Varicose Veins

Varicose veins

Raymond G Buick FRCS

Approx 12 minutes

Varicose veins

• Varicose veins are swollen and enlarged veins • usually blue or dark purple• Lumpy• Bulging • torturous• twisted

Varicose-veins.jpg Original uploader was Jackerhack at en.wikipediaCC-BY-SA-2.5.

Varicose veins

• Legs• Testicular veins• Portal vein• Ano-rectal• Oesophageal• umbilicus

Varicose veins

• common – may be present in up to 30% of the UK adult

population– 40,000 operations/year in England & Wales– F>M

Varicose veins

• Long (great) saphenous vein in 50% • Short (small) saphenous vein in 30% • both saphenous veins in 20%.

Aetiology / Pathogenesis

• Aetiology unknown.

• Limb veins – valves


• Limb veins – valves– Muscle pump

Venous drainage of the lower limb

• Limb veins – valves• Superficial veins– Great (long) saphenous vein – Small (Short) saphenous vein

• Deep Veins • Perforating veins


• Limb veins – valves– Muscle pump

• Incompetent valves

Diagnosis

• The best diagnostic tool is the duplex ultrasound. – Sensitivity 90 to 95% – specificity 95 to 100%.

Risk Factors• a positive family, • increasing age, • pregnancy.

Risk Factors• a positive family, • increasing age, • pregnancy.

• Other controversial risk factors• obesity, • menopause• standing for long periods of time, • decreased mobility• Injury / post phlebitis• Abdominal straining• Venous / arteriovenous malformations

Symptoms• aching; heavy legs• itching; • leg cramps; (making a sudden move or standing up)

• restless legs (relieved by walking, symptoms worse during the evening and night)

• Skin discolouration (brownish blue shinny skin)

• eczema-like skin changes • swelling; ankles• small reticular veins and varicosities

complications• Injury• Bleeding• superficial thrombophlebitis (Blood clotting within affected

veins. - can extend into deep veins)

• Acute fat necrosis (ankle of overweight patients – lipodermatosclerosis)

• ulceration• carcinoma or sarcoma (longstanding venous ulcers -malignant

transformation - rate 0.4% to 1%.)

complications• Injury• Bleeding• superficial thrombophlebitis (Blood clotting within affected veins. - can

extend into deep veins)

• Acute fat necrosis • (ankle of overweight patients – lipodermatosclerosis)

• ulceration• carcinoma or sarcoma (longstanding venous

ulcers -malignant transformation - rate 0.4% to 1%.)

complications• Injury• Bleeding• superficial thrombophlebitis (Blood clotting within affected

veins. - can extend into deep veins)

• Acute fat necrosis (ankle of overweight patients – lipodermatosclerosis)

• ulceration• carcinoma or sarcoma (longstanding venous ulcers -malignant

transformation - rate 0.4% to 1%.)

Treatment

• asymptomatic - no treatment required. Prophylactic treatment does not reduce the progression of venous disease.

• Symptomatic patients – to reduce symptoms– cosmetic reasons (may be valid)

Treatment

• aim of treatment

– to reduce symptoms – improve appearance

Treatment

• Conservative treatment

• Invasive Treatment

Treatment

• Conservative treatment – compression – Elevate leg– Address risk factors

Treatment


• Surgery

• Endovenous Ablation Techniques

Treatment

• Invasive Treatment• Surgery– Surgical ligation – Surgical stripping– Cryostripping

– Subfascial Endoscopic Perforator vein Surgery – SEPS– Transilluminated Powered Phlebectomy - TIPP

Treatment

• Invasive Treatment• Endovenous Ablation Techniques– Radiofrequency Ablation– Endovenous Laser Treatment

– Sclerotherapy• Liquid• foam

Surgery

– Surgical ligation – Surgical stripping• Great Saphenous Vein

– Saphenofemoral disconnection + stripping» Groin to ankle - unnecessary: increased risk of

Saphenous Nerve Injury» Groin to knee – good initial results - reduced recurrence rate

• Small Saphenous Vein– Saphenopopliteal disconnection

» Stripping – damage to Sural Nerve

Risks of Treatment

• Problems arising from superficial venous surgery are the most common reason for litigation in the UK.

Risks of Treatment

• Most settled claims result from a failure to warn patients about nerve damage.

Risks of Treatment

•Most settled claims result from a failure to warn patients about nerve damage.

Risks of Treatment

• Conservative treatment - Very few


Risks of Treatment

• Invasive Treatment– Long saphenous vein - saphenous nerve damage

– 8% to 40%

Risks of Treatment


– LONG STRIP(groin to ankle Level)

– SHORT STRIP (groin to knee level

Risks of Treatment


– LONG STRIP(groin to ankle Level) - saphenous nerve damage 40%

– SHORT STRIP (groin to knee level)- saphenous nerve damage 8%

Risks of Treatment


SHORT STRIP

more safe than

LONG STRIP

Risks of Treatment

• Invasive Treatment– Short saphenous vein - Sural nerve damage • 2.1%

• Problems arising from superficial venous surgery are the most common reason for litigation in the UK.• Most settled claims result from a

failure to warn patients about nerve damage

Varicose veins

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Varicose Veins

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