MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS

ESTABLISHMENT OF EDUCATION "VITEBSK STATE ORDER

FRIENDSHIP OF PEOPLES MEDICAL”

REFERATH

VARICOSE VEIN AND DEEP VEIN THROMBOSIS

TALAL MOHAMMAD
Group No 52

Teacher of in charge

М.И.КУГАЕВ

Vitebsk 2021
Varicose Vein
Introduction
Varicose veins are enlarged, bulging superficial veins that can be felt beneath the
skin, generally larger than 3-mm in diameter. They are usually located on the
inside of the calf or thigh and develop due to weakness of the vein wall and loss of
valve function. Under the pressure of gravity, they continue to enlarge, and in the
course of time, they may become elongated, twisted, pouched and thickened.

Spider veins or telangiectasia are tiny dilated, veins, usually less than 1-mm in
diameter, located at the surface skin layers. Spider veins cannot be felt. Veins
larger than the spider veins, but still under 3-mm are called reticular veins.

Causes

The veins have one-way valves so that the blood can travel in only one direction. If
the walls of the vein become stretched and less flexible (elastic), the valves may
get weaker. A weakened valve can allow blood to leak backward and eventually
flow in the opposite direction. When this occurs, blood can accumulate in the
vein(s), which then become enlarged and swollen.
The veins furthest from the heart are most often affected, such as those in the legs.
This is because gravity makes it harder for blood to flow back to the heart. Any
condition that puts pressure on the abdomen has the potential to cause varicose
veins; for instance, pregnancy, constipation and, in rare cases, tumors.

Risk factor
Experts are not sure why the walls of veins stretch or why the valves become
faulty. In many cases, it occurs for no clear reason. However, some potential risk
factors include:
 Age
 Genetic
 Gender
 Pregnancy
 Overweight and obesity
  Posture

Pregnancy and varicose vein

Women are much more likely to develop varicose veins during their pregnancy
than at any other time in their lives. Pregnant women have much more blood in
their body; this places extra pressure on the circulatory system.

Additionally, changes in hormone levels can lead to a relaxation of the blood

vessel walls. Both these factors raise the risk of having varicose veins.

As the uterus grows, there is more pressure on the veins in the mother’s pelvic
area. In the majority of cases, the varicose veins go away after the pregnancy is
over; this is not always the case, and sometimes, even if the varicose veins
improve, there may be some left visible.

Types of varicose Vein according to causes

varicose veins may be primary, secondary, or congenital. Primary varicose veins

develop as a result of an inherent weakness in the wall of the vein. Varicose veins
can have a hereditary factor and often occur in several members of the same
family. Varicose veins that develop after trauma or deep vein thrombosis are of
secondary cause. Congenital varicose veins are due to disorders in the natural
development of the venous system, and usually are part of a vascular malformation
in the limb, present at birth. In addition to varicose veins, these individuals may
also have an enlarged and longer limb and often have birthmarks (port-wine stains)
like in Klippel Trenaunay Syndrome (KT syndrome). No matter the cause,
defective venous valves may cause venous blood to stagnate in the leg, leading to
increased pressure in the veins. This may result in further enlargement of the
varicose veins, increasing the likelihood of symptoms, and causing complications
such as skin changes and ulcer formation. Blockage of the pelvic veins may
severely aggravate the effects of varicose veins, requiring a separate treatment.

Clinical manifestation

 Enlarged veins that are visible on skin

 Mild swelling in the ankles and feet

 Painful, achy, or heavy legs

 Thrombing or cramping in legs, especially in the lower leg and ankle

 Discoloration of the skin surrounding the varicose vein

Diagnosis

The following diagnostic tests are sometimes ordered:

  Doppler test: An ultrasound scan to check the direction of blood flow in the
veins. This test also checks for blood clots or obstructions in the veins.
 Color duplex ultrasound scan: This provides color images of the structure
of veins, which helps the doctor identify any abnormalities. It can also
measure the speed of blood flow.

Treatment

If the patient has no symptoms or discomfort and is not bothered by the sight of the
varicose veins, treatment might not be necessary. However, if there are symptoms,
treatment may be required to reduce pain or discomfort, address complications,
such as leg ulcers, skin discoloration, or swelling.

Some patients may also want treatment for cosmetic reasons – they want to get rid
of the “ugly” varicose veins.

Surgery

If varicose veins are large, they may need to be removed surgically. This is usually
done under general anesthetic. In most cases, the patient can go home the same day
– if surgery is required on both legs, they may need to spend one night in hospital.

 Ligation and stripping

 Sclerotherapy

 Radiofrequency ablation

 Endovenous laser treatment

 Transilluminated powered phlebectomy

Prevention

To reduce the risk of developing varicose veins:

 get plenty of exercise, for example, walking

 maintain a healthy weight
 avoid standing still for too long
 do not sit with the legs crossed
 sit or sleep with your feet raised on a pillow

Complication

Any condition in which proper blood flow is undermined has a risk of

complications. However, in the majority of cases, varicose veins have no
complications. If complications do occur, they may include:

 Bleeding

 Thrombophlebitis: Blood clots in the vein of the leg cause inflamation of the

vein.
 Chronic venous insufficiency – the skin does not exchange oxygen,
nutrients, and waste products with the blood properly because the blood flow
is weak. Chronic venous insufficiency is not caused by varicose veins, but
the two entities are closely related.

Deep Vein Thrombosis

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or
more of the deep veins in your body, usually in your legs. Deep vein thrombosis
can cause leg pain or swelling but also can occur with no symptoms.
Symptoms

DVT signs and symptoms can include:

 Swelling in the affected leg. Rarely, there's swelling in both legs.

 Pain in your leg. The pain often starts in your calf and can feel like cramping
or soreness.
 Red or discolored skin on the leg.
 A feeling of warmth in the affected leg.
Deep vein thrombosis can occur without noticeable symptoms.

DVT causes
DVT is caused by a blood clot. The clot blocks a vein, preventing blood from
properly circulating in your body. Clotting may occur for several reasons. These
include:

 Injury. Damage to a blood vessel’s wall can narrow or block blood flow. A

blood clot may form as a result.
  Surgery. Blood vessels can be damaged during surgery, which can lead to
the development of a blood clot. Bed rest with little to no movement after
surgery may also increase your risk for developing a blood clot.
 Reduced mobility or inactivity. When you sit frequently, blood can collect
in your legs, especially the lower parts. If you’re unable to move for
extended periods of time, the blood flow in your legs can slow down. This
can cause a clot to develop
 Certain medications. Some medications increase the chances your blood
will form a clot.

DVT test

Your doctor will use your medical history, a thorough physical exam, as well as
one or more diagnostic tests to find or rule out DVT. These tests include:

Ultrasound

This is the most commonly used test for diagnosing DVT. Ultrasound uses sound
waves to create a picture of your arteries and veins in order to see how blood flows
through them.

If a clot is present, your doctor will be able to see the interrupted blood flow and
make the diagnosis.
Venogram

If the ultrasound is inconclusive, your doctor may order a venogram. During this
test, a dye is injected into the vein in question. Then, an X-ray is taken over the
area where your doctor suspects DVT is present.

The dye makes the vein more visible, so interrupted blood flow would be easily
seen.

D-dimer test

A D-dimer blood test measures the presence of a substance that’s released when a

blood clot breaks apart. If levels of the substance are high and you have risk factors
for DVT, you likely have a clot. If levels are normal and your risk factors are low,
you likely don’t.

Other tests can be used to diagnose DVT if these aren’t successful. Read more
about each of them and how they can help your doctor find a blood clot.

DVT images
DVT treatment
DVT is a serious medical condition. Tell your doctor right away if you think
you’re experiencing symptoms of DVT or go to the closest emergency room. A
healthcare provider can check out your symptoms.

DVT treatments focus on keeping the clot from growing. In addition, treatment
may help prevent a pulmonary embolism and lower your risk of having more clots.

Medication

Your doctor might prescribe medications that thin your

blood, like heparin, warfarin (Coumadin), enoxaparin (Lovenox), or fondaparinux
(Arixtra). This makes it harder for your blood to clot. It also keeps existing clots as
small as possible and decreases the chance that you’ll develop more clots.

If blood thinners don’t work, or if you have a severe case of DVT, your doctor
might use thrombolytic drugs. People with upper extremity DVT may also benefit
from this medication.

Thrombolytic drugs work by breaking up clots. You’ll receive these

intravenously. Read more about these drugs and how they can help prevent and
destroy blood clots.

Prescribe as: LMWH full dose with warferin 5mg for 2-3 days. Check for INR.
Increase the dose of warferin until INR is 2-3. Warferin is administrated for at least
3 months, every 2 weeks INR is checked

Compression stockings

If you’re at high risk for DVT, wearing compression stockings can prevent

swelling and might lower your chance of developing clots.
Compression stockings reach just below your knee or right above it. Your doctor
may recommend you wear these every day.

Filters

You might need to have a filter put inside the large abdominal vein called the vena
cava if you aren’t able to take blood thinners. This form of treatment helps prevent
pulmonary embolisms by stopping clots from entering your lungs.

But filters do have risks. If they’re left in for too long, they can actually cause
DVT. Filters should be used for a short-term period, until the risk of
thromboembolism is reduced and blood thinning medications can be used.

DVT surgery

Your doctor may suggest surgery to remove a DVT clot in your arm or leg. This is
typically only recommended in the case of very large blood clots or clots that are
causing serious issues, like tissue damage.

During a surgical thrombectomy, or surgery to remove a blood clot, your surgeon

will make an incision into a blood vessel. They’ll locate and remove the clot. Then,
they’ll repair the blood vessel and tissue.

In some cases, they may use a small inflating balloon to keep the blood vessel open
while they remove the clot. When the clot is found and removed, the balloon is
removed with it.

Surgery isn’t without risks, so many doctors will only use this treatment in severe
cases. Risks include infection, damage to the blood vessel, and excess bleeding.
 REFERENCE LIST

https://www.google.by/search?
hl=en&sxsrf=ALeKk02Eq9YCe6UE07q6Tchq_1jRgVCOkw
%3A1614551128192&source=hp&ei=WBg8YODkCIO6sAfu_52ADw&iflsig=AI
NFCbYAAAAAYDwmaKAr1kzK1WvSnBKW3d3htloz0JQ2&q=deep+vein+thro
mbosis&oq=Deep+vein+&gs_lcp=Cgdnd3Mtd2l6EAEYADICCAAyAggAMgIIA
DICCAAyAggAMgIIADICCAAyAggAMgIIADICCAA6BAgjECc6BAguECc6C
AguEMcBEKMCOg0ILhDHARCvARAnEJMCOgoILhDHARCjAhAnOgIILjoF
CC4QkwI6BAgAEApQ2DBYwlVgg2NoA3AAeACAAa4BiAHMDpIBBDAuMT
OYAQCgAQGqAQdnd3Mtd2l6&sclient=gws-wiz

https://www.healthline.com/health/deep-venous-
thrombosis#_noHeaderPrefixedContent

https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/