Varicose Veins

Incidence

Assessment of varicose veins

History

• 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

Primary

• Cong. abs. of valves
• Weakness/wasting of muscles
• Calf muscle pump failure

Secondary

• Obstruction of venous return due to DVT, Tumours, Pregnancy, etc.
• Klippel Trenauney Syn.- Cong. A-V fistula.

Signs & Symptoms

• Pain in the calf
• Swelling
• Skin colour changes
• Cosmetic

Investigations

• Brodie-Trendelenburg test
• Hand held doppler
• Venous duplex scan
• Plethysmography
• Venogram
• Ankle-Brachial index

Treatment

• Conservative
  • Class II compression stockings
  • Daflon/Trental/Venusmin
• Surgical
  • Ligation of SFJ/SSPJ + Stripping of LSV upto knee+ multiple avulsions.
  • Valvuloplasty
• Endovenous Laser or Radiofrequency abalation
• Injection Sclerotherapy

Indications for surgery

• Primary Varicocities
• Perforator Incompetance
• Deep venous Reflux
• Secondary Varicocities

Contraindications

• Acute infective thrombophlebitis
• Deep vein thrombosis
• Pregnancy
• Tumours

Complications

Dr. Pankaj Patel a vascular surgeon has expertise in peripheral vascular diseases, varicose veins and deep vein thrombosis

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