Mr. Adeel Abbas

ObjectivesUnderstand Relevant Surgical Anatomy.Understand Relevant Patho-Physiology.Categories Venous Insufficiency.Diagnosis & Management of the Disease.

How to Approach Questions in the Exam. . .

AnatomySuperficial Venous System.

Deep Venous System.

Perforating Venous System.

Superficial Venous System

Deep Venous System

Perforating Venous System

Physiology

Venous InsufficiencyCongenital.

Primary/Familial.

Secondary.

Primary Venous InsufficiencyTelangiectasis.

Reticular Veins.

Varicose Veins.

Telangiectasisa

Reticular Veins

Varicose Veins

PathologyMechanical Abnormalities;

Valve Failure.Cellular Abnormalities;

Capillary Permeability.Macrophage Infiltration.Extravascular Fibrin Prevents Normal

Exchange of O2 and Nutrients.Molecular Abnormalities;

Decrease Elastin & Collagen.

Risk FactorsAdvancing Age.Female Gender.Heredity.Iatrogenic (Post-A/V Fistula).

SymptomsHeaviness.Discomfort.Extremity Fatigue.Dull Pain, especially at Evening.Swelling.Cutaneous Burning.Pruritus.

Clinical ExaminationInspection;

Dilated / Visible / Tortuous SubCutaneous Veins.

Gaiter Area: Edema. Hemosiderin Deposition. Lipodermatosclerosis. Eczema. Ulceration.

Palpation;Tender Defects.Pitting Edema.SFJ & SPJ.Varix & Cough/Tap Impulse.Tourniquet / Trendelenburg Test.Perthes Test.Hand Held Dopler.

DiagnosisHand-Held Doppler.Duplex Ultrasound.Venography.MRVI.

TreatmentNon-Operative Management.

Interventional/Operative Management

Non-Operative ManagementChange Occupation.Avoid Long Standing.TED (Thrombo-Embolic Deterrent) Stockings.Lower Exterimity Elevation.Regular Exercise.Local Wound Care for ulcer.

Indications for Interventional Treatment;Cosmesis.Symptoms Refractory to Conservative

Management.Bleeding from Varix.Lipodermatoslerosis.Ulceration.Recurrent Thrombophlebitis.

Interventional Management;Injection Sclerotherapy (1-3% Na-Sotradecol

Solution)

Foam Sclerotherapy.

Laser Treatment.

Surgical Management;High Tie with Stripping.Phlebectomy.Endovenous Therapy.SEPS (Subfascial Endoscopic Perforator

Surgery).

S.E.QYoung Lady comes with edema of Both legs

with discolouration of lower legs & Prominent veins. She feels heaviness in legs.

What are the Causes of Varicose Veins?What is the Pathophysiology?What types of management are available for a

patient with varicose veins?

MCQsRegarding Varicose Veins:

Are Tortuous, Dilated, Prominent, Superficial Veins in the lower limbs.

May occur after formation of A.V fistula.Duplex Ultrasounf is Standard Method of

assessing venous anatomy & function.1-3% Phenol in Almond Oil is used for

sclerotherapy.Laser Therapy is

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