Lower limb venous physiology and function
The 2 major veins of the superficial system namely the Great Saphenous and Short Saphenous (GSV and SSV).
Chronic Venous Insufficiency (CVI) and Varicose veins (VV)
Primary venous disease occurs as a result of focal or diffuse structural weakening of the vein wall. The exact nature and cause are not completely understood. Valvular incompetence in the superficial veins can occur due to disruption by thrombotic events, be congenitally absent, atretic or dysfunctional over time.
Symptoms and complications from CVI may include
Varicose veins are defined as “subcutaneous” veins in the lower extremities dilated to >3mm in diameter in the upright position. More often their appearance may be alarming but they are benign and treatment is sometimes done for aesthetic reasons.
Venous Duplex ultrasound of standard study for evaluation. They map the superficial veins and identify the location and degrees of reflux.
Treatment depends on patient choice, severity and fitness. Options include:
In patients who are considering or unsure about surgery, a trial of compression treatment can be employed. Recommendations include:
Most chronic discomfort and skin changes can be ameliorated by judicious use of compression garments, skin care, lifestyle changes and topical dressings.
Surgery may be:
When considering surgery, anatomy and general medical status are key. Endo-venous therapies are standard of care today. The obvious advantages include no incisions, no need for general anaesthesia, earlier return to work and higher likelihood of being performed as a day procedure. Nevertheless, there are instances where open surgery still proves advantageous. These include:
When a superficial saphenous vein or tributary is closely adherent to the skin; be it an extra-fascial continuation of the main GSV, superficial branch or a separate anterior accessory or a true duplicate, the inability to provide a 1cm buffer zone between skin and vein with tumescent anaesthesia risk skin burns.
Similarly, non-thermal techniques can result in inflammation and pigmentation issues when the vein is very superficial.
Treatment selectionSpeak with your friendly vascular surgeon today to discuss treatment options.
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