Varices

dr Putra Hendra SpPD

UNIBA
 Definition

 Varicose veins are

abnormally dilated,
tortuous, superficial
veins caused by
incompetent venous
valves (see Fig. 1).
Most commonly, this
condition affects the
lower extremities, the
saphenous veins (Slide
2), and may occur in
the esophagus. Fig. 1: Competent valves showing blood flow
patterns when the valve is open (A) and closed
(B), allowing blood to flow against gravity. (C)
With faulty or incompetent valves, the blood is
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unable to move toward the heart.

 Varicose Veins
Valve (open)

Skeletal
muscle

Valve (closed)

Venous valves Vein

Direction of
blood flow
(From Marieb, E.N.,Human Anatomy and Physiology, 3rd ed., Benjamin Cummings, Glenview, IL, 1995.
Varicose Veins
Fig. 2 The greater and lesser saphenous veins.
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Prevalence And Risk Factors For Developing Varicose
Veins

 Varicose veins affects about 60% of the adult population in

America. In KSA, the prevalence of chronic venous insufficiency
(of which varicose veins is just one class) was found to be 45.6%
(50% among female and 25% among male) (Bawakid et al. 2005).
 The risk for developing varicose veins is associated with

 increased age, gender, those with occupations requiring

prolonged standing, such as salespeople, hair stylists, teachers,
nurses, ancillary medical personnel, construction workers,
family history, pregnancy (hormonal effects, increased pressure).

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 Causa
 Primary
 spend long periods of time standing (barbers)
 Congenital abnormality (weak mesenchymal tissue)
Secondary
 Anything that raises intra-abdominal pressure or raises
pressure in superficial/deep venous system
 Pregnancy
 Abdominal/pelvic mass
 Ascites
 obesity
 constipation
 thrombosis of leg veins
 Clinical Manifestations
 The patient maybe asymptomatic. However,
the patient may have dull aches, muscle
cramps, increased lower legs muscle fatigue,
ankle edema and a feeling of heaviness of the
legs. Nocturnal cramps are common. When
deep venous obstruction results in varicose
veins, patients may have edema, pain,
pigmentation, and ulcerations. Susceptibility to
injury and infection is increased.
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 Assessment and Diagnostic Findings
 Duplex scanning (see figure below) has become the 'gold
standard' for confirming reflux and demonstrating anatomy in
cases of lower limb venous disease.

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 Prevention of Varicose Veins
 Activities that cause venous stasis should be avoided. These
include wearing tight socks or a constricting panty girdle (Rt.
Figure), crossing the legs, and sitting or standing for long
periods.
 Changing position frequently, elevating the legs when tired,
and walking (if not contraindicated), rather than using an
elevator, promote circulation. Swimming is also good exercise
for the legs. Patients should use knee-high stockings (Middle
Figure) than thigh-high stockings (Lt. Figure). The overweight
patient should reduce his weight.

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 Surgical Management
 Sclerotherapy. In this procedure, small- and medium-sized
varicose veins are injected with a chemical that scars and
closes those veins. In a few weeks, treated varicose veins
should fade. After the injection, elastic compression bandages
are worn for approximately 5 days. Elastic compression
stockings are then worn for an additional 5 weeks. Patients are
encouraged to perform walking activities as prescribed to
maintain blood flow in the leg.
 Laser surgeries. Laser treatments are used to close off smaller
varicose veins and spider veins. Laser surgery works by
sending strong bursts of light onto the vein, which makes the
vein slowly fade and disappear. No incisions or needles are
used.
 Surgical Management

 Vein stripping. This procedure involves

removing a long vein through small incisions.
This is an outpatient procedure for most
people. Removing the vein won't affect
circulation in your leg because veins deeper in
the leg take care of the larger volumes of
blood.
 Nursing Management

 Postoperatively, bed rest is maintained for 24 hours.

Subsequently, the patient begins walking every 2
hours for 5 to 10 minutes.
 Elastic compression stockings are used to maintain
compression of the leg. They are worn continuously
for about 1 week postop.
 The nurse assists the patient to perform exercises and
move the legs. The foot of the bed should be elevated.
 Standing still and sitting are discouraged.

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