Varicose veins

Definition; they are dilated, twisted,elongated superficial veins that look blue In the lower limb

They are produced by incompetent valves and increased intraluminal pressure

Varicose veins affect 1 out of 2 people over age 50. They are more common in women than men.

The normal veins are taut, however if the blood flow is too sluggish, the veins slowly get dilated and tortuous in order to accommodate more blood in the lumen. Another possible reason is that the valves in the vein do not function properly and the blood leaks down with gravity and collects in the veins of the legs.

classification

 1-primary varicose vein

Primary varicose veins from result hereditary weekness of the vein wall and vakves

2-secondry varicose veins

They are sequel to deep venous thrombosis

Coditions lead to varicose veins

·  standing for long periods of time

    being overweight

    age – they appear more often as people grow older

sex – they are more common in women

going through a pregnancy

    Signs and Symptoms: • May be asymptomatic • Pain in leg • Leg fatigue

    • Leg heaviness

     • Visible dilated veins

     • Feeling of heat in the leg

     • Edema

     • Itching over affected area

    • Stasis ulcers

Evaluation

trendelenburg test

aim

this test is used to determine valves incompetence of great saphenous, deep and communicating veins

Procedure

The patient lies supine and the leg is elevated 15 second to empty all varocasities

Asoft rubber tourniquet is applied to the leg just below the knee and the patient stand

Interpertation

Normally

The saphenous vien should fill slowly from below in 30 second , with the tourniquet in the place

Abnormally

Filling from above indicate retrograde flow

After 30 seconds the tourniquet is removed , any sudden filling indicates incompetence of great saphenous vein valves

Immediate filling of varicosities despite atourniquet above them, indicates incompetent deep and communicating veins

    Doppler test is an ultrasound technique that uses sound waves to produce an image of the inside of your leg. This gives your doctor information about the direction of blood flow in your vein and whether your valves are working properly.

    Colour duplex ultrasound scanning is used to look for any abnormalities in the structure of your vein, and to look at the bloodflow through it.

Complication

    Thrombophlebitis – your superficial veins can become painful and reddened due to inflammation or blockage of your veins.

    Bleeding – your varicose veins can bleed if you cut or bump your leg. You should raise your leg above the level of your heart and apply pressure to the bleeding area to help stop the bleeding.

    Varicose eczema – this is brown or purple discolouration of the skin that often becomes permanent.

    Venous ulcers – you can get ulcers when fluid leaks out of the varicose vein into the surrounding tis

Treatment

Non surgical treatment

Sclerotherapy

Include injection of chemical into your varicose veins which damages the veins, causing them to close. Liquid sclerotherapy is often used to treat smaller varicose veins. For larger veins, foam sclerotherapy is sometimes used.

Laser therapy

continuous stream of high-intensity light to cut or destroy tissue. However, the usefulness of this therapy has not yet been determined. Intense pulsed light therapy can be used to treat small spider veins. This therapy is similar to laser therapy except that the light is applied in short bursts.

Surgical treatment

    Ligation and stripping – the vein is cut and tied off (ligation). Stripping the vein involves inserting a slender instrument into the vein through a small incision. The vein is then pulled out through a second incision.

    Phlebectomy – small incisions are made, and the veins removed with a special hook.

Physiotherapy

Positioning

The patient lies on bed with the legs vertical supported by the wall

He practice this method for 20 minutes at least twice daily

The effect of this position is to reduce edema by removing gravitational effect and reduce venous hypertention

Pandaging

Augment the muscle pump mechanism and support distended veins

Elastic stocking

Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. In this way, compression stockings also can help heal skin sores and prevent them from returning. You may be required to wear compression stockings daily for the rest of your life. For many patients, compression stockings effectively treat varicose veins and may be all that are needed to relieve pain and swelling and prevent future problem.

Massage

It is effective in reducing edema though time consuming

Slow ,firm effleurage massage start from proximal to distal to edema

We can use slow kneading and squeeze kneading to soften the edema

Care must be taken to avoid ulcer

How to prevent varicose veins?

    Avoiding crossing the legs when sitting.

    Maintaining a healthy body weight.

    Avoiding tight clothing that constricts the legs, groin or waist eg: knee high pantyhose.

    Avoiding constipation.

    When standing for long periods, shifting weight from one leg to the other every few minutes.