veins are working overtime to circulate blood. Daily compression wear can help manage these changes by reducing pressure on the veins." Itching and skin changes Itching and changes in the skin around the veins, such as dryness or discolouration, are subtle signs that should prompt action. "These symptoms can indicate that blood is pooling in the veins, leading to inflammation and skin changes," Dr Bratby said. "Compression socks can improve blood flow and help maintain healthy skin." Proactive management Incorporating compression socks into your daily routine is a simple and effective way to manage symptoms and prevent further complications. "Compression socks apply gentle pressure to your legs, supporting the veins and promoting better circulation," Dr Bratby said. "They are particularly beneficial for those who spend long hours on their feet." However, while helpful, compression socks are not a cure for varicose veins. "If your symptoms are worsening, the only way to truly get rid of varicose veins is through treatment," Dr Bratby explained. "With treatment, you won't need to rely on compression stockings." Treating varicose veins eliminates both the visible bulging veins and the accompanying symptoms. "Treatment effectively removes varicose veins and all associated symptoms like persistent leg fatigue, swelling, and discomfort, reducing the need for daily compression socks," Dr Bratby explained. "Post-treatment, patients typically experience significant improvements in quality of life, including reduced leg pain, enhanced mobility, and a more aesthetically pleasing appearance of their legs," he added. MORE ON Heatwave Fitness Periods Get email updates with the day's biggest stories. 277 IMAGES (PDF) Endovascular Management of Varicose Veins: A Review of Literature (PDF) A study of etiology of secondary varicose veins Varicose veins causes symptoms and treatments (PDF) Clinical Presentation of Varicose Veins Varicose Veins Clinical Case Scenario MCQ Varicose Veins VIDEO Varicose Veins: Is Surgical Treatment Right for You? Varicose Veins Varicose Veins Causes,Symptoms And Treatment In Urdu/Hindi Medical Q&A: Part 2 โดยนายแพทย์จักรีวัชร veins example CRITICAL ISSUES IN THE TREATMENT OF VARICOSE VEINS COMMENTS Treatment Patterns and Outcomes in Patients with Varicose Veins The majority of individuals with varicose veins seek treatment because of symptoms, such as aching, throbbing, fatigue, pruritus, ankle swelling, and tenderness, rather than cosmetic reasons. Furthermore, varicose veins are a manifestation of chronic venous insufficiency, which can progress to leg pain, leg edema, chronic skin changes, and ... Global impact and contributing factors in varicose vein disease Introduction. Varicose veins (VVs) are the most frequently reported medical condition that causes significant morbidity and long-lasting costs for the patient. 1 -4 Therefore, it requires great attention. VVs are convoluted, expanded, and stretched subcutaneous veins of the lower leg and are an easily observable clinical condition. PDF Study of the Clinical Profile of Varicose Vein Disease Introduction: Varicose veins are part of the spectrum of chronic venous diseases and include dilated, tortuous veins of lower limbs, spider telangiectasia and reticular veins. Varicose vein disease is a very common problem of the western world and mostly their patients come for treatment because of cosmetic reasons. Global impact and contributing factors in varicose vein disease development Different risk factors associated with the advancement of varicose veins are age, gender, occupation, pregnancy, family history, smoking, BMI and obesity, exercise, genetic factor, and current lifestyle. In varicose veins, some contributory elements may also play an important role in the disease development, incorporating constant venous wall ... Severe varicose veins and the risk of mortality: a nationwide Introduction. Varicose veins (VVs) can be considered a common disease with prevalence ranging from 2% to 56% in the adult population. 1 Following clinical examination, VV diagnosis is primarily based on the presence of enlarged and twisted veins in the lower extremities. 1 2 Among people with VV, 1%-4% of individuals show higher severity grades (Clinical-Etiological-Anatomical ... Clinical Presentation of Varicose Veins Varicose vein is one type of venous insufficiency that presents with any dilated, elongated, or tortuous veins caused by permanent loss of its valvular efficiency. Destruction of venous valves in the axial veins results in venous hypertension, reflux, and total dilatation, causing varicosities and transudation of fluid into subcutaneous tissue. The first documented reference of varicose veins ... A Comprehensive Review on Varicose Veins: Preventive Measures and The purpose of this article was to review the different preventive measures and treatments for varicose veins disease. Varicose veins are tortuous, enlarged veins that are usually found in the lower extremities damages blood vessels leading to its painful swelling cause's blood clots, affecting people over increasing prevalence with age and affects the proficiency, productivity, and life ... Thesis The main objective of this thesis was to examine the association between varicose veins and specific risk indicators and outcomes, taking into account the effects of more severe venous disorders often found in combination with varicose veins. This work is based on the VEnous INsufficiency Epidemiological and economical Study (VEINES), a one ... PDF Risk Factors of Varicose Veins 5.3 Dietary factors, alcohol consumption, smoking and the occurrence of varicose veins (II) Subjects consuming three to four slices of bread per day had a slightly higher prevalence of varicose veins (34.9%) than the other groups, 0-2 and >4 slices of bread (32.9% and 33.2%) (Table 5). Treatment of Varicose Veins Affects the Incidences of Venous Association of varicose veins with incident venous thromboembolism and peripheral artery disease. JAMA. 2018; 319:807-817. doi: 10.1001/jama.2018.0246 Crossref Medline Google Scholar; 6. Müller-Bühl U, Leutgeb R, Engeser P, Achankeng EN, Szecsenyi J, Laux G. Varicose veins are a risk factor for deep venous thrombosis in general practice ... Pathogenesis of Varicose Veins The Framingham study data (. 9. ) yielded an annual incidence of 2.6% in women and 1.9% in men. Varicose veins mainly affect the adult population, and incidence increases with age. With a shift to less invasive, endovenous treatment modalities in recent years, much attention and interest has been drawn to venous disease. (PDF) Clinical Presentation of Varicose Veins Class-0 is no visible or palpable signs of venous disease, Class-1 is telangiectasis, Class-2 is a varicose vein, Class-3 is varicose veins with oedema, Class-4 is varicose veins with pigmentation ... The care of patients with varicose veins and associated chronic venous The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema ... Evidence for varicose vein treatment: an overview of systematic reviews Varicose veins affect nearly 30% of the world's population. This condition is a social problem and needs interventions to improve quality of life and reduce risks. ... assessment of whether lifestyle modifications might be useful as prophylaxis and for avoiding complications of varicose veins. Governments should prioritize topics like this ... Varicose Vein Diagnosis System and Therapy: A Review Varicose veins are swollen and twisted veins that occurs on the legs. It is also known as varicose or varicosities. They appear in red or bluish - purple color. They are painful. It usually occurs when veins are weak, dilated, enlarged and overfilled with blood. It usually occurs in women. Varicosed veins appears on superficial layer. It mostly affects the veins in legs and occurs mainly due ... (PDF) Varicose veins: a clinical study The objective of the study is: 1) Analysis of the clinical features of varicose vein. 2) To know the various treatment modalities adapted for the management of varicose veins. Varicosity of the lower limb is a common clinical entity with, age group of 31-40 being commonly affected. Varicose Veins of the Lower Extremity: Doppler US Evaluation Protocols Introduction. Varicose veins and venous insufficiency are common, with varying prevalence rates; in one study (), varicosities were found in 40% of men and 16% of women.In addition to causing varicosities, chronic venous insufficiency can cause eczema, edema, hyperpigmentation, and scarring, with more severe cases resulting in venous stasis ulcers (Figs E1, E2). Clinical Study And Management Of Lower Limb Varicose Veins Methods: A prospective study was carried out between July 2013 to June 2015. During this period 50 cases of varicose veins of lower limbs were admitted to our hospital and were studied in detail. After thorough clinical examination and relevant investigation they are all subjected to surgical management. Results: Out of 50 cases studied, 35 (50 ... CASE STUDY ON PATIENT WITH VARICOSE VEINS Abstract. Varicose Veins can be explained as a disorder of the veins (especially of legs) wherein they get affected due to the backward flow and turbulence in the circulation of the blood. The ... Study on the Cause and Clinical Signification of Vascular Remodeling of Varicose veins (4) at the same level there is a wall with valvular degree of synchronization remodeling changes the same vein different parts of remodeling is no obvious rule, its sequence is indefinite, i.e. \. (5) varicose veins experienced a relatively normal period, compensatory and decompensated three step-by-step development process. The Determination and Its Significance of Oxygen Free Radicals in Objective: by measuring the severity of the two groups of patients with varicose veins in different parts of the MDA concentration , SOD activity to explore the role of oxygen free radicals and antioxidant enzymes in varicose veins pathogenesis . Materials and Methods : The subjects were randomly select our hospital from 2004.5 to 2004.11 after lower extremity deep venous angiography , Doppler ... Varicose veins and their management Varicose veins are widely seen as medically unimportant and deserving low priority for treatment. They are common, affecting nearly a third of adults in Western societies, and few people with varicose veins are ever harmed by them. However, they cause concern and distress on a large scale, most of which can be dealt with by good explanation and ... "Dissertation on varicose veins" by Andrew Judson White Dissertation on varicose veins. Author. Andrew Judson White, Yale University. Date of Award. 1-1-1846. Document Type. Open Access Thesis. Degree Name. Medical Doctor (MD) Recommended Citation. White, Andrew Judson, "Dissertation on varicose veins" (1846). Yale Medicine Thesis Digital Library. 3656. Early warning signs in legs could be symptom of painful condition Varicose veins are very common, affecting one in three people at some point in their lives. Identifying early warning signs and taking proactive steps can be crucial in managing this condition. essay homework paper phd project resume review speech study thesis