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FromA Tortous Issue ...

Posted Nov 16 2009 10:03pm

From A Tortous Issue

Varicose Veins (VV) are swollen distended veins which commonly occur on the legs of varying sizes. These veins have valves within them which prevents blood from falling back and propelling the blood back to the heart defying gravity. However, these valves become weak or dysfunctional and alows blood to pool at the legs. Varicose veins can be small spider veins, thread veins, or very large subcutaneous grapelike clusters. The medical term for spider veins is telangiectasias.

1

About two or three out of every ten women at some time in their lives, and around half as many men suffer from VV.

How does the valves become weak?
There are four main factors that contribute to the development of varicose veins:
1.heredity,
2.female sex hormones,
3.force of gravity,
4.hydrodynamic muscular forces.

The chances of getting varicose veins is increased by pregnancy or being very overweight. If one or both parents had them, you are also more likely to be affected. Varicose veins have traditionally also been blamed on factors such as standing up a lot or crossing the legs, but there isn’t good scientific evidence for this.

When blood pools at the bottom of the leg, after a while a few problems arises such as vein enlargement (varicose veins), pain, leg swelling, hyperpigmentation (skin discoloration), itchiness and even skin ulcers (breakdown of the skin).

Treatment can be divide into medical or surgical treatment. Varicose veins do not tend to get better without treatment, and usually get worse with time. To prevent it from getting worse, one is encouraged to use graduated compression stockings and take micronised flavinoids which acts in increasing venous tone. Other non-surgical methods are resting with the legs elevated (with the feet raised above the hips) and losing weight.

Indications for surgery:

    � Superficial thrombophlebitis (inflammation and blood clot in a superficial vein or veins
    that lie above the muscles of the leg)

    � External bleeding

    � Ankle hyperpigmentation (increased skin color)

    � Lipodermatosclerosis (hard, plaque-like painful areas affecting the skin and the tissues under the skin)

    � Atrophie blanche (white scar
    tissue)

    � Venous ulcer (skin eruption)

The most common surgical treatment is high ligation and multiple avulsion. The most common varicose vein operation is called ligation and stripping. It involves a small cut in the groin at the top of the main affected vein. This vein is tied off (ligated), to stop blood flowing through it, and is then carefully pulled (stripped) out of the leg through the incision. Sometimes the vein is tied off but not removed. Small cuts may also be made along the legs to allow individual smaller veins to be removed. This process is known as avulsion or phlebectomy.

However, one must make sure that the deep venous system is normal and intact before surgery. This done by performing duplex ultrasound imaging (a noninvasive technique that uses sound waves to determine the direction and velocity of blood flow).

An estimated 20% of surgeries for primary varicose veins result in recurrent varicosities.

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