Home Cure for Varicose Veins
Inspection with the patient standing is one of the most important aspects of the examination of chronic venous disease. The dilated veins of superficial disease are frequently obvious. Other signs of importance include swelling, hemosiderosis of the skin of the malleolar area, lipodermatosclerosis, atrophie blanche, and ulceration (Fig. 2.10). Deep venous disease may be less obvious and present simply with chronic swelling of the limb. In later stages, all of the above signs may be present. Figure 2.10. Chronic venous insufficiency. The limbs demonstrate the brownish discoloration associated with lipatoder-matosclerosis.Varicosities are also present. Figure 2.10. Chronic venous insufficiency. The limbs demonstrate the brownish discoloration associated with lipatoder-matosclerosis.Varicosities are also present.
Surgery for varicose veins, involving long or short saphenous system in the lower Operative technique for varicose veins affecting long saphenous system The operation for varicose veins for long saphenous system comprises of The operation for varicose veins for short saphenous system comprises of
Classical physicians, such as Hippocrates (fifth century b.c.), Aurelius Celsus (first century a.d.), Galen (second century a.d.) and Paulus Aegineta (sixth century a.d.), described various methods of treating varicose veins by ligation, cauterization and even stripping of the dilated long saphenous vein 14, 38 . The Greek Antyllus of the third century a.d., the most famous surgeon of antiquity, applied the well-known Antyllus' method, an operation for aneurysm in which he applied two ligatures to the artery and cut between them. This was the accepted method of dealing with aneurysms until the work of Jon Hunter in the eighteenth century. Antyllus was the first to recognize two forms of aneurysm the developmental, caused by dilatation, and the traumatic, following arterial trauma 38 .
It has been estimated that 1 in 2000 women develop thrombosis during pregnancy. This risk increases 10 times when compared with nonpregnant women of the same age 23, 30 . This risk also goes up in the postpartum period. Pregnancy leads to increased levels of the blood clotting factors I, VII, VIII, IX, X, XI and XII, an increased platelet count and reduced protein S and anti-thrombin concentrations. Further, the fibrinolytic pathway may be blocked by the increased levels of activated plasminogen inhibitors 1 and 2, produced in the placenta. These factors, combined with the venous stasis produced by compression by the uterus of draining leg veins, can increase the risk of thrombosis during the prepartum period by up to 20 times. Some 2 months after childbirth, fibrinolytic and coagulation systems return to their normal state.
Radiofrequency or laser ablation of the greater saphenous vein (GSV) is gaining popularity as an alternative, less invasive method for GSV stripping in the treatment of varicose veins. This transforms varicose vein treatment into an office practice and limits the anesthesia needs to infiltration of local anesthetics. The skin is typically infiltrated at the site of insertion of the sheath through which the laser or radioablation catheter is introduced. Because of the heat generated with the venous ablation, additional anesthesia is needed along the course of the GSV. Tumescent anesthesia is used for this purpose. Tumescent anesthesia is prepared by the following concentration
The clinical evaluation of the peripheral venous system can be difficult. History and physical examination have a limited role in the accurate diagnosis of venous disease. Further diagnostic imaging is frequently required. Invasive techniques such as venography have been proven to be reliable and have become the gold standard against which all other techniques are measured. However, the expense and potential risks of such invasive studies have led to the development of noninvasive methods. Through recent technological advancements, ultrasound has emerged as a reliable and useful tool in the evaluation of the peripheral venous system. Its accuracy approaches that of venography, and its other benefits including portability and fewer potential risks have made it an attractive alternative to the gold standard . One of the most common manifestations of peripheral venous disease in surgical patients is venous thromboembolism. It is a dreaded complication seen in every surgical specialty...
Deep vein thrombosis usually involves the deep leg veins and may be asymptomatic. The major complication is pulmonary embolus. Varicose veins are dilated, tortuous veins caused by increased intraluminal pressure. Common sites include the superficial veins of the lower extremities, esophageal varices, and hemorrhoids.
As a superb surgical professional, Galen made his mark. He operated on tumors, hemorrhoids, varicose veins, hydroceles, abdominal walls, intestines, and nasal polyps, and performed cleft-lip reconstructions and other procedures.9-11 He utilized common surgical instruments of the time, such as scalpels, forceps, hooks, arrow extractors, retractors, and scissors.9-11 He was a formidable surgical tactician with incredible anatomical and physiological knowledge, which he extrapolated into sound surgical practice. He advanced surgery by acknowledging well-known principles, improving surgical techniques, and enhancing his vast experience with gladiators, which permitted him to achieve better outcomes than his contemporaries.2,3,7,9
Varicose veins Note the distribution of varices and any surgical scars. Edema A common presentation in patients with CEAP class 3 or greater CVI. Chronic venous insufficiency may coexist with other diseases that cause edema, such as CHRONIC VENOUS INSUFFICIENCY,VARICOSE VEINS, LYMPHEDEMA, AND ARTERIOVENOUS FISTULAS
Although the points covered above may elicit factors predisposing the patient to vascular occlusive or aneurysm disease, they are nonspecific and nondiagnostic. Because the symptoms of occlusive vascular, aneurysmal, and venous disease differ, they will be dealt with separately below. It should be remembered, however, that they may occur in combination.
The history and physical examination generally facilitate classification of the degree of arterial insufficiency. Diagnostic studies are indicated when the diagnosis is in question, or in preparation for intervention. Noninvasive vascular testing is also useful in establishing the degree of ischemia when there are other confounding factors present, such as venous disease, diabetic foot ulcers, or active infection. Usually the ABI facilitates accurate determination of the degree of limb ischemia however, several conditions exist in which the ABI and segmental pressures may be falsely elevated. These include diabetes, chronic renal failure, and advanced age (over 80 years), which can cause calcification of the medial layer of the arterial wall, which in turn causes incompressibility and subsequent false elevation of any cuff-based determination of peripheral perfusion pressure. An ABI of greater than 0.9 is associated with a readily palpable pulse, and the absence of a pulse with such...
In addition to the multisession embolosclerotherapy as independent and or adjunct perioperative therapy to the VM lesions, the conservative supportive measures to improve and or maintain overall venous function have been supplemented with the use of a graded compression above-knee stocking to prevent chronic venous insufficiency.
CHRONIC VENOUS INSUFFICIENCY,VARICOSE VEINS, LYMPHEDEMA, AND ARTERIOVENOUS FISTULAS Table 10.5. Lymphangiographie classification of primary lymphedema CHRONIC VENOUS INSUFFICIENCY,VARICOSE VEINS, LYMPHEDEMA, AND ARTERIOVENOUS FISTULAS Table 10.5. Lymphangiographie classification of primary lymphedema
The pioneer of vascular surgery in Russia was N. I. Pirogov who, in 1865, developed surgical approaches to the aorta and peripheral arteries, arguing against the dogmatic views that a vascular suture was not promising. P. Girsztowt of Warsaw recommended in 1868 the excision of the large varicose veins. Eugene Koeberle, a surgeon in Strasburg, invented a simple haemostatic clamp and applied it in surgery in 1868. It was the first operation actually ushering in our present technique of clamping and tying, which was carried out and popularized by J. Pean with a clamp he invented in 1869 38 . N. V. Ekk, an outstanding Russian surgeon and physiologist in Pavlov's laboratory in St. Petersburg, performed in Friedrich Trendelenburg, in Leipzig Germany, introduced an operation for varicose veins and in 1907 attempted a pulmonary embolectomy however, he saw his pupil W. Kirchner perform a successful embolectomy in 1924, which was popularized later by many surgeons in Europe and the USA 40 . I...
On the dorsum of the foot, the toes appear square due to confinement of footwear, and the skin on the dorsum of the toes cannot be pinched due to subcutaneous fibrosis (Stemmer's sign). Lymphedema usually spreads proximally to knee level and less commonly affects the whole leg. In the early stages, lymphedema pits, and the patient reports that the swelling is down in the morning. This represents a reversible component to the swelling, which can be controlled. Failure to do so allows fibrosis, dermal thickening, and hyperkeratosis to occur. In general, primary lymphedema progresses more slowly than secondary lym-phedema. Chronic eczema, fungal infection of the skin (dermatophytosis) and nails (ony-chomycosis), fissuring, verrucae, and papillae (warts) are frequently seen in advanced disease. Ulceration is unusual except in the presence of chronic venous insufficiency.
The patient opted for surgical treatment, under general anaesthesia. On admission and after obtaining patient consent, the operating surgeon marked the position of the varicose veins, with an indelible ink pen, with her standing. The previous duplex ultrasound scan report was reviewed, with attention paid in particular to the position of the incompetent perforating vein and the saphenopopliteal junction. closure of wounds, the patient was placed supine, with the legs abducted and with head-down tilt (Trendelenburg position), to help reduce any intraoperative blood loss. The skin was re-prepared and new drapes were placed appropriately. A short, oblique incision was made in the groin crease, near to the saphenofemoral junction, and by careful dissection, the saphenofemoral junction was identified formally. Subsequently, all tributaries to the LSV were ligated (using absorbable sutures) and divided and in particular, the deep pudendal vein(s). Formal exposure of a small length of the...
There is growing evidence that saphenous surgery improves the quality of life in patients with VVs, and augments the healing and reduces the recurrence of CVU better than compression alone (Dwerryhouse et al., 1999). For optimal results, it is necessary to define the extent and severity of venous disease, usually by means of DU, prior to surgery. Surgery for CVU
Most cases are asymptomatic, without the presence of microfilariae. Acutely there can be adenitis, centrifugal lymphangitis and recurrent fever. Lymphangitis of the genitals is not uncommon. The disease is generally recurrent. Chronic disease is characterized by adenolymphoceles, varicose veins, lymphedema and elephantiasis.
Trendelenburg Test cause of superficial varicose veins, the patient is asked to lie supine and raise the affected limb to about 45 degrees. Venous blood is milked proximally by firm stroking of the leg to empty all of the superficial veins. A tourniquet is applied as proximally as possible to occlude the superficial venous system. The patient is then asked first to sit up and swing the legs over the side of the examination couch, and then to stand. Where saphenofemoral incompetence is the major cause of superficial varicosities, the varicosities will remain collapsed. It is usual for the superficial veins to fill slowly, but rapid filling of the varicosities with the tourniquet in place indicates significant perforator disease distal to the tourniquet. It is possible to localize incompetent perforating veins by repeating the test with the tourniquet just above the knee. In this case calf varicosities will remain collapsed if the guilty perforating vein is between the saphenofemoral...
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