Varicose Veins | Medical Science Optional Notes for UPSC PDF Download

Varicose veins-Etiology

Pressure Gradient Dysfunction

• Increased Abdominal or Thoracic Pressure: Factors like COPD and pregnancy contribute to elevated pressure levels.

Dysfunction of the Venous System

(a) Venous Structural Deficit: Involves conditions such as valvular agenesis or incompetence.
(b) Decreased Calf Muscle Pump Function: Contributed to by factors like obesity, large tumors, and constipation.
(c) Venous Occlusion: Occurs due to agenesis, thrombosis, iatrogenic causes, or trauma.
(d) Venous Compression: Resulting from conditions like May-Thurner syndrome, pelvic/abdominal tumors, or radiotherapy in the pelvic/abdominal region.

Pathogenesis

Causes of chronic ulcers in leg

• Congenital AV fistula
• Bazins disease 
• Martorell's Ulcer 
• Gummatous Ulcer 
• Infective Ulcers 
• Trophic Ulcers 
• Malignant Ulcers

Symptoms

• Aching/heaviness
• Ankle swelling
• Itching
• Severe night cramps

Signs

• Twisted and enlarged veins
• Detectable pulse on tapping
• Visible tiny blood vessels (telangiectasia)
• Fine, bluish-purple veins (reticular veins)
• Swollen vein near the saphenous opening (saphena varix)
• White, scar-like spots on the skin (atrophie blanche)
• Dilated veins around the ankle (corona phlebectasia)
• Discoloration of the skin (pigmentation)
• Skin inflammation (eczema)
• Swelling in the lower legs (dependent pitting edema)
• Hardening and scarring of the skin (lipodermatosclerosis)
• Ulcers

Complications

• Bleeding
• Superficial thrombophlebitis
• Venous ulcers
• Marjolin's ulcer
• Skin discoloration (pigmentation)
• Skin inflammation (eczema)
• Hardening and scarring of the skin (lipodermatosclerosis)
• Vein calcification
• Inflammation of the tibial bone covering (tibial periostitis)
• Deformity in foot position (equinus deformity)

Investigations

• Tourniquet tests
• Handheld continuous wave Doppler
• Duplex Ultrasound Scanning
• Varicography
• Descending intravenous venography
• MR venography

Clinical Classification

• CO: No signs of venous disease
• C1: Telangiectasia or reticular veins
• C2: Varicose veins
• C3: Edema
• C4a: Pigmentation or eczema
• C4b: Lipodermatosclerosis or atrophie blanche
• C5: Healed venous ulcer
• C6: Active venous ulcer

Conservative Approaches

• Utilization of compression stockings for relief of symptoms; however, they do not impede the advancement of the condition.
• Implementation of physical therapy and manual lymphatic drainage for symptomatic relief.
• Adoption of practices such as avoiding prolonged periods of standing or sitting with bent legs, and minimizing exposure to heat.
• Regular elevation of the legs to alleviate symptoms.

Definitive Treatments

• Interventional Measures: 
  a. Primary approach: Endovenous thermal ablation involving techniques like laser and radiofrequency.
  b. Alternative: Chemical ablation through procedures such as sclerotherapy.
• Surgical Intervention:
  a. Open surgery with partial or complete removal of a vein is reserved for cases where veins are inaccessible through interventional methods.

Varicose Veins-Repeat

Q1: Complications of varicose veins in the lower extremity. (1994) 

Q2: Describe the pathogenesis of varicose ulcer. (1997)

Q3: How would you manage a young man with recurrent ulceration just above the medial malleolus of right lower limb? (2010)

Q4: Enumerate the various causes of chronic ulcers in the leg. Briefly describe how you will assess and treat a patient with varicose veins including newer modalities. (2012) 

Q5: Discuss the clinical features, investigation and management of varicose vein in Right lower limb. (2016)