Varicose veins are dilated, tortuous, enlarged veins. Veins have leaflet valves to prevent blood from flowing backwards. Leg muscles pump the veins to return the blood to the heart against gravity.

Anatomy and physiology of the venous system

Deep venous system:

The channel through which 90% of venous blood is pumped out of the legs

Superficial venous system:

The collecting system of veins

Perforating veins:

The conduits for blood to travel from the superficial to the deep veins

Musculovenous pump:

Contraction of foot and leg muscles pumps the blood through one-way valves up and out of the legs

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varicose-vein

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  • Prolonged dilation damages the valves, so the blood flows in the wrong direction
  • The resulting back pressure is
    termed “venous hypertension”,
    and this is what causes symptoms

FACTORS PREDISPOSE TO VARICOSE VEINS :

Age, sex Weight, height, heredity, posture and occupation. There is a clear family history of disorder having abnormalities in Fox C2 gene. It is classified by ICD 10 as I 183 diseases.

SYMPTOMS AND SIGNS :

Aching, Heavy legs, Swelling, Cramps, Eczema Cramping Bleeding and Ulcers.

INVESTIGATION:

Varicose veins patients need to undergo an assessment by duplex scan. Routine tests before surgery

STAGES:

  • C0-No visible or palpable signs of venous disease.
  • C1-Telangectasia or spider veins.
  • C2-varicose veins
  • C3-oedema.
  • C4- Skin changes due to venous disorder.
  • C5- As with c4 with healed ulcer.
  • C6- Skin changes with active ulcer.

TYPE OF VARICOSE VEINS :

  • Trunk Varicose Veins
  • Reticular Varicose Veins are Red.
  • Telangiectasia / Spider Veins / Thread Veins

MANAGEMENT :

Patients without symptoms or signs of Lipodermatosclerosis or ulceration can be treated by compression stockings. Active treatment is a must for patient who has complication of venous hypertension. Treatment can be divided into:
Conservative: 1) Elevation 2) Compression
Interventional : 1) Stripping 2) Laser Abletion 3) Radio Frequency Abletion 4) Micro or Stab Phlebectomy 5) Sclerotherapy

ENDOGENOUS LASER TREATMENT:

The endogenous laser treatment is a 30-45 min in office procedure with no downtime or scarring. The Surgeon determines particular treatment that is most appropriate for the patient. EVLT for elimination of varicose veins is quickly becoming the gold standard treatment for truncate varicose veins. Treatment uses laser energy, which is simply a highly concentrated beam of light. This procedure is minimally invasive and requires no general anesthesia. Only local anaesthesia is used to numb the area where the surgeon is working. A thin fiber is inserted in the vein through a small entry point in the skin. A laser light is emitted by the fiber as the fiber is pulled back by through the vein. The veins that are closed are superficial veins that handle less than five percent of body’s blood flow.

PHLEBECTOMY:

It is a minimally invasive surgical procedure that removes varicose veins. An ambulatory Phlebectomy is performed under L.A. No stitches are required. It is often performed following laser procedure to remove any large surface veins left behind after the procedure.

ADVANTAGES OF LASER TREATMENT :

  • Treatment less than an hour
  • Can be performed under local anesthesia
  • 96% success rate
  • Immediate relief of symptoms
  • Return to normal activity early
  • Minimal to no scarring.

CAN VARICOSE VEINS REOCCUR ?

Yes, most commonly recurrences are due to growth of new veins on from untreated sources of venous reflux.

HOW LONG WILL I HAVE TO BE OFF WORK ?

One can return to work the day after procedure, unless otherwise instructed by Doctor.

DISCHARGE INSTRUCTIONS :

A compression dressing will be put. Stocking must be worn for 2 days continuously and during the day for one month. Working as much as possible is recommended. We do not recommend high …… aerobics for one week. Return to work after the day.