2. WHAT IS VARICOSE VEINS
Varicose veins are abnormally
dilated, tortuous, superficial
veins caused by incompetent
venous valves. Most commonly
seen in lower extremities

3. LOWER LIMB VENOUS ANATOMY

4. VALVES
Maintain unidirectional
flow.
Extremity to heart.
Superficial to deep.

5. PERFORATORS
Connects deep
and superficial
systems
Flow normally from
superficial to deep

6. MUSCLE PUMP
Contractions propel
blood toward heart
Relaxation draws blood
from superficial veins
and pour into deep veins

7. ETIOLOGY
HERIDITARY
LACK OF
EXCERCISE
HORMONAL
MEDICATION
SURGERY/
TRAUMA

8. ETIOLOGY
OBESITY
PREGNANCY

9. ETIOLOGY
AGE OVER
40
JOBS REQ LONG
STANDING/SITTING
HOURS

10. STAGES OF VARICOSE VEINS
0.No visible
venous disease
3.Oedema
1.Telangiectasias
or reticular veins
4.Skin changes
2.Visible Varicose
veins
6.Active ulceration
5.Healed ulceration

11. STAGE 0 NO VISIBLE DISEASE

12. STAGE 1 TELENGECTASIA / RETICULAR
VEINS

13. STAGE 2 VISIBLE VARICOSE VEINS

14. STAGE 3 OEDEMA

15. STAGE 4 SKIN CHANGES

16. STAGE 5 HEALED ULCERATION

17. STAGE 6 ACTIVE ULCERATION

18. SIGNS AND SYMPTOMS
Aching, heavy
legs
• Often worse
at night and
after exercise

19. SIGNS AND SYMPTOMS
Brownish-Blue shiny skin
discoloration near the
affected veins
Statis dermatitis or venous
eczema
Redness, dryness and
itchiness

20. SIGNS AND SYMPTOMS
Cramps
Restless leg syndrome
Atrophie blanche
• Whitened, irregular scar-like patches
on the ankles

21. SIGNS AND SYMPTOMS
Minor injuries to the area may bleed more
than normal and/or take a long time to heal.
Lipodermatosclerosis
• Skin above the ankle may shrink
• Due to hardening of the fat underneath the skin

22. DIAGNOSTICS
Venous doppler examination of both legs
Superficial and deep venous system evaluated

23. TRADITIONAL TREATMENT
Surgical ligation and stripping
High ligation
Injection sclerotherapy
Phlebectomy
Only treats the visible varicosities with out treating the actual problem

24. MODERN ADVANCED TREATMENT
Hybrid technique
Endovenous laser treatment
plus
Foam sclerotherapy

25. ENDOVENOUS LASER TREATMENT
Simple procedure
Safer
• Performed under local anesthetic/ sedation
• Immediate relief of symptoms
No ugly scar
• Minimally invasive, so minimal risk of scarring
and postoperative infection

26. ENDOVENOUS LASER TREATMENT
Less than one hour examination and
treatment time.
Rapid recovery with reduced postoperative
pain.
Normal activities can be resumed
immediately
Excellent clinical and aesthetic results.

27. ENDOVENOUS LASER TREATMENT
Less reocurrence (surgery Vs EVLT:
25% Vs 5%)
Accepted by insurance providers.
EVLT is an American FDA approved
treatment for varicose veins.

28. FOAM SCLEROTHERAPY

29. DIFFERENCE BETWEEN
SURGERY
/
EVLT
Req- general
anaestheis
Req only sedation
Pain, bruising
and scarring
No
pain, bruising, scarring
Req -Hospital
admission
Day care procedure

30. DIFFERENCE BETWEEN
SURGERY
/
EVLT
Reoccurance
25%
Reoccurance 5%
Not suitable for
every pt
No age limit, almost
suitable for every pt
Long healing
time
Can return to work
the next day

31. SURGERY
/
EVLT

32. BEFORE AND AFTER

33. BEFORE AND AFTER

34. BEFORE AND AFTER

35. BEFORE AND AFTER

36. PREVENTION

37. PREVENTION
Elevate legs while sleeping
Regular exercise daily
Wear stockings regularly
No continuos sitting/ standing
for more than 30 minutes

38. THANK YOU

40. NEXT TOPICS
CARCINOMA OF
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UTERINE FIBROIDS