Varicose Vein
It is the permanently elongated, dilated vein with tortuous path causing pathological circulation. There is reversal of blood flow through its faulty valves. Risk factors being heredity; female sex; occupation that demands prolonged standing; immobility; raised intra- abdominal pressure like in sports, tight clothing, pregnancy, raised progesterone level and altered estrogen-progesterone ratio, chronic constipation, high heels.
Prevalence of varicose veins is 35%; severe varicose veins is 10%; chronic venous insufficiency (CVI) is 8% ; ulcer is 2%. Pathogenesis include 2 theories : Fibrin Cuff Theory & White cell Trapping Theory . Incompetence of venous valves leading to stasis of blood leading to ambulatory venous hypertension followed by defective microcirculation & RBC diffuse into tissue planes ,lysis of
RBC’s followed by release of hemosiderin ,pigmentation happens followed by dermatitis, endothelial damage occurs , followed by severe anoxia and chronic venous ulceration.
SYMPTOMS IN VARICOSE VEINS : Dragging pain, postural discomfort ,Heaviness in the legs, Night-time cramps-usually late night ,Oedema feet, itching (feature of CVI) , Discoloration/ulceration in the feet/painful walk.
Signs include Visible dilated veins in the leg with pain, distress, nocturnal cramps, feeling of heaviness, pruritus, Pedal oedema, pigmentation, dermatitis, ulceration, tenderness, restricted ankle joint movement. + Bleeding, thickening of tibia occurs due to periostitis. Positive cough impulse at the saphenofemoral junction. Saphena varix-a large varicosity in the groin which becomes visible and prominent on coughing. Investigations that can be done Venous Doppler ,Duplex scan ,Digitally Coded Free Flow USG,Plethysmography,Venography ,Varicography.
