Varicose Veins

     

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  Introduction
   
 

 

  • Varicose veins are enlarged veins with retrograde blood flow

 

  • It is an inherited disorder that is chronic and progressive

 

  • While arteries carry blood from the heart to all tissues and organs, veins serve to transport blood back to the heart.  To perform that efficiently against gravity, veins have one-way valves.  When the valves malfunction, blood flow is impaired and the veins enlarge

     

  • The abnormal veins are named after their size with the smallest called spider veins and the largest called varicose veins

     

  • The lower limbs are the commonest site for varicose veins

     

  • The veins of the lower limb can be divided into three groups:

    • Superficial veins (close to the skin surface)

    • Deep veins (close to the bones

    • Perforators (joining the above two groups)

     

  • Superficial venous incompetence is the most common

     

  • The most important of the superficial system are the saphenous veins.  From a venous arch in the foot, the Great Saphenous Vein (GSV) travels all the way to join the deep vein in the groin, while a smaller vein called the Small Saphenous Vein (SSV) joins the deep vein at the knee level on the back of the leg.  Some people have a duplicate GSV and rarely three or may be four.  In addition, some are born with veins running parallel to the main saphenous veins and called accessory saphenous veins.  These may also get diseased and require treatment

     

  • 70% of patients with varicose veins have the disease secondary to incompetence of the great saphenous vein (GSV)

     

  • Around the ankle particularly on the inner aspect, clusters of small veins could be an indication of reflux into the great saphenous vein (GSV).  This finding- in addition to skin pigmentation and or ulceration- is a landmark of chronicity and severity of venous insufficiency.