5. Great saphenous vein:
• It is formed on the dorsum of foot by the
union of the medial end of the dorsal
venous arch of the foot and medial
marginal vein of the foot. The vein runs
upward about 2.5 cm in front of the medial
malleolus, crosses obliquelythe medial
surface of the lower third of tibia, and then
ascends a littlebehind the medial border of
tibia to reach the knee, where it lies on the
posteromedial aspect of the knee joint, about
one hand-breadth posteriorto the patella;it is
accompanied by saphenousnerve.
• From here it runs upward along the medial
side of the thigh to reach the saphenous
opening(fossa ovalis).
• It passes through the saphenousopening
after piercing the cribriform fascia and
drains into the femoral vein after piercing
the femoral sheath.
6. Small saphenous vein
• It is formed below and behind the lateral
malleolus by the union of the lateral end of
the dorsal venous arch, and the lateral
dorsal digital vein of the little toe. It runs
upward behind the lateral malleolus, along
the lateral edge of tendocalcaneus, and is
accompanied by the sural nerve on its
lateral side.
• Thereafter it runs in the middle of the back
of the leg, pierces the deep fascia, and
undergoes a subfascial course between the
two heads of the gastrocnemius until it
reaches the middle of the popliteal fossa.
Here it turns inward to terminate into the
popliteal vein.
7.
8.
9. • Permanently dilated (>3mm)
and tortuous leg veins with
reflux of blood caused by
incompetent valve closure,
which results in venous
congestion and vein
enlargement
• Usually affects the saphaenous
vein and its branches
18. Clinical manifestations
• Enlarged veins that are visible on skin
• Mild swelling of ankles and feet
• Painful, achy, or “heavy” legs
• Throbbing or cramping in legs
• Itchy legs, especially in the lower leg and ankle
• Discoloration of skin surrounding the varicose veins
19.
20.
21.
22. Telangiectasia and
reticular veins.
Advanced skin changes –
lipodermatosclerosis, eczema
and atrophie blanche.
Pigmentation (haemosiderosis) and mild
eczema. Severe eczema.
venous ulcer.
23. Clinical Signs
1.Brodie-trendelenberg’s test I
-Saphenofemoral incompetence
2.Brodie-trendelenberg’s test II
-Perforator incompetence
3.Perthe’s test / modified perthe’s – DVT
4.Tourniquet’s test - Perforator incompetence
5.Schwartz test - Valvular incompetence
6.Fegan test -Perforator site localisation
7.Pratt’s test - Blow outs = perforators
29. Sclerotherapy
Sclerosant agent: sodium tetradecyl sulphate
dose: 0.25 - 1ml at one site and maximum can be 4 ml at 4
different sites in superficial vein.
Action: irritation to the intima of the vein wall, causes
hardening of vein so that they no longer fill with blood.
Blood that would normally return to the heart through
these veins returns to the heart by way of other veins. The
veins that received the injection will eventually shrivel
and disappear. The scar tissue is absorbed by the body.
30.
31. Surgery
Vein stripping and ligation:
involves tying off all varicose veins associated
with the leg's main superficial vein and
removing it from the leg. The removal of
veins from the leg will not affect the blood
circulation in the leg as deeper veins will be
able to take care of the increased blood
circulation
34. Laser treatment:
This procedure uses no incisions or injections. Light
energy from a laser is used to make the vein fade
away. Laser surgery is typically used to treat smaller
varicose veins.
35. Endovenous ablation therapy:
A tiny incision is made in the skin & small
catheter is inserted into the vein. A device at the
tip of the catheter heats up inside the vein, which
causes it to close off.