Varicose Veins

Varicose Vein Development

  • Veins contain valves that only allow blood to flow one direction – towards the heart
  • In the legs this means that as the leg muscles contract, they squeeze blood upwards against gravity
  • When these valves become incompetent, the blood pools (drawn by gravity) in the veins and is not effectively pumped back to the heart
  • The deep vs superficial veins have a connection called the “perforators” that allow blood to flow from the superficial veins to the deep veins
  • When the valves are incompetent in these perforators, blood flows from the deep veins back into the superficial veins and overloads them
  • This leads to dilatation and engorgement of the superficial veins

 

Venous Disease

  • These veins are referred to as “varicose veins”
  • These veins become leaky due to the pressure, and leak small amounts of blood into the nearby tissues
  • The haemoglobin in this blood breaks down to “haemosiderin”, which is deposited around the shins
  • This gives a brown discolouration to the lower legs
  • This causes the skin to become dry and inflamed. This is called “varicose eczema
  • The skin and soft tissue become fibrotic causing tight, narrowed lower legs. This is called “lipodermatosclerosis

 

Presentation

  • Cosmetically unappealing dilated superficial leg veins
  • Heavy / dragging sensation in the legs
  • Muscle cramps
  • Complications
    • Ulcers
    • Infection
    • Thrombophlebitis and DVT
  • Positive Trendelenburg’s Test

 

Management

  • Simple measures
    • Mobilising
    • Keep legs elevated when possible to help drainage
    • Compression stockings
  • Surgical options
    • Endothermal ablation (a catheter is inserted into the vein and radiowaves are used to heat the vein and make it permanently collapse)
    • Sclerotherapy (an injection into the vein causes it to permanently collapse)
    • Stripping (veins are pulled out of the leg)
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