What is varicose vein?
Varicose vein is a vein that have become prominently elongated, dilated and tortuous which is moat commonly affecting the superficial vein of the lower limbs. Thread veins also known as spider veins or reticular veins refer to superficial venous telangiectasia and varicosities.
What cause varicose vein?
The cause of varicose veins can be divided into 2 categories such as primary cause that includes a genetic or developmental weakness in the vein wall resulting in reduction in elasticity, dilation over time and valvular incompetence.
The secondary cause are due to pregnancy, pelvic malignancy, ovarian cyst, ascites, lymphadenopathy, retroperitoneal fibrosis.It is also cause after deep vein thrombosis or any arteriovenous fistula.
What is it is associated with ?
Varicose vein is associated with increasing age, family history and certain race ( caucasian ) and obesity .
How common is it ?
Varicose vein is common with increasing age with prevalence 10%-15% adult men and 20%-25% adult women .
How does it present?
Patient with varicose veins may complain of cosmetic appearance or experience symptom such as aching in the legs, worse towards the end of the day or after standing for long period and also present with swelling, itching, or complication such as bleeding, infection or ulceration
How to detect the condition?
The investigation done for varicose vein include duplex ultrasound to locate the sites of incompetence or reflux. Also to exclude deep vein thrombosis.
How to manage this condition?
The management of this condition includes conservative treatment that includes advice on exercise ( to improve the calf muscle pump) and elevation of the leg at rest . Class II support stockings also can be protective.
In the case of venous telangiectasia and reticular veins microinjection or laser therapy can be applied.
The next step is the surgical approach where the veins are marked with the patient in the standing position prior to operation. Stripping of the long saphenous veins to the knee and avulsion of varicosities via small stab incision is performed. However the short saphenous vein is not stripped , just ligated to avoid potential damage to nearby leg. Post operative, the legs are bandaged and early mobilization encouraged. Subfascial endoscopic perforator surgery is a more recent development involving ligation of incompetent perforating veins using an endoscopic technique.
What is the complication?
Varicose vein has its own complication that include venous pigmentation, eczema, lipodermatosclerosis and venous ulceration.
Treatment with sclerotherapy also has its own complication such as skin staining, local scarring. Treatment with surgery also has its own effect such as hemorrhage, infection, recurrence of varicose vein, loss of sensation and injury to the nerve.
What is the prognosis?
In general the condition is slowly progressive and the recurrence rates post surgery can be up to 40 %