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| Image = Varicose-veins.jpg| | | Image = Varicose-veins.jpg| |
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| {{Varicose veins}} | | {{Varicose veins}} |
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| {{CMG}}
| | '''For patient information, click [[Varicose veins (patient information)|here]]''' |
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| {{SK}} Varicosities; venous insufficiency; phlebectasia | | {{CMG}}; {{AE}} {{Ochuko}}; {{Sapan}};{{Lovepreet Randhawa}} |
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| | {{SK}} Varicosities; phlebectasia |
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| | ==[[Varicose veins overview|Overview]]== |
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| ===Non-surgical treatment=== | | ==[[Varicose veins historical perspective|Historical Perspective]]== |
| ====Sclerotherapy====
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| A commonly performed non-surgical treatment for varicose and "spider" leg veins is [[sclerotherapy]]. It has been used in the treatment of varicose veins for over 150 years.<ref>Goldman M, Sclerotherapy Treatment of varicose and telangiectatic leg vein, Hardcover Text, 2nd Ed, 1995</ref> Sclerotherapy is often used for telangiectasias (spider veins) and varicose veins that persist or recur after vein stripping.<ref>"Veins & Lymphatics," L. K. Pak et al, ''in'' Lange's Current Surgical Diagnosis & Treatment, 11th ed., McGraw-Hill, </ref><ref>Tisi PV, Beverley C, Rees A. Injection sclerotherapy for varicose veins. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD001732.</ref>
| | ==[[Varicose veins classification|Classification]]== |
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| Sclerotherapy can also be performed using microfoam sclerosants under ultrasound guidance to treat larger varicose veins, including the greater and short saphenous veins.<ref>Paul Thibault, Sclerotherapy and Ultrasound-Guided Sclerotherapy, The Vein Book / editor, John J. Bergan, 2007.</ref><ref>Padbury A, Benveniste G L, Foam echosclerotherapy of the small saphenous vein, Australian and New Zealand Journal of Phlebology Vol 8, Number 1 (December 2004)</ref> A study by Kanter and Thibault in 1996 reported a 76% success rate at 24 months in treating saphenofemoral junction and great saphenous vein incompetence with STS 3% solution.<ref>Kanter A, Thibault P. Saphenofemoral junction incompetence treated by ultrasound-guided sclerotherapy, Dermatol Surg. 1996. 22: 648-652.</ref> A Cochrane Collaboration review<ref>http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001732/abstract.html</ref> concluded sclerotherapy was better than surgery in the short term (1 year) for its treatment success, complication rate and cost, but surgery was better after 5 years, although the research is weak.<ref>Rigby KA, Palfreyman SJ, Beverley C, Michaels JA. Surgery versus sclerotherapy for the treatment of varicose veins. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004980. [http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004980/abstract.html]</ref>
| | ==[[Varicose veins pathophysiology|Pathophysiology]]== |
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| A Health Technology Assessment found that sclerotherapy provided less benefit than surgery, but is likely to provide a small benefit in varicose veins without reflux.<ref>Michaels JA, Campbell WB, Brazier JE, MacIntyre JB, Palfreyman SJ, Ratcliffe J, et al. Randomized clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial). Health Technol Assess 2006;10(13). [http://www.hta.ac.uk/fullmono/mon1013.pdf] This Health Technology Assessment monograph includes reviews of the epidemiology, assessment, and treatment of varicose veins, as well as a study on clinical and cost effectiveness of surgery and sclerotherapy</ref> Complications of sclerotherapy are rare but can include blood clots and ulceration. [[Anaphylaxis|Anaphylactic]] reactions are "extraordinarily rare but can be life-threatening," and doctors should have resuscitation equipment ready.<ref>William R. Finkelmeier, Sclerotherapy, Ch. 12, ACS Surgery: Principles & Practice, 2004, WebMD (hardcover book)</ref> There has been one reported case of stroke after ultrasound guided sclerotherapy when an unusually large dose of sclerosant foam was injected.
| | ==[[Varicose veins causes|Causes]]== |
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| ====Endovenous laser and radiofrequency ablation==== | | ==[[Varicose veins differential diagnosis|Differentiating Varicose veins from other Diseases]]== |
| The Australian Medical Services Advisory Committee (MSAC) in 2008 has determined that endovenous laser treatment for varicose veins "appears to be more effective in the short term, and at least as effective overall, as the comparative procedure of junction ligation and vein stripping for the treatment of varicose veins."<ref>Medical Services Advisory Committee, Endovenous laser therapy (ELT) for varicose veins. MSAC application 1113, Dept of Health and Ageing, Commonwealth of Australia, 2008. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/2E0BACBB8704139ACA25745E001C2F21/$File/1113report.pdf</ref> It also found in its assessment of available literature, that "occurrence rates of more severe complications such as DVT, nerve injury and paraesthesia, post-operative infections and haematomas, appears to be greater after ligation and stripping than after EVLT". Complications for endovenous laser treatment include minor skin burns (0.4%)<ref name="Elmore"> Elmore FA and Lackey D, Effectiveness of laser treatment in eliminating superficial venous reflux, Phlebology 2008 :23 :21-31</ref> and temporary paraesthesia (2.1%).<ref name="Elmore"/> The longest study of endovenous laser ablation is 39 months.
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| <div align="left">
| | ==[[Varicose veins epidemiology and demographics|Epidemiology and Demographics]]== |
| <gallery heights="175" widths="175">
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| Image:000 1486.jpg|Varicose veins after [[EVLT]]
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| </gallery>
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| </div>
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| Two prospective randomized trials found speedier recovery and fewer complications after radiofrequency obliteration (AKA radiofrequency ablation) compared to open surgery.<ref>Rautio, T, et al., Endovenous oblitration versus conventional stripping operation in the treatment of primary varicose veins, J Vasc Surg 2002:35:958-65</ref><ref>Lurie F, et al., Prospective randomized study of endovenous radiofrequency oblitration (closure) versus ligation and vein stripping (EVOLVeS: two-year follow-up. Eur J Vasc Endovasc Surg 2005;29:67-73</ref> Myers<ref>Kenneth Myers, An opinion —surgery for small saphenous reflux is obsolete!" Australian and New Zealand Journal of Phlebology, Vol 8, Number 1 (December 2004)</ref> wrote that open surgery for [[small saphenous vein]] reflux is obsolete. Myers said these veins should be treated with endovenous techniques, citing high recurrence rates after surgical management, and risk of nerve damage up to 15%. In comparison, radiofrequency ablation has been shown to control 80% of cases of small saphenous vein reflux at 4 years, said Myers. Complications for radiofrequency ablation include burns, paraesthesia, clinical phlebitis, and slightly higher rates of deep vein thrombosis (0.57%) and pulmonary embolism (0.17%).One 3-year study compared radiofrequency, with a recurrence rate of 33%, to open surgery, which had a recurrence rate of 23%.
| | ==[[Varicose veins risk factors|Risk Factors]]== |
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| Endovenous laser and radiofrequency ablation require specialized training for doctors and expensive equipment. Endovenous laser treatment is performed as an outpatient procedure and does not require the use of an operating theatre, nor does the patient need a general anaesthetic. Doctors must use ultrasound during the procedure to see what they are doing. Some practitioners also perform phlebectomy or ultrasound guided sclerotherapy at the time of endovenous treatment. Follow-up treatment to smaller branch varicose veins is often needed in the weeks after the initial procedure.
| | ==[[Varicose veins screening|Screening]]== |
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| ===Other treatments are:=== | | ==[[Varicose veins natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| *[[Ambulatory phlebectomy]]
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| *Laser vein removal
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| *Vein ligation
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| ==Complications== | | ==Diagnosis== |
| Most varicose veins are relatively benign, but severe varicosities can lead to major complications, due to the poor circulation through the affected limb.
| | [[Varicose veins history and symptoms| History and Symptoms]] | [[Varicose veins physical examination | Physical Examination]] | [[Varicose veins laboratory findings|Laboratory Findings]] | [[Varicose veins CT|CT]] | [[Varicose veins MRI|MRI]] | [[Varicose veins ultrasound|Ultrasound]] | [[Varicose veins other imaging findings|Other Imaging Findings]] | [[Varicose veins other diagnostic studies|Other Diagnostic Studies]] |
| * Pain, heaviness, inability to walk or stand for long hours thus hindering work
| | ==Treatment== |
| * Skin conditions / [[Dermatitis]] which could predispose skin loss
| | [[Varicose veins medical therapy|Medical Therapy]] | [[Varicose veins surgery|Surgery]] | [[Varicose veins primary prevention|Primary Prevention]] | [[Varicose veins secondary prevention|Secondary Prevention]] | [[Varicose veins cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Varicose veins future or investigational therapies|Future or Investigational Therapies]] |
| * Bleeding : life threatening bleed from injury to the varicose vein
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| * [[Ulcer]] : non healing varicose ulcer could threaten limb amputation.
| | ==Case Studies== |
| * Development of carcinoma or sarcoma in longstanding venous ulcers. There have been over 100 reported cases of malignant transformation and the rate is reported as 0.4% to 1%.<ref>Goldman M. Sclerotherapy, Treatment of Varicose and Telangiectatic Leg Veins. Hardcover Text, 2nd Ed, 1995</ref>
| | [[Varicose veins case study one|Case #1]] |
| * Coagulation of blood in varicose veins cause superficial thrombosis, [[deep vein thrombosis|deep vein thrombosis (DVT)]], [[Pulmonary Embolism]] (PE) & could precipitate [[stroke]] in the rare case of predisposed individuals (that is, patients with [[patent foramen ovale]]).
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| ==External Links==
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| * [http://www.venousresearchfoundation.com/index.asp Varicose Veins and varicosities ]
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| * [http://www.postgradmed.com/issues/1999/09_99/pn_veins.htm Varicose Vein overview]
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| * [http://www.nhsdirect.nhs.uk/en.aspx?articleId=387 NHS Direct - Varicose Veins]
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| * [http://www.vascularweb.org/_CONTRIBUTION_PAGES/Patient_Information/NorthPoint/Varicose_Veins.html Varicose Veins] Society for Vascular Surgery patient pages. Good illustrations.
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| * [http://www.phlebology.com.au/forms/selmenu.aspx?selmenu=5 Varicose Vein Treatment in Australasia] Information from the Australasian College of Phlebology Website
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| *[http://cvdforum.veinclinics.com Venous disease forum] Blog for physicians to collaborate on vein disease treatment
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| *[http:////www.wikisurgery.com/index.php?title=Varicose-veins-Operationscript Varicose veins: Operation Script on Wikisurgery].
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| *[http://www.wikisurgery.com/index.php?title=Varicose-veins-day-case-Patientinformation Varicose veins: Information for patients on Wikisurgery]
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| ==References==
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| {{Reflist|2}}
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| {{Circulatory system pathology}} | | {{Circulatory system pathology}} |
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| [[Category:Medical conditions related to obesity]] | | [[Category:Medical conditions related to obesity]] |
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