Cause Of Varicose Veins Research Articles

CHIVA treatment for pelvic leak points in men

Pelvic Leak Points (PLPs) are a possible cause of varicose veins of the lower limbs even in men, and can be easily overlooked without a thorough assessment, or leading to incorrect treatment with high recurrence rate. CHIVA is a minimally invasive approach by recorrecting hemodynamic changes, preserving the venous drainage network in lower extremity. In this study, we present two cases of male patients with symptomatic varicose veins related to PLPs that were successfully treated with the CHIVA method. With proper venous hemodynamic assessment and strategic support, CHIVA could be a safe and effective way to treat PLPs in men.

Efficacy of compression and phlebotropic therapy varicose veins in pregnant women

Introduction. Pregnancy is the leading cause of varicose veins(VVs) in women. Therapeutic measures during pregnancy include the wearing of compression hosiery and the phlebotropic therapy.Purpose. To evaluate the clinical effectiveness of graduated elastic compression and phlebotropic therapy in pregnant women with VVs.Materials and methods. A total of 88 pregnant women were included, 30 of whom used compression stockings (group 1), 28 women received phlebotonics together with compression (group 2) and 30 were controls. VVs severity was determined using the Venous Clinical Severity Score (VCSS). Quality of life (QoL) was calculated using the Chronic Venous Insufficiency Questionnaire (CIVIQ-20). The calf circumference was measured with a measuring tape in an orthostatic position.Results and discussion. At the end of the study there was a decrease in VCSS (p < 0.001 and p < 0.008) in both treatment groups, whereas the control group showed an increase in VCSS severity (p < 0.001). At the end of follow-up the QOL score in the treatment groups showed a tendency to improve while the control group showed a decrease in QOL. A bilateral decrease in tibial circumference (p < 0.001) was seen in groups 1 and 2 and the adjuvant phlebotropic treatment was found to be superior in controlling the oedema.Conclusions. The combined use of elastic compression and phlebotonics is more effective in eliminating venous oedema in pregnant women with VVs.

Incidence of Various Types of Varicose Veins in Relation to Age and Gender Among Patients Presenting in Mayo Hospital

Amongst the most frequent illnesses in civilised nations of West is chronic venous insufficiency (CVI). It is believed that 40-50 percent of all individuals have superficial venous insufficiency of the leg, which manifests primarily as varicose veins. Individuals with varicose veins typically complain of leg pain at the conclusion of the day following extended walking. Ankle edoema, itch, hemorrhage, superficial thrombophelibitis, dermatitis, lipodermatosclerosis, and open wounds are some of the additional manifestations. Methods: In this cross sectional study, conducted at the surgical floor, Mayo Hospital, Lahore. Varicose veins were defined as dilated, tortuous, subcutaneous veins usually seen in upright posture. Any case of suspected chronic venous insufficiency was assessed on clinical examination by unbiased consultant surgeon. The severity of varicose vein was assessed by clinical grading from CEAP (Clinical-Etiological-Anatomical-Pathophysiological) system in which there are six classes. Results: Patients in our study were mostly males; male to female ratio of patients of varicose veins is 3:1, most of the male patients had class 2 or class 5; Association of class of varicose veins and gender was also insignificant (p-value calculated for the class of varicose veins and gender was 0.25). Conclusion: In our study population, male patients suffered worse than female patients. The occurrence rate was comparable between people of different ages. There was a higher prevalence of varicose veins in classes 2 and 3. To further understand the causes of varicose veins, larger-scale studies focusing on female gender-related risk factors and occupation-related risk factors are needed. Additional measures, such as patient education, can aid in lowering the frequency of varicose veins. Keywords: Varicose Veins, DVTs, Ankle edema, Thrombophelibitis, lipodermatosclerosis

A Brief Review on Herbs Used in the Treatment of Varicose Veins

A weakening of the venous valves and walls is a common cause of varicose veins. Blood might flow back and pool in veins due to damaged valves, causing them to enlarge. Weakened vein walls are longer, broader, and less elastic than normal, causing valve flaps to split, resulting in increased blood pooling and twisted veins. Primary varicose veins are characterised by valvular incompetence and reflux, which have long been assumed to be the cause. Recent research, on the other hand, reveals that valve dysfunction may be preceded by alterations in the vein wall. This condition is referred to as "Siragranthi" in Ayurvedic literature (ie.Varicose vein). As a result, the current review critically assesses the possible utility of herbal medications in the treatment of varicose veins.
 Keywords- Herbal Plants, Varicose veins, Types, Pathophysiology

TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING VARICOSE VEINS AND ITS PREVENTION AMONG OT AND ICU STAFF NURSES

Many factors predispose human beings to a disease of the lower extremities, and this condition affects approximately eighty million Americans. Itsmanifestations may appear to be little more than a cosmetic nuisance, yet it may be an indication of a more serious underlying problem undetected by visual inspection. Venous disease is also capable of producing a plethora of uncomfortable symptoms, and left untreated, may progress to cutaneous pigmentation, dermatitis, ulceration, haemorrhage, or superficial thrombophlebitis. Although uncomplicated cases of the disease are more common, venous disease should not be taken lightly. Steps to retard disease expression and progression should be implemented whenever possible. As blood rushes through our legs the veins send it back to the heart. In case of prolonged standing, due to force of gravity the veins lose their ability to push the blood upwards, causing the blood to settle down in certain areas of the veins. Varicose veins are tortuous, distended and bulging vein s (varicosities) beneath the skin of the legs. They are most often swollen and gnarled veins that most frequently occur in the legs, ankles and feet. Even though the exact cause of varicose veins is unknown, there are some risk factors which contribute to development of this problem. Some of the risk factors are, low physical activity, smoking, family heredity of varicose veins, congenital valve or vein wall defects, valve damage from trauma, obstruction, deep vein thrombosis (DVT) or inflammation, chronic venous distention associated with occupations requiring prolonged standing, obesity or pregnancy, systemic conditions that interfere with venous return and loss of vein wall elasticity with ageing.

Эндоваскулярные вмешательства у мужчин с синдромом хронической тазовой боли на фоне вторичной варикозной болезни вен малого таза

Objective to study the effectiveness of methods of endovascular treatment of May-Turner syndrome and nutcracker syndrome as a cause of varicose veins of the pelvis in men with chronic pelvic pain syndrome. Materials and methods a comprehensive examination was carried out in 445 men with chronic pelvic pain syndrome. The patients age ranged from 20 to 68 years (mean age 39.5 years). The diagnosis of varicose veins of the pelvis was established in 49 patients, of which 25 had primary varicose veins of the pelvis, in 24 - secondary varicose veins of the pelvis (13 patients with May-Turner syndrome, 11 patients with nutcracker syndrome). The patients with the nutcracker syndrome underwent embolization of the testicular and pelvic veins using the combined sandwich technique. Patients with May-Turner syndrome underwent stenting of the left common iliac vein. Results In order to assess the technical efficiency of endovascular treatment, control ultrasound was performed at 1, 3, 6 and 12 months. In 100% of cases, throughout the observation period, the patency of venous stents was maintained; in all cases of embolization of the left testicular vein, there was no blood flow in the embolized vein. In order to assess the clinical efficacy of endovascular treatment after 1, 3, 6, 9 and 12 months. after it, patients were questioned using the NIH-CPSI scale and VAS. The most significant changes in clinical manifestations and ultrasound data were observed after 3 months. after endovascular treatment. Conclusions Balloon angioplasty and iliac vein stenting in May-Turner syndrome and left gonadal vein embolization in nutcracker syndrome are minimally invasive treatments with a favorable patient safety profile.

Features of the Cognitive Component "Self-Concept" Structure in Middle-Aged Women with Different Stages of Varicose Veins

The article is devoted to the study of the structural features of the cognitive component of the "I-concept" in middle-aged women. They are at different stages of development of varicose veins. The cognitive component of the “I-concept” is a significant prerequisite for the manifestation of potential behavioral reactions. In modern psychological science, the most studied are aspects related to the psychosomatic manifestation of varicose veins, issues related to the psychological causes of varicose veins and the effect of the disease on the human psyche. At the same time, the question of how the level of development of varicose veins manifests itself in the features of the "I-concept" (in particular, its cognitive component) remains insufficiently studied. The study involved 50 women (35-40 years old) with varying degrees of development of varicose veins. The first group included 25 women with varicose veins of the first stage (no surgical intervention is required). The second group consisted of 25 women with the second stage of the disease (with surgery). According to the survey, the main causes of the disease were quite different. This is a sports load, a criterion for heredity, diseases during pregnancy, etc. There were revealed certain similarities and differences in the manifestations of the cognitive component of the "I-concept" of the personality of these women, depending on the stage of development of varicose veins. General factors were determined that describe the nature of the relationship between the elements of the cognitive component "I-concept" and a certain stage of varicose veins in middle-aged women. Individual psychological characteristics of the personality play a major role in the manifestation of types of self-attitude in middle-aged women with different stages of development of varicose veins. The nature of the relationship between the types of attitudes, self-attitudes towards the disease, the degrees of clarity of the "I‑concept" is different. A more complex and diverse nature of the relationship is inherent in a group of women with a medication type of treatment.

The Significance of Doppler Ultrasound in the Causes of Varicose Veins

Varicose veins could be clinically diagnosed with visual inspection but the use of Doppler ultrasound (US) in varicose veins is to identify the cause of varicose veins. Need for an extensive systematic review is therefore felt to itemize different causes of varicose veins. Relevant literature was searched and systematic analysis was performed with the aim to show the significance of US in the diagnosis of various causes of varicose veins. Various causes can be diagnosed with color and spectral Doppler US which can be usual causes and unusual causes as well including neovascularization, chronic venous ulceration, obesity, incompetency of the perforating veins, deep vein thrombosis, saphenofemoral junction incompetence, recurrence of the varicose veins after surgical treatment, vulvoperineal varicosities, intraosceous perforating vein incompetence, round ligament varicosity, persistent sciatic vein incompetence, congenital venous malformation and Klippel– Trenaunay syndrome, portosystemic collateral–related varicose veins, and pelvic congestion syndrome. It is concluded that duplex ultrasonography plays an important role in the diagnosis of the various causes of varicose veins.

Matrix Metalloproteinases in Remodeling of Lower Extremity Veins and Chronic Venous Disease.

The veins of the lower extremity are equipped with efficient wall, contractile vascular smooth muscle (VSM), and competent valves in order to withstand the high venous hydrostatic pressure in the lower limb and allow unidirectional movement of deoxygenated blood toward the heart. The vein wall structure and function are in part regulated by matrix metalloproteinases (MMPs). MMPs are zinc-dependent endopeptidases that are secreted as inactive pro-MMPs by different cells in the venous wall including fibroblasts, VSM, and leukocytes. Pro-MMPs are activated by other MMPs, proteinases, and other endogenous and exogenous activators. MMPs degrade various extracellular matrix (ECM) proteins including collagen and elastin, and could affect other cellular processes including endothelium-mediated dilation, VSM cell migration, and proliferation as well as modulation of Ca2+ signaling and contraction in VSM. It is thought that increased lower limb venous hydrostatic pressure increases hypoxia-inducible factors and other MMP inducers such as extracellular matrix metalloproteinase inducer, leading to increased MMP expression/activity, ECM protein degradation, vein wall relaxation, and venous dilation. Vein wall inflammation and leukocyte infiltration cause additional increases in MMPs, and further vein wall dilation and valve degradation, that could lead to chronic venous disease and varicose veins (VVs). VVs are often presented as vein wall dilation and tortuosity, incompetent venous valves, and venous reflux. Different regions of VVs show different MMP levels and ECM proteins with atrophic regions showing high MMP levels/activity and little ECM compared to hypertrophic regions with little or inactive MMPs and abundant ECM. Treatment of VVs includes compression stockings, venotonics, sclerotherapy, or surgical removal. However, these approaches do not treat the cause of VVs, and other lines of treatment may be needed. Modulation of endogenous tissue inhibitors of metalloproteinases (TIMPs), and exogenous synthetic MMP inhibitors may provide new approaches in the management of VVs.

Matrix Metalloproteinases as Regulators of Vein Structure and Function: Implications in Chronic Venous Disease.

Lower-extremity veins have efficient wall structure and function and competent valves that permit upward movement of deoxygenated blood toward the heart against hydrostatic venous pressure. Matrix metalloproteinases (MMPs) play an important role in maintaining vein wall structure and function. MMPs are zinc-binding endopeptidases secreted as inactive pro-MMPs by fibroblasts, vascular smooth muscle (VSM), and leukocytes. Pro-MMPs are activated by various activators including other MMPs and proteinases. MMPs cause degradation of extracellular matrix (ECM) proteins such as collagen and elastin, and could have additional effects on the endothelium, as well as VSM cell migration, proliferation, Ca(2+) signaling, and contraction. Increased lower-extremity hydrostatic venous pressure is thought to induce hypoxia-inducible factors and other MMP inducers/activators such as extracellular matrix metalloproteinase inducer, prostanoids, chymase, and hormones, leading to increased MMP expression/activity, ECM degradation, VSM relaxation, and venous dilation. Leukocyte infiltration and inflammation of the vein wall cause further increases in MMPs, vein wall dilation, valve degradation, and different clinical stages of chronic venous disease (CVD), including varicose veins (VVs). VVs are characterized by ECM imbalance, incompetent valves, venous reflux, wall dilation, and tortuosity. VVs often show increased MMP levels, but may show no change or decreased levels, depending on the VV region (atrophic regions with little ECM versus hypertrophic regions with abundant ECM) and MMP form (inactive pro-MMP versus active MMP). Management of VVs includes compression stockings, venotonics, and surgical obliteration or removal. Because these approaches do not treat the causes of VVs, alternative methods are being developed. In addition to endogenous tissue inhibitors of MMPs, synthetic MMP inhibitors have been developed, and their effects in the treatment of VVs need to be examined.

Venous Reflux From the Pelvis and Vulvoperineal Region as a Possible Cause of Lower Extremity Varicose Veins

The aim of this study was to demonstrate with the use of computed tomography and ultrasonography that isolated venous reflux from the pelvis and vulvoperineal region is a possible cause of lower extremity varicose veins. From a consecutive series of patients who were referred to the vascular imaging laboratory, we retrospectively selected patients who had unusual lower extremity varicose veins that arose from the pelvis and vulvoperineal region. Computed tomographic venography and ultrasonograhy were used to exclude other causes of varicose veins. We reviewed medical records to evaluate the presence of pelvic congestion syndrome. Computed tomographic findings were reviewed to locate ovarian vein dilatation. Twenty limbs of 15 female patients (age range, 33-72 years; mean age, 53.2 years) were diagnosed with varicose veins that arose from the pelvis and vulvoperineal region without any saphenofemoral insufficiency. Eleven patients (73.3%) had no history of chronic pelvic pain. Four patients (26.7%) presented with chronic pelvic pain without any other evident gynecological etiology. Dilatation of the left ovarian vein was seen in 10 patients (67%; mean dilatation, 8.6 mm; range, 7.5-9.6 mm). Five patients (33%; mean dilatation, 4.9 mm; range, 3.8-6.6 mm) showed no ovarian vein dilatation. The combined use of computed tomographic venography and ultrasonography may be a possible noninvasive method for the diagnosis of unusual lower extremity varicose veins. Venous reflux from the pelvis and vulvoperineal region as a cause of lower extremity varicose veins can manifest without evidence of pelvic congestion syndrome or ovarian vein dilatation.

Unusual Causes of Varicose Veins in the Lower Extremities: CT Venographic and Doppler US Findings

There are various causes of varicose veins in the lower extremities. Among the causes are venous insufficiency of the saphenofemoral junction, saphenopopliteal junction, or usual perforating veins. Traditionally, Doppler ultrasonography (US) has been used for evaluation of varicose veins. Sometimes, varicose veins arise from an unexpected anatomic source; in these cases, computed tomographic (CT) venography can provide an overview of the varicose veins. Doppler US with complementary CT venography is useful for determining the precise cause of varicose veins. Between November 2003 and March 2008, the authors evaluated 1350 cases of varicose veins in the lower extremities with both CT venography and Doppler US. The varicose veins were classified according to their causes; unusual causes were studied and included vulvoperineal varicosity, intraosseous perforating vein incompetence, round ligament varicosity, persistent sciatic vein incompetence, Klippel-Trenaunay syndrome, and portosystemic collateral pathways. Radiologists should be familiar with the complete range of primary causes of varicose veins in the lower extremities and with their radiologic manifestations and should recognize the complementary role of CT venography in their evaluation.

Veias linfonodais: uma causa pouco conhecida de varizes

As veias linfonodais fazem parte de uma rede venosa no triângulo de Scarpa, que liga em vários pontos o sistema venoso superficial às veias profundas, e podem tanto ser causa de incompetência do sistema venoso superficial quanto estar envolvidas na recorrência pós-safenectomia. Na rotina diária dos exames de Doppler venoso de membros inferiores, temos notado de maneira cada vez mais freqüente a associação das veias linfonodais com varizes primárias e recorrentes. A adequada caracterização dessas veias pode ajudar na compreensão do mecanismo fisiopatológico do aparecimento das varizes e permitir um controle e tratamento mais dirigidos. Este artigo lança luz sobre os aspectos anatômicos e fisiológicos das veias linfonodais, objetivando chamar a atenção dos profissionais envolvidos no diagnóstico de doenças venosas dos membros inferiores para uma causa pouco difundida de varizes.

Endovenous Laser Ablation and Sclerotherapy for Treatment of Varicose Veins

Superficial venous insufficiency is a common problem associated with varicose veins. Venous insufficiency and varicose veins can be symptomatic, but more commonly they are a cosmetic concern. In this article, we discuss the relevant anatomy and pathophysiology of superficial venous insufficiency, review the current literature for varicose vein treatment, and cover the technical aspects of diagnosing and treating superficial venous insufficiency. Saphenofemoral junction incompetence with resultant greater saphenous vein reflux is the most common cause of varicose veins; because this condition constitutes the majority of patients encountered in practice, we will concentrate on this area. Endovenous laser ablation and sclerotherapy are covered, including patient workup and selection, procedure set-up, and anesthesia.

Is arteriovenous shunting involved in the development of varicosities? A study of the intraluminal pressure and oxygen content in varicose veins

Arteriovenous (AV) shunting has been postulated as the underlying cause of varicose veins. The aim of this study was to analyse pressure and oxygen content in primary varicose veins in order to determine evidence of arterial shunting. Thirty-nine patients with varicose veins underwent cannulation of varicosities. The pressure and the blood oxygen content within varicosities were measured in different positions and during exercise. Similar measurements were made in the long saphenous veins of 10 control subjects without venous disease. Mean pressure in varicose veins in the supine position was 12.3 mmHg (Standard deviation [SD] 3.6 mmHg). Control subjects had similar pressures measured in the long saphenous vein. No pulsatile pressure tracings were obtained. Varicosity pressures in the erect position averaged 66 mmHg (SD 9 mmHg). In all cases, the pressure correlated with the distance of the varicosity from the heart. Pressure reduction in varicosities after exercise was significantly less than that in control subjects. Recovery time (RT 90) was also significantly shorter than in the control group. Mean venous pO2 in varicosities was 4.5 kPa (SD 1.0) in the supine position dropping to 3.9 kPa (SD 0.9) on standing; these values were not significantly different to samples from control subjects. AV shunting is unlikely to be a causative factor in the development of primary varicose veins.

The venous valve agger and plasma noradrenaline-mediated venodilator feedback

To investigate the structure and function of the venous valve agger, a fibroelastic structure located at the base of every valve in veins that are responsive to noradrenaline (NA). Constant flow perfusion studies of the responses of in situ and in vitro canine lateral saphenous vein segments to NA and electrical stimulation, supplemented by histological studies of the segments. University Departments of Physiology and Histology. Segments of canine lateral saphenous vein. In vitro=84, in situ=60 plus. The agger is a crescentic fibroelastic sleeve, spanning the vein wall very obliquely through which the local vasa venarum network drains. It has a dedicated musculature which, when the tone rises, contracts and stretches the fibroelastic of the agger and opens the drainage channels to reflux. Each agger has four muscles, two each of which insert on the concave and convex margins of the agger. They pull in opposite directions when they contract. The agger forms part of a complex that, in conjunction with its dedicated musculature, a reversible transmural pressure gradient and physiological turbulence in the valve sinuses, positively facilitates drainage from the local segment of the vasa venarum network when venous tone is normal; and when venous tone is elevated it pumps and sucks blood from the lumen of the vein to perfuse the vasa venarum network. When the plasma NA in the perfusate diffuses from the network, it causes a localized venodilator feedback effect that restores the elevated tone of the vein to normal. The feedback effect is potent, being estimated to reduce the venonstrictor effect of neuronal NA by about 50% when flow is laminar and considerably more when flow is turbulent. There is evidence that plasma NA may constitute the lateral inhibitory component of the NA chemostimulus of the smooth muscle cell, neuronal NA constituting the excitor component. A chronic breakdown in agger function is believed to be the cause of varicose veins.

Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: a 2-year follow-up.

Saphenous vein reflux is often the underlying anatomic cause of varicose veins. It is necessary to eliminate this reflux originating at the saphenofemoral junction (SFJ) to treat the resultant varicose veins. To report 2-year follow-up results after closing the incompetent greater saphenous vein starting from its junction (SFJ) with the femoral vein using radiofrequency (RF) endoluminal ablation. One hundred and forty incompetent greater saphenous veins from 120 patients with an incompetent SFJ and large painful varicosities were treated. Patients were evaluated clinically and with duplex ultrasound at 1 week, 6 weeks, 6 months, 12 months, and 24 months to determine treatment efficacy as well as adverse sequelae. Vein occlusion, defined as the absence of any duplex ultrasound-determined flow, was successfully achieved in 137 of 140 (98%) scanned veins at 1-week follow-up. At the 12-month follow-up, none of the treated patients developed recanalization that was not seen at 6 weeks, with a successful outcome in 90%. At the 24 month follow-up, 19 of 21 patients had complete disappearance of the treated saphenous vein, for a success rate of 90%. Side effects were minimal, and no skin burns or thromboses were observed. RF endovenous occlusion allows patients to obtain treatment with the positive attributes of surgery, that is, a single treatment and low rate of recurrent reflux, but without the morbidity, need for general anesthesia, or extensive convalescence associated with vein stripping and ligation surgery. Patient satisfaction was routinely achieved, with 98% of patients indicating a willingness to recommend the RF endovascular procedure to a friend or family member.

Controlled Radiofrequency Endovenous Occlusion Using a Unique Radiofrequency Catheter Under Duplex Guidance to Eliminate Saphenous Varicose Vein Reflux

BACKGROUND Saphenous vein reflux is often the underlying anatomic cause of varicose veins. It is necessary to eliminate this reflux originating at the saphenofemoral junction (SFJ) to treat the resultant varicose veins. OBJECTIVE To report 2-year follow-up results after closing the incompetent greater saphenous vein starting from its junction (SFJ) with the femoral vein using radiofrequency (RF) endoluminal ablation. METHODS One hundred and forty incompetent greater saphenous veins from 120 patients with an incompetent SFJ and large painful varicosities were treated. Patients were evaluated clinically and with duplex ultrasound at 1 week, 6 weeks, 6 months, 12 months, and 24 months to determine treatment efficacy as well as adverse sequelae. RESULTS Vein occlusion, defined as the absence of any duplex ultrasound-determined flow, was successfully achieved in 137 of 140 (98%) scanned veins at 1-week follow-up. At the 12-month follow-up, none of the treated patients developed recanalization that was not seen at 6 weeks, with a successful outcome in 90%. At the 24 month follow-up, 19 of 21 patients had complete disappearance of the treated saphenous vein, for a success rate of 90%. Side effects were minimal, and no skin burns or thromboses were observed. CONCLUSION RF endovenous occlusion allows patients to obtain treatment with the positive attributes of surgery, that is, a single treatment and low rate of recurrent reflux, but without the morbidity, need for general anesthesia, or extensive convalescence associated with vein stripping and ligation surgery. Patient satisfaction was routinely achieved, with 98% of patients indicating a willingness to recommend the RF endovascular procedure to a friend or family member.

Diagnosis and Treatment of Varicose Veins

Varicose veins are dilated, tortuous veins exhibiting reflux because of valvular insufficiency. Dilatation of veins may be primary, that is, initiated by an unknown process, or may be the result of postthrombotic changes, arteriovenous fistula, or diverted flow resulting from a blockade of deep veins. Theoretical causes of varicose veins are heredity, race, gender, posture, gravitational back pressure, pregnancy, hormonal influence, weight, primary and secondary valvular incompetences, incompetent perforating veins, arteriovenous communications, and vein wall weakness. Visual inspection and palpation permit a clinical classification with respect to many different factors, especially the type of varix and the clinical stage of chronic venous insufficiency. Refluxes play a decisive role in the pathogenesis of large varices. They are usually detected over the sapheno femoral junction or the saphenopopliteal junction. Identification of these refluxes needs Doppler ultrasonographic techniques. Highly effective noninvasive examination methods have become available and include photoplethysmography, air plethysmography, portable Doppler ultrasound, and duplex scanning. The sole invasive diagnostic technique is ascending or descending phlebography. Several different treatments have been recommended for varicose veins. Flush ligation combined with stripping, avulsion of local varicosities, and perforator interruption are still the most common surgical techniques. The aim of varicose vein surgery is the removal of diseased incompetent vein segment and the control of reflux. Development of new sclerosing agents renders sclerotherapy for varicose veins more effective, and use of Doppler and the duplex ultrasound techniques provides a better hemodynamic and anatomic precision, which ultimately improves the treatment efficacy. Because patients seek treatment for varicose veins most commonly for cosmetic reasons, recently developed lasers and intense pulsed light(IPL) have become the methods for treating telangiectasia. In summary, surgery treats the major venous reflux, sclerotherapy treats the feeding venous system, and the laser or IPL seals effectively the superficial vessels.

Primary venous valve incompetence of the leg

Chronic venous insufficiency due to stretching of the venous valve cusp in the leg is described. Details of the pre- and postoperative clinical and radiographic features of this entity are presented. Hemodynamic findings are described. The surgical results show that permanent control of ulceration was achieved in all 18 limbs afflicted, severe aching was relieved in 80 percent and severe swelling was controlled in 70 percent. Follow-up extends to 10 years in some cases, and the average is 5 years. The importance of this entity is that it is one cause of the chronic venous insufficiency syndrome that can be corrected by reconstructive venous surgery. The occurrence of primary valve incompetence may be widespread and may be an important cause of varicose veins in the saphenous system. Its occurrence in the deep veins has been recognized by those who have performed descending venography, but the possibility of its pathologic significance was only advocated by Bauer [1] in 1948 and mentioned by Lockhart-Mummery and Smitham [2] in 1951. With the development of a surgical method of repair, the clinical benefit of repair of femoral vein incompetence can be assessed. Its frequency is yet to be determined. By adding surgical repair in the deep system of veins to conventional surgical methods in the saphenous and perforator veins, there is hope for relief of aching and suffering for many of those now afflicted with severe degrees of chronic venous insufficiency and of return of many disabled persons to full- or part-time work. The cost-effectiveness of this approach will depend on savings in both outpatient and inpatient care as well as return of persons to self-supporting work status.