WHAT IS VARICOSE VEINS

Varicose veins are abnormally

dilated, tortuous, superficial

veins caused by incompetent

venous valves. Most commonly

seen in lower extremities

LOWER LIMB VENOUS ANATOMY

VALVESMaintain unidirectional flow.

Extremity to heart.

Superficial to deep.

PERFORATORSConnects deep and superficial systems

Flow normally from superficial

to deep

MUSCLE PUMP

Contractions propel blood toward heartRelaxation draws blood from superficial veins and pour into deep veins

ETIOLOGY

HERIDITARY LACK OF EXCERCISE

HORMONAL MEDICATION

SURGERY/ TRAUMA

ETIOLOGY

OBESITY

PREGNANCY

ETIOLOGY

AGE OVER 40

JOBS REQ LONG STANDING/SITTING

HOURS

STAGES OF VARICOSE VEINS0.No visible venous disease1.Telangiectasias or reticular veins2.Visible Varicose veins

3.Oedema4.Skin changes5.Healed ulceration6.Active ulceration

STAGE 0 NO VISIBLE DISEASE

STAGE 1 TELENGECTASIA / RETICULAR VEINS

STAGE 2 VISIBLE VARICOSE VEINS

STAGE 3 OEDEMA

STAGE 4 SKIN CHANGES

STAGE 5 HEALED ULCERATION

STAGE 6 ACTIVE ULCERATION

SIGNS AND SYMPTOMS

Aching, heavy legs

• Often worse at night and after exercise

SIGNS AND SYMPTOMSBrownish-Blue shiny skin discoloration near the affected veins

Statis dermatitis or venous eczema

Redness, dryness and itchiness

SIGNS AND SYMPTOMS

CrampsRestless leg syndrome

Atrophie blanche• Whitened, irregular scar-like patches

on the ankles

SIGNS AND SYMPTOMSMinor injuries to the area may bleed more than normal and/or take a long time to heal.Lipodermatosclerosis• Skin above the ankle may shrink• Due to hardening of the fat underneath the

skin

DIAGNOSTICS

Venous Doppler examination of both legs

Superficial and deep venous system evaluated

TRADITIONAL TREATMENTSurgical ligation and strippingHigh ligationInjection sclerotherapy

Phlebectomy Only treats the visible varicosities with out treating the actual problem

MODERN ADVANCED TREATMENT

Hybrid technique

Endovenous laser treatment plus

Foam sclerotherapy

ENDOVENOUS LASER TREATMENTSimple procedure

Safer• Performed under local anesthetic/ sedation• Immediate relief of symptomsNo ugly scar• Minimally invasive, so minimal risk of

scarring and postoperative infection

ENDOVENOUS LASER TREATMENTLess than one hour examination and treatment time.

Rapid recovery with reduced postoperative pain. Normal activities can be resumed immediately

Excellent clinical and aesthetic results.

ENDOVENOUS LASER TREATMENT

Less reocurrence (surgery Vs EVLT: 25% Vs 5%)

Accepted by insurance providers.

EVLT is an American FDA approved treatment for varicose veins.

FOAM SCLEROTHERAPY

DIFFERENCE BETWEEN SURGERY /EVLT

Req- general anaestheisPain, bruising and scarringReq -Hospital admission

Req only sedationNo pain, bruising, scarringDay care procedure

Reoccurance 25%Not suitable for every ptLong healing time

Reoccurance 5%

No age limit, almost suitable for every ptCan return to work the next day

DIFFERENCE BETWEEN SURGERY /EVLT

SURGERY / EVLT

BEFORE AND AFTER

BEFORE AND AFTER

BEFORE AND AFTER

BEFORE AND AFTER

PREVENTION

PREVENTION

Elevate legs while sleeping

Regular exercise daily

Wear stockings regularlyNo continuos sitting/ standingfor more than 30 minutes

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