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Common Congenital Heart Lesions - page 118 / 126

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Varicose Veins

Clinical Presentation:

  • Patient with dilated, tortuous superficial vessels – usually involving legs

    • o

      Most often occur along the saphenous veins, but can occur in any vein…for example:

        • Hemorrhoids (ano-rectal varicose veins)

        • Varicocele (spermatic cord varicose vein)

        • Esophageal varices (esophageal varicose veins): associated with portal hypertension

  • Many patients are asymptomatic, but seek clinical help for cosmetic reasons.

  • If have symptoms, they can include:

      • Dull ache or pressure sensation in legs after prolonged standing

      • Swelling and skin ulceration, usually near ankle: due to superficial insufficiency when venous valves can’t function normally due to dilation of the veins

      • Superficial vein thrombosis: due to stasis of blood in a varicosity

      • Localized hematoma: due to rupture of a varicosity

Etiology, Classification, & some Epidemiology:

  • In legs, varicose veins are classified as Primary or Secondary:

Problem originates from…

Predisposing factors

Explanations about condition

Primary Varicose Veins the superficial system

  • pregnancy

  • prolonged standing

  • obesity

  • pregnancy or prolonged standing: high venous pressure in legs Æ

  • varicosities in people with weak- walled vessels

  • obesity: adipose tissue can’t support veins as well as lean mass could

Secondary Varicose Veins underlying problem in the deep venous system

  • deep venous insufficiency

  • deep venous occlusion

  • perforating veins incompetent

  • deep venous blood shunted retrograde via perforating channels into superficial veins

  • increase luminal pressure and volume there

  • cause dilatation and varicosities

  • 10-20% of population has clinically apparent varicose veins

  • Affect women 2-3 times more than men

  • Half of affected patients have family history of varicose veins

Pathology:

  • Thought to result from intrinsic weakness of venous wall, caused by one of the following:

    • o

      Increased intraluminal pressure

      • o

        Congenital defects in the venous valves…impairing flow toward the heart

Treatment:

  • Usually treated conservatively:

    • o

      have patients elevate legs while laying down

      • o

        avoid prolonged standing

      • o

        wear compression hose (to counterbalance increased venous hydrostatic pressure)

  • Injection of sclerosing solution: for small, symptomatic varicose veins

  • Laser treatments: improves cosmetic appearance for small, symptomatic varicose veins

  • Surgical therapy: vein ligation and removal only done for patients who are very symptomatic, suffer recurrent superficial vein thrombosis, or develop skin ulcerations

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