VARICOSE VEINS

• They are dilated, tortuous, elongated veins in the leg. There is

reversal of blood flow through its faulty valves.
• It is permanently elongated, dilated vein/veins with tortuous
path causing pathological circulation
Causes
• heredity;
• female sex;
• occupation that demands prolonged standing;
• immobility;
• raised intra-abdominal pressure like in sports, tight clothing,
• pregnancy, raised progesterone level and altered estrogen-
progesterone ratio,
• chronic constipation,
• High heels.
• Classification I
♦ Long/great saphenous vein varicosity.
♦ Short/small saphenous vein varicosity.
♦ Varicose veins due to perforator incompetence
• Classification II
♦ Thread veins .
♦ Reticular varices (1-4 mm in size): Are slightly larger varices than
thread veins located in subcutaneous/subdermal region.
♦ Varicose veins. Dilated palpable subcutaneous veins more
than 4 mm in diameter (specifically located in saphenous
compartment).
♦ Combination of any of the above.Small varicose vein is < 4 mm in
diameter. Large varicose vein is > 4 mm in diameter
Clinical Features

• Dragging pain, postural discomfort

Heaviness in the legs
Night time cramps—usually late night
Oedema feet, itching (feature of CVI)
Discolouration/ulceration in the feet/painful walking
Investigations

• Venous Doppler:
Venography
Plethysmography:
U/S abdomen
Treatment

• Conservative treatment:
• Drugs used for varicose veins: like calcium dobucilate , diosmin
• Sclerotherapy
• Foam sclerotherapy

Surgery:
• Trendelenburg operation
• Stripping of vein
• Linton’s vertical approach for subfascial perforator ligation in the leg
ATHEROSCLEROSIS

• It is a chronic, complex inflammatory condition of elastic and

muscular arteries, involving as systemic and segmental

Common arteries involved are—infrarenal part of abdominal aorta,

coronary arteries, iliofemoral vessels, carotid bifurcation, popliteal
arteries. It is less common in upper limb arteries, common carotid,
renal and mesenteric arteries
Clinical features
• It is common after 50 years, but can occur at earlier age group.
♦ It occurs in males and females. Family history is common.
♦ Smoking, hypertension, diabetes, raised cholesterol are common causes.
♦ Arterial wall is thickened on palpation.
♦ Thrill and bruit over femoral, renal, carotid arteries may be felt/heard. It
suggests localised stenosis with turbulence of blood flow.
♦ Features of ischaemia in the affected limb seen. Absence/feeble pulses
including of main arteries of the limb—femorals. Abdomen should be
examined for aortic aneurysm.
♦ Transient ischaemic attacks, chest pain, eye problems,mesenteric
ischaemia, altered renal function may be associated.
Investigations
• Blood sugar, fasting lipid profile, Doppler, angiogram (CT /DSA),
• US abdomen, ECG, echocardiography are essential investigations.
• Angiogram shows typical narrowed artery,site, extent, percentage of
stenosis, and collaterals.
Management
• Risk factor modification: Avoid smoking; control of hypertension, diabetes,
hypercholesterolaemia; weight reduction by diet, and exercise.
♦ Drugs: Antiplatelet agents (aspirin 75 mg, clopidogrel 75mg); cilostazol 50
mg bd; atorvastatin to reduce cholesterol;pentoxiphylline.
♦ Percutaneous transluminal angioplasty (PTA) is very useful for iliac blocks
and lower limb blocks.
♦ Surgeries:
Thrombectomy, endarterectomy, profundaplasty.
Reverse/saphenous vein graft.
By pass grafts—iliofemoral, aortofemoral, iliopopliteal,femorofemoral grafts.
Amputations if limb is gangrenous—toe/below knee,above knee. Forefoot
and Syme’s amputations are not feasible in vascular conditions.
ANEURYSM

• It is an abnormal permanent dilatation of localised segment

of arterial system.

True aneurysm contains all three layers of artery.

False aneurysm contains single layer of fi brous tissue as
wall of the sac and it usually occurs after trauma
Types
• Fusiform—uniform dilatation of entire circumference of
arterial wall
Saccular—dilatation of part of circumference of the arterial wall
Dissecting—through a tear in the intima blood dissects
between inner and outer part of tunica media of the artery
Causes
♦ Acquired:
Degenerative: Atherosclerosis (most common cause);mucoid degeneration of intima
and media (in South African young Negroes).
Traumatic: Direct; indirect like in post-stenotic dilatation by cervical rib; traumatic AV
aneurysmal sac; aneurysm due to irradiation (due to dryness and destruction of
vasavasorum causing weakening).
Infective: Syphilis; mycotic; tuberculosis (in lung);arteritis; acute sepsis.
Collagen diseases like Marfan‘s syndrome, polyarteritis nodosa, Ehler-Danos
syndrome.
♦ Congenital:
Berry aneurysm; cirsoid aneurysm; congenital AV fistula.
Clinical features
♦ Swelling at the site which is pulsatile (expansile), smooth,soft, warm,
compressible, with thrill on palpation and bruit on auscultation.
Swelling reduces in size when pressed proximally.
♦ Distal oedema due to venous compression.
♦ Altered sensation due to compression of nerves.
♦ Erosion into bones, joints, trachea or oesophagus.
♦ Aneurysm with thrombosis can throw an embolus causing gangrene
of toes, digits, extending often proximally also.
Investigations

♦ Doppler study, duplex scan, angiogram, DSA.

♦ Tests relevant for the cause, like blood sugar, lipid profile,
echocardiography.
Treatment
Thank you.