Varicose Vein (Varicosities): Pathophysiology, Clinical Manifestation, Treatment &Home Based Care

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Varicose vein (varicosities) are abnormally dilated, torturous, superficial veins caused by incompetent venous valves. This condition mostly occurs in the lower extremities, the saphenous veins, or the lower trunk, but can also occur elsewhere in the body. It is estimated that varicose veins occur in up to 60% of the adult population with an incidence correlated with increased age. It is usually common in women and in people whose occupation require prolonged standing such as medical personnel, nurses, salespeople, teachers, policemen ( traffic police) and construction workers. A hereditary weakness of the vein may contribute to the development of varicosities and commonly occurs in several members of the same family. Pregnancy may cause varicosities because of hormonal effects related to decreased venous outflow, increased pressure by the gravid uterus and increased blood volume.

Pathophysiology

Varicose veins may be primary  (without the involvement of deep veins) or secondary  (resulting from obstruction of deep veins). Veins have a leaflet valve to prevent blood from flowing backwards (reflux or Retrograde flow). The muscles of the legs pump the veins to return blood to the heart against the effects of gravity. When the veins are dilated, the leaflets of the valves no longer meet properly, and valves do not function well, this allows blood to reflux and enlarges even more. A reflux of venous blood in the veins results in venous stasis. If only superficial veins are affected, the person may have no symptoms however, it may be troublesome by their appearance. Secondary veins are those developing a collateral pathway, usually after stenosis or obstruction of the deep veins.

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Clinical manifestation of Varicose Vein

  • Increased muscle fatigue in the lower legs
  • Dull aches
  • Muscle cramps
  • Oedema of ankle
  • Feeling Heaviness in the legs
  • Enlarged bluish veins are visible

Healing of muscle cramps through binaural beats.

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Signs and symptoms of chronic venous insufficiency; pain, oedema, pigmentation and ulceration. A possibility of injury and infection is increased.

Diagnostic findings and Assessment

Diagnostic tests for varicose veins include the duplex ultrasound scan, wh8ch documents the anatomic site of the of reflux and provides a quantitative measure of the severity of valvular reflux. Air plethysmography measures the changes in venous blood volume. Venography is not routinely performed to evaluate for valvular reflux. However, when it is used, it involves injecting a radiopaque contrast agent into the leg veins so that the vein anatomy can be visualized by x-ray studies during various leg movements.

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Preventive approach of Varicose Vein

  • The patient should avoid activities that cause venous stasis such as wearing socks that are too tight at the top.
  • Avoid standing for a longer period of time.
  • Change position frequently, elevating the legs when they are tired, and getting up for a walk to promote circulation.
  • The patient is encouraged to walk, use stairs rather than using the elevator.
  • The overweight patient should be encouraged to reduce weight.

Treatment of Varicose Vein

Surgical approach (ligation and stripping) :

Surgery for varicose veins requires the deep veins be patent and functional. The dilated visible veins are first marked by the surgeon for ligation. The saphenous vein is ligated and divided. The vein is ligated high in the groin, where the saphenous vein meets the femoral vein. Also, the vein may be removed (stripped). After the vein is ligated, an incision is made below the knee, and a metal or plastic wire is passed through the full length of the vein to the point of ligation. The wire is then withdrawn, pulling (stripping) the vein as it is removed. Finally, the incision is closed using absorbable and non-absorbable sutures. Pressure Compressed bandage is applied and elevation minimizes bleeding during surgery. The surgery is done under the aseptic procedure followed by postoperative care.

Thermal ablation:

It is a nonsurgical approach using thermal energy. Radiofrequency ablation uses an electrical contract inside the vein. As the device is withdrawn, the vein is sealed. Laser ablation uses a laser fibre tip that seals the vein. A topical gel may be used initially to numb the skin followed by the delivery of 100-200 ml of diluted lidocaine to the perivenous space using ultrasound guidance. The saphenous vein is entered percutaneously near the knee using ultrasound guidance. A catheter is introduced into the saphenous vein and advanced to the saphenofemoral junction. The device is then activated and withdrawn, sealing the vein. After the procedure, small bandages and compressed stockings are applied. The patient is advised not to remove stockings for at least 48 hours and then to rewrap the legs and wear the compression stockings while ambulatory for 3weeks or more. NSAID (Nonsteroidal anti-inflammatory drug) such as ibuprofen or acetaminophen are given orally to relieve pain. The patient is informed about the bruising that may occur over the course of the saphenous vein, may experience leg cramps for several days and may find difficult to straighten the knees for up to 2 weeks.

Sclerotherapy:

It involves an injection of an irritating chemical into a vein to produce localized phlebitis and fibrosis, thereby obliterating the lumens of the vein. This treatment may be done alone for small varicosities or may follow vein ablation, ligation or stripping. It is typically performed in an examination room and does not require sedation. After the sclerosing agent is injected, anti-embolism stockings are applied to the leg and are worn for at least 5days. Physical activities and walking are encouraged after the Sclerotherapy as prescribed to maintain the circulation and dilute the sclerosing agent. Sclerosing is palliative rather than curative.

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Nursing care:

The patient is moved to the postoperative facility after the surgical procedure where the nurses care for the patient to Prevent possible complication. Rest is encouraged only for a limited period till the effect of anaesthesia hasn’t worn off whereas walking and ambulation is instructed every 5 to 10 minutes while awake for the first 24 hours as per the tolerance of the patient. The nurse assists patient to perform exercise and move the legs. The foot should be elevated, sitting and standing are discouraged. Prescribed medication and dietary consults are carried out by the nurse. Dressings are inspected for leakage and bleeding, particularly at the groin, where the risk for bleeding is most. The nurse is alert for reported sensations of “pins and needles”. Hypersensitivity to touch in the involved extremity may indicate a temporary or permanent nerve injury resulting from surgery. Mild analgesic medications are given for the pain.

Home-based care

Long-term venous compression is essential after discharge, and the patient needs to obtain adequate supplies of graduated compression stockings or elastic bandages. An exercise of the leg is necessary; the development of an individualized plan requires consultation with the patient and healthcare team.

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