VARICOSITY
A. VAYDA
department of surgery with urology and anesthesiology
VARICOSITY
The varicose veins is the disease which is characterized by
nonreversible progressing changes in superficial,
perforating and deep veins, and clinically manifests by the
dilation of superficial veins of the inferior extremities
Epidemiology
Varicosity is the most widespread disease among the
vascular pathology. Aproximately 20 % of male and 40 % of
female population suffer from different forms of varicosity.
50 % of patients are the people before aged from 20 to 60,
furthermore, 10-15 % of this pathology occurs in school
children.
The cost of treatment of varicosity in UK is 2000-4000 €
consisting annually of 2 % of national budget of the
country.
Etiology
•Hereditary factors (60 %)
Congenital weakness of the vascular connective tissue, anatomical
insufficiency of venous valves
•Endocrine factors
Pubertal and climacteric age, pregnancy, labor
•Obesity
Excess weight on 20 kg increases the risk of varicosity in 5 times.
•Mode of life
Prolonged standing, hot environment, increased intraabdominal
pressure, weightlifting
varicosity is the consequence of the human vertical
standing position
Factors of normal venous hemodynamic
•Venous vascular tonus
•Venous valves
•Muscular contractions
•Arterial pressure, arterio-venous
fistulae
•Negative diaphragmatic pressure,
breathing movements
•Arterial pulsation
•Intraabdominal pressure
Pathogenesis
Pathogenesis
Increased venous
pressure
Dilatation of
superficial veins
Intravascular stagnation of
venous blood
Dilatation of perforating
veins
Valvular
incompetence
Sclerosis of venous wall and
valves
Dilatation of deep veins, venous
microcirculatory congestion
Edema, extravasal
exudation
Lipodermatosclerosis, dermatitis,
eczema, hyperpigmentation
Trophic
ulcer
CLINIC
60-80 % of varicosity represents
only cosmetic disturbances
•“Heavy leg” sensation
•Edema
•Hyperpigmentation
•Lipodermatosclerosis (indurative
cellulitis)
•Eczema
•Trophic ulcer
Classification
І stage – heavy sensation;
ІI stage – transitory or persistent edema,
lipodermatosclerosis, hyperpigmentation;
ІII stage – trophic ulcer (open or healed).
Diagnostic
•Anamnesis
•Objective examination
•General blood and urine analyses
•Coagulogram
•Functional tests for definition of the state of a valvular
system of superficial, deep and perforating veins
•Dopplerography
•Colour-flow duplex imaging
•Phlebography
AIM OF THE DIAGNOSTICS
•The cause of varicosity (the state of deep veins)
•The presence of saphenofemoral and saphenopopliteal
reflux
•Localization of saphenopopliteal junction
•The valvular state of great and small saphenous veins
•The presence of perforating reflux and its localization
Differential diagnosis
•Postthrombotic disease
•Arterio-venous fistulas
•Venous angiodysplasia
Treatment
•Conservative treatment
•Sclerosing therapy
•Surgery
MEDICAMENTAL TREATMENT
Aim:
•Exclusion of the risk factors (correction of job overload, diet )
•Improving of the venous wall nutrition and venous
outflow
•Correction of microcirculation, rheology and lymph
outflow
•Arrest of inflammatory reaction
•Trophic changes sanation
Conservative treatment
•Elastic bandage
•Phlebotonics (detralex, phlebodia, venoplant, hincor-forte)
•Antiinflammatory therapy (diclofenac Na, mesulid, naclofen)
•Physiotherapy (darsonvalization, ultraviolet insolation in
suberythematous doses, laser therapy)
•Local therapy (antiseptics, curiosin, treatment of dermatitis and
eczema)
Elastic bandage
•І – 18,4-21,2 mm Hg
•ІІ – 25,1-32,1 mm Hg
•ІІІ – 36,4-46,5 mm Hg
•ІV – more than 59 mm Hg
THE TREATMENT OF TROPHIC ULCERS
•Exclusion of the risk factors (correction of job overload, diet )
•Elastic bandage
•Correction of microcirculation, rheology and lymph
outflow (phlebodia, detralex – double doses, enzymes)
•Antiinflammatory therapy (diclofenac Na, mesulid, naclofen)
•Physiotherapy (darsonvalization, ultraviolet insolation in
suberythematous doses, laser therapy)
•Local therapy (antiseptics, curiosin)
•Surgical treatment (subfascial ligation of perforative veins by
Linton, endoscopic subfascial clipping of perforative veins )
SCLEROSING TREATMENT
•Reticular varicosity
•Teleangiectases
•Varicosity relapse (diameter
of vein less 4 mm)
Complications
•Early (urticaria, allergic
reactions, pain syndrome)
•Late (thrombophlebites, skin
necrosis)
Fibrovein 0.5 %, varicocid
•Saphenectomy
SURGERY
SURGERY
THE CAUSES OF VARICOSITY RELAPCE
•Diagnosis mistakes
•Secondary varicosity, arterio-venous fistulae, proxymal
compression by tumour, scars.
•Technical errors
•Unligated and unremoved the trunk of v. Saphena magna
•Missed double or triple trunk of v. Saphena
•Long stump of v. Saphena magna
•Missed varicose trunk of v. Saphena parva
•Unligated incompetent perforative veins
• The mistakes in postoperative period
•Early refuse of elastic compression
•Obesity
•Prolonged standing job
•Job overload
•Repeated pregnancies