Diagnosis and Treatment of Varicose Veins

Park, Ho Chul

Abstract

Varicose veins are dilated, tortuous veins exhibiting reflux because of valvular insufficiency. Dilatation of veins may be primary, that is, initiated by an unknown process, or may be the result of postthrombotic changes, arteriovenous fistula, or diverted flow resulting from a blockade of deep veins. Theoretical causes of varicose veins are heredity, race, gender, posture, gravitational back pressure, pregnancy, hormonal influence, weight, primary and secondary valvular incompetences, incompetent perforating veins, arteriovenous communications, and vein wall weakness. Visual inspection and palpation permit a clinical classification with respect to many different factors, especially the type of varix and the clinical stage of chronic venous insufficiency. Refluxes play a decisive role in the pathogenesis of large varices. They are usually detected over the sapheno femoral junction or the saphenopopliteal junction. Identification of these refluxes needs Doppler ultrasonographic techniques. Highly effective noninvasive examination methods have become available and include photoplethysmography, air plethysmography, portable Doppler ultrasound, and duplex scanning. The sole invasive diagnostic technique is ascending or descending phlebography. Several different treatments have been recommended for varicose veins. Flush ligation combined with stripping, avulsion of local varicosities, and perforator interruption are still the most common surgical techniques. The aim of varicose vein surgery is the removal of diseased incompetent vein segment and the control of reflux. Development of new sclerosing agents renders sclerotherapy for varicose veins more effective, and use of Doppler and the duplex ultrasound techniques provides a better hemodynamic and anatomic precision, which ultimately improves the treatment efficacy. Because patients seek treatment for varicose veins most commonly for cosmetic reasons, recently developed lasers and intense pulsed light(IPL) have become the methods for treating telangiectasia. In summary, surgery treats the major venous reflux, sclerotherapy treats the feeding venous system, and the laser or IPL seals effectively the superficial vessels.