Arterial Disorders

Venous Disease

Varicose Vein

Dilated tortuous veins

5% of adult population

Equal gender prevalence

Family history
Introduction:

Incompetence of the venous valves

Primary venous incompetence
Secondary venous incompetence


Pathology:

Unsightly appearance

Discomfort and aching at the end of the day
Ankle swelling towards the end of the day
Complications:
Itching and eczema
Lipodermatosclerosis
Venous ulceration
Clinical manifestations:

Venous Eczema (stasis dermatitis):

Lipodermatosclerosis:

Venous Ulcer:

On examination:
Great or small saphenous vein
• Incompetent saphenofemoral junction or incompetent perforators
Exclude DVT or deep vein incompetence

Usually diagnosed clinically

Investigations done to confirm and exclude
• Duplex ultrasound
• Venography
• Abdominal and/or pelvic imaging
Investigations:

• Reassurance

• Elastic compression stockings
• Avoid prolong standing and change of occupation may be required
• Periodic elevation of the feet
Treatment:
• I- Conservative Treatment:


Sodium tetradecyl sulfate (STD)
II- Injection sclerotherapy:

Indications for surgery:

Symptomatic varicose veins
Complicated or bleeding varicose veins
Large varicose veins
Cosmetic purposes
Surgical options include:
Ligation and stripping of the saphenous vein
Multiple subfacial perforator ligation
Combination of both.
Complications of varicose vein surgery:
Nerve injury (saphenous nerve and sural nerve)
Recurrence

III- Surgical Treatment:

Varicose vein stripping:

Radiofrequency Ablation
Endovascular laser ablation.
IV- New Techniques:

Deep Vein Incompetence

Pathology:

Leg swelling,
Discomfort on walking,
Edema,
Varicose veins (which may not be present),
Ankle flare (small varices),
Lipodermatosclerosis
Ulceration
Clinical presentation

Post Phlebetic syndrome:

• Duplex ultrasound
• Venography.
Investigations:

• Elastic compression stockings

• Avoid prolong standing and change of occupation may be required
• Periodic elevation of the feet
• Exercise of the calf muscles
Treatment:
• I- Conservative Treatment:

• Venous bypass procedures (e.g. Palma procedure)

• Venous valve reconstruction
• Venous valve transposition
II- Surgical Treatment:


Venous Ulceration

Venous disease: deep vein incompetence

Arterial ischemia
Rheumatoid ulcer
Traumatic ulcer
Neuropathic ulcer (diabetic)
Neoplastic ulcer (squamous cell carcinoma and basal cell carcinoma).

Differential diagnosis of leg ulcers:

Not fully understood
Ambulatory venous hypertension
Due to valve incompetence:
Incompetent superficial veins
Incompetent perforator veins
Incompetent or obstructed deep veins
Etiolgy:

Site: gaiter region (between calf and ankle)

Size: usually large
Depth: usually superficial
Edges: gently sloping edges
Base: granulation tissue + slough and exudates
Discharge: pus occasionally blood
Surrounding tissue: features of chronic venous disease
Local lymph nodes: enlarged (superadded infection)
Movement of ankle joint: restricted due to pain
Clinical examination

Venous Ulcer:

• Swab and culture from the ulcer
• Duplex ultrasound
• Venography
Investigations:

multilayered elastic compression bandaging system,

avoid prolong standing,
periodic leg elevation
Treatment:
• I- conservative Treatment:

Multilayer elastic compression

• Surgery for the cause of the venous ulcer (varicose vein, DVT or chronic venous insufficiency)
• Perforator vein subfacial ligation
• Skin graft to the ulcer after dealing with the underlying cause
II- Surgical Treatment:

Superficial Thrombophlebitis

External trauma,
Venepunctures and infusions of hyperosmolar solutions and drugs.
Intravenous cannula
Some systemic diseases: buerger’s disease, and malignancy,
Coagulation disorders: polycythaemia, thrombocytosis and sickle cell disease

Etiology:

• Treatment::
• Reassurance
• NSAIDs
• Warm massage

Superficial thrombophlebitis

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