Varicose veins

What are varicose veins?

Varicose veins are swollen, tortuous, green, blue, or purple veins that are often found on the lower legs and feet.

Varicose veins are also called varicose veins or varicosities.

Who gets varicose veins?

About a third of men and women ages 18 to 64 have varicose veins. [one]. They are more common in women and those with a family history of venous disease.

What causes varicose veins?

In normal leg veins, one-way valves direct the flow of venous blood from the surface venules to larger superficial veins, then to deep veins, and eventually to the heart. Muscle contractions create a pumping action to help blood flow to the heart (known as venous return).

Risk factors for varicose veins

Risk factors for varicose veins include:

• Obesity: Obesity increases venous reflux and venous pressure as a result of increased intra-abdominal pressure [2]
• Age: Varicose veins become increasingly common with age [3]

• Pregnancy: the enlarged uterus increases intra-abdominal pressure and direct pressure on the iliac veins; Hormonal changes also cause valves and vessels to become more malleable during pregnancy. [4]

• Long stay: sustained pressure over time can cause venous distention and valve failure [3]
• A family history primary valve failure is hereditary, and varicose veins can affect identical twins in 75% cases [5].

What are the clinical characteristics of varicose veins?

Patients with varicose veins present because they are unsightly and because of a feeling of discomfort, heaviness, itching, or dull pain. Patients can also present complications such as bleeding, ulcerationand thrombophlebitis.

What are the complications of varicose veins?

Bleeding

Superficial veins are prone to trauma and it can bleed, which can be life threatening [6,7].

Ulceration

Increasing pressure in varicose veins allows protein, hormones, and circulation. proinflammatory molecules exit the vein and enter the extravascular space, leading to located inflammation and the formation of a chronic venous leg ulcer.

Thrombophlebitis

Phlebitis is inflammation of a vein with erythema and painful hardening. It is often associated with a blood clot. (thrombosis) that arises as a result of slow circulation and increasing factors coagulation. Phlebitis can be superficial (ie, superficial thrombophlebitis) or deep (ie, deep vein thrombosis) [6].

Venous stasis dermatitis

Venous stasis dermatitis is associated with increased venous pressure and pro-inflammatory molecules. Patients have brown discoloration, pruritusand discoid or circumferential, acute or chronic eczema about him distal lower limbs [7].

Lipodermatosclerosis

Lipodermatosclerosis is a thickened, inflammatory form of panniculitis resulting from the presence of proinflammatory molecules, poor venous flow and hypertension. The lower leg is reddened in acute lipodermatosclerosis and indurated in chronic lipodermatosclerosis.

How are varicose veins diagnosed?

Varicose veins are clinically diagnosed. A physical examination should include the entire venous system and is generally performed with the patient lying down and standing.

The National Institute of Excellence in Health and Care (NICE) in the United Kingdom uses the Clinical-Etiological-Anatomic-Pathophysiological (CEAP) classification of varicose veins.

CEAP classification

The CEAP classification categories are as follows:

• C0 - Not visible or palpable signs of venous disease
• C1 - Telangiectasias or lattice the veins
• C2 - Varicose veins; diameter> 3mm
• C3 - Edema
• C4 - Changes in the skin and subcutaneous tissue including pigmentation, eczema, lipodermatosclerosis or atrophie blanche
• C5 - Healed venous ulcer
• C6 - Active venous ulcer [8].

A duplex doppler ultrasound An evaluation should be performed to determine the extent of the disease and the level of trunk reflux (the failure of one of the three main trunk veins) and to plan treatment options [8].

Which is the differential diagnosis for varicose veins?

Varicose veins are larger than telangiectasia (small red 'thread' streaks, <1mm in diameter) and venulectasis (blue reticular vessels, 1–3 mm in diameter). These are not detected in duplex ultrasound.

What is the treatment for varicose veins?

Weight loss (if overweight) and moderate physical activity in patients with varicose veins should be encouraged to reduce the risk of complications. Compression stockings should be worn to relieve discomfort and swelling, especially when traveling.

Treatment for varicose veins is available at a vascular Service. Treatment options are listed below.

Endovenous thermal ablation

Endovenous thermal ablation, using a To be or radiofrequency device, causes irreversible thermal injury to the vein wall, leading to scarring and tissue absorption for several months. The success rate of both ablation methods is 95%. [9.10].

Injection sclerotherapy

Sclerotherapy involves the injection of a sclerosing agent. solution inside the veins under ultrasound guidance to cause inflammation in the vessels and the eventual collapse of the varicose network. The smallest superficial veins can be injected by microsclerotherapy, which involves smaller gauge needles with smaller amounts of sclerosing [11].

Intravenous adhesive ablation

Endovenous adhesive ablation, or "venous glue" technique, involves injecting a medical grade cyanoacrylate adhesive through a catheter. Long-term security and effectiveness Data are missing for this procedure [12].

Endovenous mechanochemical ablation (ClariVein^®)

ClariVein is a swivel occlusion catheter that mechanically shakes the lining of the vein while spraying a sclerosing fluid. Can induce endothelial damage but lacks long-term data on its use [13].

Surgery

Surgeries such as high ligation (vein fixation), vein extraction, and avulsion (surgical removal of veins) are used less often to treat varicose veins than in the past due to the postoperative period. morbidity, reappearance rates and risks associated with anesthesia and hospitalization [10].

Lasers

Telangiectasia and venulectasis can be treated with long-wavelength vascular lasers, but these lasers are not suitable for larger varicose veins. [14].

What is the result for varicose veins?

Whatever treatment option is used, varicose veins can come back and can usually be treated again. [14].