Clinical Profile and Management of Lower Limb Varicose Veins

Abstract

BACKGROUNDThe first written reference of varicose veins appears to be the Ebers Papyrus dated 1550 B.C. It is one of the oldest documented pathological conditions in existence today. This study deals with its aetiology, pathology and the different modes of treatment and their efficacy in detail. MATERIALS AND METHODS50 patients with lower limb varicose veins admitted in the Department of General Surgery, KIMS, Karad from October 2014 to July 2016 were included in the study. All patients were subjected to detailed history taking, clinical examination and relevant investigations. Depending on the merits of the disease, appropriate treatment options are selected. All the results are evaluated and analysed by comparing with other standard results. RESULTSIn this study, there were 34 males and 16 females (M:F = 2.1:1). Most of the patients were between 20 -50 yrs. of age (80%); 56% of patients had occupations, which involved prolonged standing. In this study, 48% of patients had positive family history. The most common presenting complaint was prominent veins (100%) and pain in 54% of patients. Right limb was involved in 38% and the left limb involved in 52% of patients. Long saphenous vein was involved in 98% of patients, the second commonest being perforators which were involved in 86% of patients. Majority of the patients had combined saphenofemoral and perforator incompetence (70%). Duplex ultrasound was very accurate in diagnosing perforator incompetence. Treatment was depended upon the individual cases. In patients with venous ulcers Bisgaard's method of treatment was followed till the ulcer heals and then the patient was subjected to further definitive treatment. SFJ ligation with stripping was the most common surgery performed. Among post-operative complications, wound infection was the most common (14%). CONCLUSIONThis study showed that the prevalence of varicose veins of lower limb have a male predominance and is more common in younger age group. Family history and occupation are important contributing factors in the development of lower limb varicose veins. Left lower limb involvement is more than the right. Duplex ultrasound is the investigation of choice of lower limb varicose veins. Saphenofemoral flush ligation with stripping is very effective in the treatment of varicose veins.

Study of different surgical management approach in lower limb varicose veins at tertiary care hospital

“…15 The present study noted long saphenous vein involvement in most 18 (85.7%) of the cases followed by both long and short saphenous vein involvement in 3 (14.28%). These observations are in accordance with the findings of Janugade et al and Naik et al 9,16 In this present study 95.23% of patients had perforator incompetence. Which shows that majority of the cases presenting to hospital for treatment are advanced cases of hemodynamic disturbances of the limb and it is compared with study conducted by Donnell et al where 79.48% of patients had perforator in competence.…”

“…By definition they are dilated, elongated and tortuous veins.8 In the present study, the higher incidence of varicose veins was observed between the age group 20-40 years which correlates well with the studies of Janugade et al and Vaidyanathan et al 9,10 Males 20 (95.3%) are commonly affected than females in this study. Similar observations were seen in the studies of Nagaraj et al 11 This variation might due to the factor that cosmesis is not concern for low and middle-class women in our country, only complications associated with the disease makes the patient to consult the doctor.…”

“…These procedures were done individually or in combination with other procedures depending on the venous system involved. 9 In the present study, ligation of saphenous vein was done in 1 (5%) patient, ligation with stripping in 1 (5%) case, All the patients were cured of their varicosities except one, who had residual varicosity over the back of the leg for which he was advised re-operation. But the patient refused surgery.…”

Clinical Presentation of Varicose Veins

“…The era of vascular intervention for varicose veins was modernized by Friedrich Trendelenburg, in the 1860s, who not only popularized his eponymous Trendelenburg test for saphenous reflux but also performed great saphenous vein (GSV) ligation by making a transverse upper thigh incision to ligate and divide the proximal GSV [1]. William Moore, an Australian surgeon, moved the site of ligation cephalad to the sapheno-femoral junction [1]. Ligation of the saphenofemoral junction as it is practiced today was first described by John Homans in his paper in 1916 [1].…”

“…Varicose veins constitute a progressive disease, and remission of the disease does not occur, except after pregnancy and delivery. During its course, the disease produces complication; most frequent are superficial thrombophlebitis, acute bleeding originating in one of the thin-walled varices, eczema, and, finally, skin ulceration [1].…”