Page 87 - Medicine and Surgery

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Chapter 2: Hypertension and vascular diseases 83

Clinical features Clinical features
Patients complain of cosmetically unsightly veins and The pain may be dull or burning, usually superficial and
aching, heavy legs. There may be a family history or his- on examination there may be one or more visible cord-
tory of previous deep vein thrombosis. like swellings, which are firm and tender with associated
erythema.
Complications
Rupture is uncommon. The superficial veins are prone Complications
to thrombus formation due to stasis, causing tender, If there is a portal of entry, e.g. previous site of can-
reddened, painful swollen veins (superficial throm- nula,itmaybecomeinfected,causingacellulitis.Throm-
bophlebitis).
bosis in a superficial vein does not cause pulmonary
embolism.
Investigations
The site of the incompetent valve can be identified by the
Investigations
TrendelenbergtourniquettestorbyDopplerultrasound.
No investigations are necessary, except to diagnose un-
derlying deep venous insufficiency.
Management
Elderly patients are managed conservatively with weight
reduction, regular exercise and avoidance of constricting Management
garments. Sclerotherapy and laser therapy can be used The condition usually responds to symptomatic treat-
for small varices, but only surgery is effective if there ment with rest, elevation of the limb and non-steroidal
is deeper valve incompetence. Surgery consists of three anti-inflammatory drugs. Anti-coagulants are not nec-
parts: essary. After the acute attack, treatment of underlying
To interrupt incompetent connections between deep
chronic venous insufficiency may be necessary, scle-
and superficial veins. The sapheno-femoral junction rotherapy or laser therapy may be used as treatment for
is visualised and the saphenous vein is ligated and varicose veins.
divided.
To strip the main saphenous channels from which

Prognosis
pressure is distributed, and the long saphenous vein is
Recurrence is common.
stripped out from knee to groin (omitted if a saphe-
nous coronary bypass may be needed at a later date).
To eradicate varices by dissection or avulsion tech-

Chronic venous ulceration
nique where the varices are winkled out through small
incisions. Definition
Ulceration of the gaiter area (lower leg and ankle) due to
venous disease.
Superficial thrombophlebitis
Definition Incidence
Inflammation of veins combined with clot formation. 4% over 60 years of age. It is a major cause of morbidity
in the elderly.
Aetiology/pathophysiology
Thrombophlebitis arising in a previously normal vein

Age
may result from trauma, irritation from intravenous
Increases with age.
infusion or the injection of a noxious agent.
Spontaneous thrombophlebitis almost invariably

arises in a varicose vein due to stasis, with thrombus Sex
formation and inflammation. 3F : 1M