Percussion

Schwartz test-most prominent part of varicose veins are tapped, impulse can be
felt by finger at saphenous opening. Percussion waves can be transmitted from
above downwards and will imply absent or incompetent vslves between tapping
finger and palpating finger.
Auscultation
Importance is limited to arteriovenous fistula, continuous machinery murmur may
be heard.
General examination
Examination of the abdomen-
Pregnant uterus ,intrapelvic tumour (fibroid, ovarian cyst, cancer of cervix or
rectum) or abdominal lymphadenopathy may cause pressure on the external iliac
vein and become responsible for secondry varicosity.
Complications of varicose veins
Haemorrhage- simple elevation of legs does a lot to stop bleeding
Phlebitus- in this condition varicose vein become tender and firm and overlying
skin vecomes red and edenatoys.
Ulceration-majority have incompetent veins. Mostly found on lower 3rd of leg
usually on medial side and on foot. They are shallow and flat,sloping edge, pale
purple blue colour, floor covered with pink granulation tissue. Seropurulent
discharge with trace of blood. Ragged edges
Marjolin’s ulcer- malignancy devrloping from edge of ulcer. Due to lomg standing
Pigmentation
Eczema
Lipodermatosclerosis- skin thickened fibrosed and pigmented.
Calcification of vein
Periostitis
Equinus deformity- walking on toes relieve pain and resultingky Achilles
tendon bevome smaller.
CAUSES
Primary-
Cause isnot known
Valves are incompetent
Venous wall weak which permit dilatation leading to incompetent valve.
Rarely absence of valves.
Secondary
Obstruction to venous outflow- pregancy , fibroid, ovarian cyst, pelvic
cancer, abdominal lymphadenopathy, ascites, iliac venous thrombosis,
retro peritoneal fibroisis
Destruction of valve
High pressure flow
Management
Adjunctive management:-
Compression garments or stockings
Dressing for ulcer
Definitive management
For great saphenous vein and SFJ incompetence
Traditional surgery- trendelenberg procedure
Latest- EVLT And RFA
Short saphenous vein and SPJ competence
Traditional surgery- flush ligation ofSPJ and no stripping done ( to prevent sural
nerve injury)
Perforator incompetence- dodd and cocket procedure ( multiple shb facial ligation
of perforators or SEPS