Improving the preoperative assessment of varicose veins

Salaman, Robert; Salaman, J H; Singh, Sartajvir

doi:10.1002/bjs.1800841232

Cited by 17 publications

(9 citation statements)

References 4 publications

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“…The Doppler ultrasound and duplex imaging have become the mainstay of investigations in the diagnosis of chronic venous insufficiency. 2 The treatment options for varicose veins include Trendelenburg operation, Stripping, Subfascial ligation of perforators, Laser, Sclerotherapy, Subfascial endoscopic perforator surgery and Radiofrequency ablation. In the recent past, minimally invasive procedures are replacing the more invasive procedures.…”

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confidence: 99%

Clinical Profile and Management of Lower Limb Varicose Veins

B¹,

Patil²,

Tata³

et al. 2017

jemds

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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.

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confidence: 99%

Clinical Profile and Management of Lower Limb Varicose Veins

B¹,

Patil²,

Tata³

et al. 2017

jemds

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“…6 It is accepted that colour duplex scanning is the gold standard in planning surgery for varicose veins 8,10 and improves long-term outcome, 11 but many have supported the opinion that HHD increases the accuracy of the examination of varicose veins. 4,12,13 The HHD is now firmly established as part of the vascular surgeon's routine examination of varicose veins, with some centres now progressing to the use of portable duplex scanners in the vascular laboratory or out-patient setting.…”

Section: Discussionmentioning

confidence: 99%

“…The accuracy of the HHD is limited in the popliteal fossa due to the complex anatomy of veins in this area. 13,14 However, many studies have investigated the accuracy of HHD in identifying venous reflux and directly compared this to the traditional tests. [3][4][5]9,13 Campbell et al 3 demonstrated that when using a HHD reflux was correctly detected in the long saphenous vein in 91% of cases, and 71% of cases at the SPJ.…”

Section: Discussionmentioning

confidence: 99%

“…3 These values agree with other published data giving HHD a sensitivity and specificity of 92% and 94%, respectively, for assessing incompetence at the SFJ. 13 Kim et al 4 directly compared the sensitivity and specificity of HHD against the more traditional tests and found them to be inaccurate as compared to HHD in localising sites of reflux. The respective specificity and sensitivity for the Trendelenberg, cough and tap tests were, 0.91 and 0.15, 0.59 and 0.67 and finally, 0.18 and 0.924.…”

Section: Discussionmentioning

confidence: 99%

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How Should a Candidate Assess Varicose Veins in the MRCS Clinical Examination? A Vascular Viewpoint

Bhasin

Scott

2006

annals

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The Brodie-Trendelenburg (tourniquet) test, cough impulse and tap test are outdated but candidates should be aware of the principles and failings behind them. In the MRCS clinical examination, candidates should examine varicose veins by means of clinical examination and HHD as this is now accepted standard practice. To aid candidate education, the HHD technique should replace traditional clinical tests which continue to be taught in medical school and remain within the classical surgical text books.

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“…The Doppler ultrasound and duplex imaging has become the mainstay of investigations in the diagnosis of chronic venous insufficiency. 2 The treatment options for varicose veins includes Trendelenburg operation, stripping, subfascial ligation of perforators, laser, sclerotherapy, subfascial endoscopic perforator surgery and radiofrequency ablation. In the recent past, minimally invasive procedures are replacing the more invasive procedures.…”

Section: Introductionmentioning

confidence: 99%

Varicose veins of lower limb: clinical presentation and management

2019

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Background: Varicose veins is a common clinical condition affecting the lower limbs. Usually patient comes for a cosmetic problem, it can cause complications giving rise to significant morbidity if not treated in time. Different options are available for surgical management. The present study has been carried out to study demographic factors, evaluate clinical presentation and outcome of various modalities of management of varicose veins of lower limb.Methods: The present study was carried out in a tertiary care academic hospital from October 2016 to October 2018 and 54 cases were enrolled. The clinical presentation of varicose veins were studied. Mean age and gender preponderance were calculated. All patients underwent clinical tests and venous doppler and accordingly appropriate treatment in the form of conservative, surgical or endovenous laser ablation was given. Complications following the procedures were studied.Results: A total of 39 (72%) patients out of 54 were below the age of 50 years. Prominent veins over lower limb was most common presentation. Sapheno-femoral junction was most commonly involved vein. Male preponderance was observed with a male to female ratio of 12.5:1. Venous Doppler had accuracy of 92.59% in detecting sapheno-femoral and perforator incompetence. Results of endovenous laser ablation are similar to surgery but with less morbidity.Conclusions: This study revealed the disease is prevalence in active phase of life with male preponderance. Majority of the patients had great saphenous vein incompetency and the complications are more when both great saphenous and perforator systems are involved. Venous Doppler is the investigation of choice as it has high accuracy.

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Improving the preoperative assessment of varicose veins

Cited by 17 publications

References 4 publications

Clinical Profile and Management of Lower Limb Varicose Veins

Clinical Profile and Management of Lower Limb Varicose Veins

How Should a Candidate Assess Varicose Veins in the MRCS Clinical Examination? A Vascular Viewpoint

Varicose veins of lower limb: clinical presentation and management

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