Explaining varicose veins


Explaining varicose veins


Definition and introduction of the venous system

Varicose vein means dilated tortuous or twisting and elongated veins which are common medical problem in the general populations

The venous system are a dynamic and complex system which responsible for carrying deoxgynated blood from all parts of the body through the veins to the heart this occur against the gravity in upright individual
 the venous blood flow depend on multiple factors such as gravity valves of the veins the heart and respiratory cycles blood volume and the calf muscle pump any changes in the balance of these factors can result in venous pathology such as varicose veins

 Explaining varicose veins
Varicose veins
veins are thin walled highly distensible and collapsible structures which transport the blood towards the heart in one direction when the person is upright and standing the veins are maximally distended and their diameters may be several times greater than if the person was in a horizontal position


the blood flow runs normally in one direction toward the heart this occur under control of the multiple venous valves which more increased in number below the knee and decreased in number in the more proximal veins
there are many veins which has no valve such as inferior vena cava IVC common iliac veins portal venous system and the cranial sinuses

The varicose veins can be occurs at any part of the body which may external such as varicose veins of the lower legs or internal such as inside the abdominal cavity from any veins

Varicose veins of the lower limbs

These are the most common type of varicose veins which can be seen in the lower legs
the veins of lower limbs are divided into three types superficial ,deep and perforating veins
The superficial veins lies above the upper most fascial layer of the legs and thigh these are the veins which appear or seen in the varicose veins and these veins consist of greater saphenous vein and lesser saphenous veins and their tributaries
The deep veins follow the course of the major arteries in the lower limb such as popliteal veins which continous upward to become femoral veins which joined the deep femoral vein in upper thigh to form the common femoral vein which become external iliac vein at the level of inguinal ligament which joint the internal iliac vein to form common iliac vein which drain into the inferior vena cava then it is enter the heart carrying the blood 

The perforated veins there are multiple perforated veins which connect the superficial veins with the deep veins there are two important perforated are called Cockett perforator which drain the medial or inner part of the lower legs they are relatively constant and they connect the greater saphenous vein with the posterior tibial vein and the Body,s perforator veins which connect the greater saphenoue vein to the deep veins about 10 cm below the knee and 1 to 2 cm medial to the tibia
There are venous sinuses which are thin walled valveless veins which located within the substance of the soleus and gastrocnemius muscles which connected  valved small venous channels which prevent blood reflux these venous sinuses can stored a large amount of the blood with each contraction of the calf muscle pump the blood is pumped out through the venous channels into the main veins to return to the heart

 

There are two types of varicose veins which are
Primary varicose veins and secondary varicose veins
 
There are many risk or predisposing factors which has a role in varicose veins formation such as
  • Congenital absence of the valves from the veins or congenital weakness of the venous wall which causes incompetent valves and blood return again into the veins instead of pumped toward the heart
  • Prolonged standing or sitting for a long duration so varicose veins are common in certain occupations such as surgeon nurse traffic policemen hair dressers
  • pelvic or abdominal tumors which compress the veins and lead to impaired venous blood flow
  • Deep venous thrombosis which causes occlusion of the deep veins which interfere with the lower limb muscle pump
  • Repeated pregnancy which causes compression on the pelvic veins and impaired venous blood flow
  • Prolonged used of oral contraceptive pills
  • Obesity which may causes weakness on the venous wall and increased stress over it which may not seen by the eye and can be felt by the hand
  • Congenital or acquired arterio-venous fistula which causes raising in the venous blood pressure

These include the following symptoms and signs
  • The patient may have no symptoms and present for cosmetic reasons
  • The patient may complaining from mild dull aching or heaviness pain in the legs which increased by prolonged siting or standing and relieved by walking or legs elevation upward sometimes walking increased pain when there are many perforator veins are incompetent
  • The patient may complaining from ankle swelling in the form of edema mainly at night which resolves after sleep
  • Skin pigmentation or colour changes in the form of brown pigmentation these due to ruptured small venules in the skin and release of the blood from it these are common with secondary varicose veins
  • Skin inflammation in the form of dermatitis skin redness and itching due to released haemosiderin which causes their irritation
  • Venous leg ulcer at the medial malleolus
  • These complaining are mild in case of primary varicose veins and more marked in secondary varicose veins
What are the difference between primary varicose and secondary varicose veins

Primary varicose veins are more common usually bilateral on both side of the legs take the shape of tubule or blow out has minimal skin complications and minimal ankle edema
Secondary varicose veins are less common usually unilateral one side of the legs can affect any veins take shape of serpentine or spider veins  has marked skin complications  and marked ankle edema local gigantism  common due to deep venous thrombosis and arteriovenous fistula
What are the investigations of varicose veins
Non invasive  technique
Doppler ultrasound
Which measures the changes in the blood flow in the veins by placing the ultrasound probe on a vein and squeezing below it then the blood flow can be heard 

Duplex ultrasound
Which can be seen the veins under the skin and showing malformed venous valves this is most common used nowadays as non invasive technique  and also can detect deep venous thrombosis and valve reflux and venous obstruction
Invasive technique
  
Venography
Can be used in selected cases when duplex if cannot see the vein such as in pelvic veins
Arteriography
Can be used in case of arteriovenous fistula
Other investigations according to the causes
Treatment of varicose veins see here

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