Venous Diseases
Question.1. Write short note on complications of varicose veins with reasons.
Answer. Varicose veins are dilated and tortuous, superficial veins predominantly in lower limbs. Varicose veins are the price that man has to pay for erect posture.
Varicose Complications
- Eczema and dermatitis: This occurs because of extravasation and breakdown of RBCs in the lower leg.
- It leads to itching which precipitates varicose ulcer.
- This condition is treated by application of zinc oxide cream or silver sulfadiazine cream (stasis dermatitis).
- Lipodermatosclerosis: It refers to various skin changes in the lower leg associated with varicose veins such as thickening of subcutaneous tissue, indurated feel like wood, pigmentation, etc.
- It occurs because of increased venous pressure resulting in capillary leakage with extravasation of blood and firin into surrounding tissues. Blood is broken down and heme is released.
- This combines with iron giving rise to hemosiderin which is responsible for pigmentation. Classically, this affcts gaiter area of leg just above the malleoli.
Read And Learn More: General Surgery Question And Answers
- Hemorrhage: It occurs due to trauma or eczema. This is controlled by elevation of the leg and crepe bandage.
- Thrombophlebitis: It refers to the inflammation of superficial vein. In this vein is tender, hard, and cord-like.
- Here skin is inflamed and pyrexia is usually present. It is treated by bed rest, elevation, crepe bandage, antibiotics and anti-inflammatory drugs.
- Venous ulcer: It is also called gravitational ulcer. Precipitating factors are venous stasis and tissue anoxia.
- Deep vein thrombosis is also an important cause of venous ulcer where in valves is either destroyed or incompetent due to damage.
- Sustained venous pressure results in extravasation of cells, activation of capillary endothelium resulting in release of free radicals.
- These free radicals cause tissue destruction and ulceration.
- Calcification: This is seen inside the walls of vein.
- Periostitis: It may occur in tibia because of the ulcer present on the medial surface of leg.
Due to involvement of periosteum ulcer leads to severe pain. - Equinovarus deformity: It occurs due to improper habit of walking on toes which leads to shortening of tendo Achilles.
- Marjolin’s ulcer: It is the squamous cell carcinoma which arises from healed varicose ulcer with scarring.
Question 2. Write short note on varicose veins of lower leg.
Answer. Dilated, tortuous, and elongated superficial veins of limb are called as varicose veins.
Varicose veins of lower leg Symptoms
- Majority of the patients come, with dilated veins in the leg.
They are minimal to start with and at the end of the day they are sufficiently large because of the venous engorgement. - Dragging pain in the leg or dull ache is due to heaviness.
- Night cramps occur due to change in the diameter of veins.
- Aching pain is relieved at night on taking rest or elevation of limbs.
- Sudden pain in the calf region with fever and edema of the ankle region suggests deep vein thrombosis.
- Patients can present with ulceration, eczema, dermatitis,bleeding, etc. Symptoms of pruritis/itching and skin thickening are also seen.
Varicose Veins of lower leg Signs
- Dilated veins are present in the medial aspect of leg and the knee. Sometimes they, are visible in the thigh also.
- Single dilated varix at SF junction is called saphena varix.
It is due to saccular dilatation of the upper end of long saphenous vein at the saphenous opening. - Veins are tortuous and dilated
- Ankle flare is a group of veins nearer the medial malleolus.
Varicose veins of lower leg Diagnosis
- Venous Doppler: With the patient standing, Doppler probe is placed at saphenofemoral junction and later wherever required.
Basically by hearing the changes in sound, venous flow, venous patency, venous reflx can be well identifid. - Duplex scan: It is a ultrasonographic Doppler imaging technique which along with direct visualization of veins,gives functional or anatomical information and also the color map.
- Venography: Before introduction of venous Doppler, venography is the common method of diagnosis.
- Plethysmography: This is a non-invasive method which measures the volume change in leg.
- Arm foot venous pressure: Foot pressure is not more than 4 mm Hg above arm pressure.
- Varicography: In this non-ionic, iso-osmolar, non-throm-bogenic contrast is injected directly in variceal vein to get detailed anatomical mapping ofvaricose veins.
This is used in recurrent varicose veins.
Varicose veins of lower leg surgical treatment
Trendelenburg’s operation:
- An inguinal incision is made, long saphenous vein identifid and the 3 tributaries are ligated.
- Long saphenous vein is ligated close to the femoral vein juxta femoral flsh ligation.
- An incision is given in front of the medial malleolus and long saphenous is isolated.
- The lower end is ligated and the vein incised.
- A long metallic stripper is introduced within the vein and brought out from the long saphenous vein in the inguinal incision.
- A metallic head is connected to the stripper and the vein is avulsed.
- Tight crepe bandage is applied, inguinal incision is sutured and the limb is elevated.
Subfascial ligation ofCocket and Dodd:
- In this operation, perforators are identified deep to deep fascia and they are ligated subfascial. This is indicated in cases of perforator incompetence with saphenofemoral competence. This is also done by an endoscope.
Question.3. Write short note on thrombophlebitis.
Answer. Thrombophlebitis is a superficial vein thrombosis with inflammation.
Thrombophlebitis Types
- Acute: It is caused due to IV cannulation, trauma, minor infections and hypercoagulability.
- Recurrent
- Spontaneous: Polycythemia vera, polyarteritis, Buerger’s disease
- Thrombophlebitis migrans: It is spontaneous migrating thrombophlebitis seen in visceral malignancies like pancreas, stomach.
- Mondor’s disease
Thrombophlebitis Clinical Features
- Pain, redness, tenderness, cord-like thickening of veins
- Fever is present
- It is seen in upper limb or lower limb.
Thrombophlebitis Investigations
Duplex ultrasound Doppler of both limbs is must.
Thrombophlebitis Complications
- Destruction of venous valves leads to varicose veins
- Embolism, infection.
Thrombophlebitis Treatment
- Elevation of the limb.
- Anti-inflammatory drugs and antibiotics should be given
- Application of crepe bandage—Compression therapy
- Anticoagulation: Low molecular weight heparin for superficial venous thrombosis >3 cm in length.
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