You are on page 1of 3

International Journal of Advanced Research and Publications

ISSN: 2456-9992

Surgery, Management And Analysis Of Risk
Factors For Varicose Veins In Setif University
El-Hachmi Seddik, Khenchouche Abdelhalim, Behar Abdelaziz
Department of General Surgery. University Hospital of Setif. Algeria,

Laboratory of Health and Environment, Faculty of Medicine, UFAS, Setif 1, Algeria,

Abstract: Aims: the appearance of varicose veins is due to several factors. Some are known. Others are misunderstood to nowadays. If
studies in this area are limited, this is because it is a disease that is not of much interest in medicine. In recent years and with the availability
of treatments and the surgical procedure, an epidemiological study is necessary. In this study, we try to analyze the factors involved in order
to prevent or at least limit its damage. Methods: Follow a group of patients with varicose veins at different stages of the disease. Establish
an epidemiological investigation. Identify the different risk factors that characterize these patients, such as hereditary factors, age, sex,
occupation, number of pregnancies in women, obesity, race, geographical area, socio-economic level... Conclusion: Establishing a balance
of the most relevant factors, in order to be limited to the treatment before the surgical act. Patients, who have undergone surgery, plan a
recovery at a lower cost.

Keywords: Varicose, risk factors, treatments, surgery.

1. Introduction the increasing cost of treatment (prolonged hospitalization
Varicose veins sometimes appear as enlargement of the and postoperative care); it becomes necessary to take care of
veins, dilation or overload of blood. Varicose appear as with these cases from the point of view of prevention and
Blue-violet or red color. Varicose veins often occur in complications and adequate surgical procedures [6]. In this
women on the lower legs. In recent years, knowledge about study, we found it useful to strike a balance between the most
varicose veins has been developed. In particular, the relevant factors. The goal is to preserve the patient from the
physiological characteristics of the venous system, which evolution of this patient and to avoid the solution of the
lead to trophic changes in the skin. Viewing the nature of surgical act. When this is unavoidable, it must be ensured
progressive appearance and the multi-factorial causes of that post-operative follow-up care at a lower cost.
them, this makes it difficult to analyze and determine exactly
what these are. Thus, the complexity of the system makes it 2. Risk factors
difficult to predict the evolution of these varicose veins that Some factors may be aggravating causes of risk for varicose
lead to cutaneous trophy changes and ulcers. Hence, it is veins. These factors can be summarized as follows:
necessary to address the issue from an epidemiological point  Family History
of view in order to improve the understanding this subject. Generally, the genetic factor is for many in the
Surveys based on this at-risk population are critical in appearance of varicose veins. Family history is
assessing the prevalence, risk factors and geographic considered a risk factor.
distribution of venous disorders [1]. Generally, varicose
veins are not well taken care of and continue to be considered  Age
of little medical importance, although they affect close to one With age, the risk of varicose veins increases. This
third of adults, especially in developed countries. These last can be explained by the aging and weakening of the
times they cause concern because most can be treated. A valves in the veins.
wide variety of therapeutic options are available.
Epidemiological studies relate factors that are often  Gender
hereditary to explain the causes of valve dysfunction and Women are more likely to have varicose veins than
hydrostatic venous pressure. Other studies report causes men. Again, this can be explained by the hormonal
related to imbalance of matrix metalloproteinase (MMP) factor. Changes in these hormones often occur
which is related to the viscosity of the blood [2]. Opinions during puberty, pregnancy or menopause. Also, the
differ as to the etiology of varicose veins. This is varied and use of the contraceptive pill can contribute to the
some cause rapid disease progression and slow deterioration. onset of varicose veins.
Wedell [3] reported that the male-female ratio is higher.
Wearing clothes that reveal certain parts of the body means  Pregnancy
that the number of patients is more important for cosmetic During pregnancy, the increase in fetal weight
reasons [4]. Risk factors include occupations that require exerts pressure on the veins of the legs.
prolonged periods of physical effort that contribute to the
prevalence of varicose veins. It is also necessary to consider
other factors such as age, sex, hereditary factor and history of
the patient with regard to deep venous thrombosis [5]. Given

Volume 2 Issue 2, February 2018 16
International Journal of Advanced Research and Publications
ISSN: 2456-9992

 Overweight or obese factor is a factor that cannot be addressed. The same applies
Logically, the increase in body weight can be an to sex or woman during pregnancy. On the other hand, it is
aggravating risk. Overweight due to weight is possible to act on the overweight factor for example as an
exerted on the veins of the legs. aggravating factor. Mainly, the best prevention remains the
 Lack of movement
Depending on the position of the legs curved or Lifestyle Changes
crossed over a long time can increase the risk of Lifestyle changes are often the first treatment for varicose
varicose veins. veins. These changes can prevent varicose veins from getting
worse, reduce pain and delay the onset of varicose veins.
3. Treatment & management of varicose veins Prevention cannot usually prevent varicose veins from
forming. However, this can prevent those who are already
A. Medical Procedures getting worse. Adequate measures can prevent other varicose
Medical procedures are performed either to remove varicose veins from forming.
veins or to close them. The procedure most commonly used
to treat smaller varicose veins and spider veins is sclera- Conclusion
therapy. It consists of using a liquid chemical to close a In view of the nature of this disease, several treatments are
varicose vein. The chemical is injected into the vein to cause dispensed these days. However, in most cases surgery is
irritation and healing in the vein. The irritation and the scars inevitable. In this field, our healthcare structure does not
cause the vein to close, and it disappears. However, allow the use of modern techniques using sophisticated
involuntary injection of concentrated sclerosants into the equipment. As mentioned above, we must act on the risk
deep vein system can cause deep vein thrombosis or factors that we have the possibility to intervene. We limit
pulmonary embolism. Other treatment techniques are used as ourselves just to prevention by the factors related to the
micro sclera-therapy, laser surgery, endovenous ablation lifestyle mentioned above
therapy, endoscopic vein surgery, ambulatory phlebectomy,
vein stripping and ligation. Varicose vein surgery remains a Conflict of interest - none
solution to this disease. The choice of the patient is taken into Funding – none
account in particular in the case where this necessitates
bilateral surgery. Generally, unilateral surgery is the most References
frequent procedure for ambulatory procedures. While [1]. Carpentier PH, Maricq HR, Biro C, Poncot-Makinen
bilateral surgery is often done as an intra-hospital procedure CO, Franco A. Prevalence, risk factors and clinical
[7]. patterns of chronic venous disorders of the lower
limbs. A population-based study in France. J Vasc
B. Surgery Surg 2004; 40:650e9.
At the level of our general surgery department of Setif
university hospital in Algeria, interventions on varicose veins [2]. Remya K, Rajesh Ballal, Sunil Kumar Y. To study
that are considered large, our surgical procedures are done enzyme imbalance for the development of varicosity
under general anesthesia. The protocol consisted of a in young adult male population of South India
sapheno-femoral ligature with long saphenous vein stripping International Journal of Research in Health Sciences.
and phlebectomy as stipulated by Dwerryhouse (1999) [8]. Oct–Dec 2013 Volume- 1, Issue-3
All patients who underwent single-leg interventions returned
home the same day. However, a minority was concerned by [3]. Wedell JM. Varicose veins - a pilot survey. Br J Pr
an intervention on both legs and there patients spent one Soc Med. 1969; 23:179)
night in the hospital. If laser treatment is often used to close
small veins and also spider veins, at the level of our service, [4]. Shankar KH. Clinical study of varicose veins of lower
no laser treatment has been performed. Also, the technique of limbs. Int Surg J. 2017;4:633-6.
radioblocks and laser ablation as alternative techniques to the
pickling of the long saphenous vein with or without incision [5]. Mohd Shafiuddin, T. P. Bhavanishankar. Study of
of the groin [9] [10] [11] [12] was not performed. As risk factors and clinical assessment of lower limb
reported by Bruce (2006) [15], obese patients in our varicose vein in a tertiary care hospital. International
department did not show significant postoperative bruising Surgery Journal Shafiuddin M et al. Int Surg J. 2017
and did not have any additional surgery and were completely Aug;4(8):2480-2483
discontinued of their varicose veins.
[6]. Mironiuc A, Zanfir AM, Gherman C, Mironiuc C.
4. Prevention Correlation of risk factors and complications in the
Varicose veins are treated with lifestyle changes and medical conventional surgery of varicose veins. Chirurgia
procedures. The objectives of the treatment are to alleviate (Bucur). 2010 Jul-Aug;105(4):509-13.
the symptoms, prevent complications and improve the
appearance. In order to prevent the appearance of varicose [7]. Gemayel G, Christenson JT. Can bilateral varicose
veins, we can note that some risk factors are uncontrollable. vein surgery be performed safely in an ambulatory
Among these factors we can cite the family history because setting? Eur J Vasc Endovasc Surg. 2012
we cannot intervene on the genetic factor. Also, age as a risk

Volume 2 Issue 2, February 2018 17
International Journal of Advanced Research and Publications
ISSN: 2456-9992

Jan;43(1):95-9. doi: 10.1016/j.ejvs.2011.09.022.
Epub 2011 Oct 19.

[8]. Dwerryhouse S, Davies B, Harradine K, Earnshaw JJ.
Stripping the long saphenous vein reduces the rate of
reoperation for recurrent varicose veins: five year
results of a randomized trial. J Vasc Surg 1999;29:

[9]. Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL,
Pichot O, et al. Prospective randomized study of
endovenous radiofrequency ablation (Closure
procedure) versus ligation and vein stripping
(EVOLVeS): two-year follow-up. Eur J Vasc
Endovasc Surg 2005;29: 67-73.

[10]. Rautio T, Ohinmaa A, Perala J, Ohtonen P,
Heikkinen T, Wiik H, et al. Endovenous obliteration
versus conventional stripping operation in the
treatment of primary varicose veins: a randomised
controlled trial with comparison of the costs. J Vasc
Surg 2002;53: 958-65.

[11]. Merchant RF, DePalma RG, Kabnick LS.
Endovascular obliteration of saphenous reflux: a
multicenter study. J Vasc Surg 2002;35: 1190-6.

[12]. Nicolini PH and the Closure Group. Treatment of
primary varicose veins by endovenous obliteration
with the VNUS closure system: results of a
multicentre study. Eur J Vasc Endovasc
Surg 2005;29: 433-9.

[13]. Min RJ, Khilnani N, Zimmet SE. Endovenous laser
treatment of saphenous vein reflux: long term
results. J Vasc Interv Radiol 2003;14: 991-6.

[14]. Mundy L, Merlin TL, Fitridge RA, Hillier JE.
Systematic review of endovenous laser treatment for
varicose veins. Br J Surg 2005;92: 1189-94.

[15]. Bruce Campbell. Varicose veins and their
management. BMJ. 2006 Aug 5; 333(7562): 287–
292. doi: 10.1136/bmj.333.7562.287

Volume 2 Issue 2, February 2018 18