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VARICOSE VEINS

What are varicose veins ?

Varicosities or varicose veins are tortuous and dilated veins of the subcutaneous venous system. They are enlarged veins, filled with excessive blood and are bluish-purple or red in appearance. They appear raised and swollen and often the result of incompetence in the one-way venous valves. There is a disruption in the flow of blood into the heart thus causing venous hypertension. When one system develops incompetence the other system follows suit. The failure of valves located at SFJ and SPJ lead to a deficiency in the superficial venous system.

varicose veins treatment kochi, ernakulam, kerala

Types of Varicose Veins

  • Primary :
    • Valvular insufficiency of superficial veins at the SFV is the causative factor
    • Results in venous hypertension
  • Secondary :
    • Occurs because of DVT and trauma
    • Leads to chronic deep venous obstruction and valvular insufficiency
    • Results in post Thrombotic Syndrome
  • Congenital :
    • Any kind of venous malformations such as avalvulia and Klippel-Trenaunay variants

Varicose veins causes

  • Pregnancy
  • Menopause
  • Chronic heart valve conditions
  • Standing for a long time
  • Obesity: body weight increases pressure on the legs
  • Midsection of the body and the abdomen undergo a lot of pressure

Varicose veins signs, symptoms and complications

  • Swelling at ankles and feet
  • Large veins are visible under the surface of the skin
  • Heavy, painful and aching legs
  • Cramping and throbbing of legs
  • Lower leg and ankles itching: sometimes erroneously diagnosed as dry skin
  • Skin around the area of the varicose veins is discolored

varicose veins treatment kochi, kerala, india

Varicose Veins Diagnosis

  • To rule out DVT:
    • Duplex Ultrasonography
    • Perthes maneuver or Linton test
    • Maximum venous or MVO functional test
    • MRV or magnetic resonance venography: to look for anatomic obstruction
  • For the demonstration of reflux:
    • Duplex ultrasonography with color-flow imaging
    • Trendelenburg test
    • Doppler auscultation
    • Venous refilling time
    • Muscle pump ejection fraction or MPEF test
  • To delineate anatomy:
    • Duplex US
    • Direct venous venography
    • Staging of the disease: according to clinical-etiologic-pathophysiologic classification

Varicose Veins Treatment

  • Self-care: Recommended self-care treatments are:
    • Loss of weight
    • Wearing loose clothing
    • Avoiding standing or sitting for prolonged periods of time
    • Elevating legs
  • Compression stockings
    • First approach to treatment
    • Steady squeezing of leg muscles for efficient movement of blood
    • Variable amounts of compression according to brand
    • Prescription-strength stockings, as well as over-the-counter compression stockings, are available
  • Severe varicose veins treatments
    • Sclerotherapy :
      • Suitable for small to medium varicose veins
      • Solution is injected for scarring and closure of veins in a few weeks
      • Out-patient therapy with no anesthesia required
      • Foam sclerotherapy :
        • Fairly new technique
        • Foam solution is injected into large veins
        • Vein closure and sealing can also be accomplished
    • Trendelenburg Surgery with Stripping and multiple ligation
      • Also known as high ligation and vein stripping
      • A vein is tied before it joins the deep vein
      • It is then removed through small incisions
      • There is no adverse effect on the blood circulation in the leg due to the deep vein taking care of the flow
      • It is an outpatient procedure
    • Catheter-assisted procedures
      • The procedure uses radiofrequency and laser
      • A thin catheter or tube is inserted into the vein
      • The tip of the catheter is heated up with laser or radiofrequency
      • The vein is destroyed by the heat and it seals up as the catheter is pulled out
      • Ideal for treatment of large varicose veins
    • Endoscopic vein surgery:
      • Done as an outpatient procedure when other techniques fail
      • Performed for the treatment of advanced leg ulcers
      • A tiny video camera is inserted into the leg
      • The veins are removed under close visualization by making small incisions

At Jacob’s hospital, compression stockings may be recommended after the surgery. Dr. Zubin Jacob strongly advises minimal activity after any of the treatments. Jacobs Multispeciality Hospital, Ernakulam provides Varicose Veins Treatment in Kochi with treatment options like Sclerotherapy, trendelenburg surgery in Kerala, India

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