A Simple Guide to Varicose Veins

A Simple Guide to Varicose Veins
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What are Varicose Veins?
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Varicose Veins are swollen veins in the legs which has ballooned up over time.
They are more common in women than in men.

What are the causes of Varicose Veins?
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The cause of the Varicose Vein is due to the accumulation and stagnation of blood in the veins over time.
From the heart blood flows easily downwards to the legs into the capillaries to supply nutrient and oxygen to the foot.
From the foot the blood is then pushed up though the veins right up to the heart.
Movement of the blood in the veins is assisted by the contraction of muscles pushing the blood upwards.
When the muscle relaxes, the blood in the veins gravitates downwards but is prevented from going down by valves in the veins.
If the valve in the vein fails, blood begins to accumulates and stagnate in the veins causing ballooning and dilation of the veins.
The distended veins are then called Varicose Veins.

Causes for the failure of the valves in the veins are:
1.Hereditary - some people are born with inherent weakness of the valve of the veins.

2.Prolonged standing -causes gravitation of the blood down the veins

3.Pregnancy - the veins may be partially blocked by weight of the foetus causing stagnation of blood

4.Obesity - the weight of the body causes the blood to slow down and gravitates down wards in the veins.

5.pelvic tumours like ovarian cysts can partially block the blood flow up the veins.

6.Tight stockings- constricts the blood vessels mechanically

7.Smoking- constricts the blood vessel through its chemicals

What are the complications of Varicose Veins?
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Varicose Veins reduces the blood flow in the legs and can give rise to
complications:

1.Phlebitis-
inflmmation of the varicose vein is due to a blood clot stucked in the vein forming a thrombosis.
The skin over the inflammed vein becomes hot, red, swollen and tender.
A thrombosis in the superficial veins are usually not dangerous but a deep vein thrombosis can become detached and lodged in the lungs causing pulmonary embolism.

2.Haemorrhage-
bleeding may occur when a swollen varicose vein with thinned walls burst.
Blood will then flow out.
Trauma or injury of the swollen varicose vein can also cause bleeding.

3.varicose ulcers may occur when the swollen venous wall gradually stretched and breaks without bleeding.
The break may slowly develop into a ulcer becoming larger unless treated.

4.varicose pigmentation results from skin discoloration from an iron containing pigment called hemosiderin from broken down red blood cells stucked in the varicose veins.

What are the symptoms of Varicose Veins?
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1. Swollen blood vessels in the legs
2. Varicose pigmentation
3. Varicose ulcers
4. Phlebitis

What are the investigations needed in assessment of varicose veins?
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The type, size, location and depth of the varicose vein problem can be determined by various non-invasive diagnostic tests:

1.venous doppler,

2.PPG, and

3.color duplex ultrasound.

What is the treatment for Varicose Veins?
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1. No treatment if condition is mild

2. Elastic stocking- support stockings and pressure bandaging compress the valves of the veins together to prevent backflow and prevent dilation of the veins.
Once the stockings are in place, you should exercise by walking as much as possible. When sitting raise the legs.
While sleeping do not use the stockings.
Raise the bottom of bed or put legs on pillows to elevate the legs.
While stockings can slow down the natural course of the disease and reduce the painful symptoms. they WILL NOT CURE the disease.

3. Medical treatment:

Injection of veins-

a.Traditional Sclerotherapy
Here the veins are injected with a small amount of a solution causing them to collapse and disappear.

b.Ultrasound Guided Sclerotheraphy
By using a Doppler/Duplex Ultrasound system the doctor can get a x-ray-like picture of the deeper vein and inject at strategic locations of the vein.

c.Foam Sclerotherapy
Similar to traditional sclerotherapy, but using a foaming agent, making it more suitable for larger veins.

d.IPL Laser Therapy used mostly for the smallest spider veins.
In this method a light beam is pulsed onto the veins to seal them.

4. Surgical treatment:

a.tying of veins-
The simplest treatment consist of tying the superficial vein in the upper thigh preventing the flow of blood in the superficial vein and deflecting it into the deeper vein.

b.stripping of veins
this consist of removal of the long superficial vein using a instrument called the stripper.
After the removal of the vein, firm pressure is applied to the leg.

c.Ambulatory Phlebectomy
Parts of the vein is removed through tiny incisions leaving only small puncture marks and requires no stitches.

d.Closure(Radiofrequency Occlusion)
A super-thin catheter is inserted in the vein and when removed it closes the vein behind it by the use of radio frequency waves.

e.Endovenous Laser Treatment -same as the Closure Procedure, except the catheter emits laser rays instead of radio frequency waves

How can Varicose Veins be prevented?
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1.Reduce weight

2.Exercise

3.Aviod prolonged standing

4.Put your feet up

A Simple Guide to Deep Vein Thrombosis

A Simple Guide to Deep Vein Thrombosis
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What is Deep Vein Thrombosis?
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Deep vein thrombosis (DVT) is a blood clot (thrombus) in a deep vein leading to the heart, usually in the legs.The blood clot may either block the vein completely or partially.
It is more common in the elderly and the obese.
Women are more prone to it.

What is the danger of Deep Vein Thrombosis?
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Blood Clots can form in superficial veins (called superficial thrombophlebitis or phlebitis) and in deep veins due to poor blood flow or stasis.
Blood clots in superficial veins rarely cause serious problems.
Blood clots in deep veins (deep vein thrombosis) require immediate medical care.
These clots are dangerous because they can break loose and then travel through the bloodstream to the lungs, causing a pulmonary embolism(Blockage of a pulmonary artery resulting in damge to the lung supplied by it).
A pulmonary embolism is often life-threatening.
Blood clots most often develop in the calf and thigh veins, and less often in the arm veins or pelvic veins.

What causes Deep Vein Thrombosis?
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3 major factors play a part in the development of DVT.

1.Venous stasis i.e. the pooling of blood in the veins. This may be the result of immobility, old age or heart failure.

2.Damage of the vein due to trauma or local pressure. Surgery or an injury can damage your blood vessels and cause a clot to form.

3.Increased coagulability (tendency of blood to clot) of the blood which is sometimes seen in clotting disorders, pregnancy, the use of oral contraceptives, dehydration or in some cancers.

Sitting for long periods without exercising your leg muscles is a main factor. Passengers in first class seats in a plane have been known to develop DVT.
Similarly, DVT has been seen in students sitting for many hours preparing for exams.
Blood clots can form in veins when you are inactive.

For example, clots can form if you are paralyzed or bedridden or must sit while on a long flight or car trip. Some people have blood that clots too easily, a problem that may run in families.

What are the symptoms of Deep Vein Thrombosis?
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Symptoms of DVT include :

1.Pain and tenderness of the affected limb which may become worse especially when standing

2.Swelling of the affected limb

3.Redness and warmth of the area surrounding the blood clot.

If a blood clot is small, it may not cause symptoms.
These symptoms may not be present immediately the clot is formed.
Sometimes it may take up to 2 weeks before the symptoms became apparent.
In some cases, pulmonary embolism is the first sign that you have DVT.

How is Deep Vein Thrombosis diagnosed?
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1.If there is any suspicion that you have DVT, you probably will have an ultrasound test within 24 hours to measure the blood flow through your veins and help find any clots that might be blocking the flow. Unless done within 24 hours, an ultrasound may or may not be able to detect the blood clot .However it is useful in measuring the blood flow through your vein.

2.A venogram is the most accurate of all the tests. However because it requires a doctor to administer it and is invasive unlike an ultrasound, it is only done if ultrasound results are unclear. A venogram is an X-ray test that takes pictures of the blood flow through the veins.

3.Other tests like a MRI will also be able to show the blood clot and the flow of the blood in the vein. Like the ultrasound , it must be done early in order to detect any blood clot.

How is Deep Vein Thrombosis treated?
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Treatment must start right away to reduce the chance that the blood clot will grow or that a piece of the clot might break loose and flow to your lungs.

Treatment for DVT usually involves taking blood thinners (anticoagulants) such as heparin and warfarin.
Heparin is given through a vein (intravenously, or IV) or as an injection.
Warfarin is given as a pill.
Treatment usually involves taking blood thinners for at least 3 months to prevent existing clots from growing.

Anti-coagulants - these are agents which prevent further clot formation and thins the blood. Examples are Heparin injection, warfarin, Plavix, Ticlid, Aspirin
Thrombolytic agents - these are agents which dissolve clots that have already formed. Examples are streptokinase, tPA.

After this first course of blood thinners, your doctor may want you to keep taking a lower dose of warfarin to prevent deep vein clots from happening again. He may need to adjust the dose of your medicine or change the medicine to a lighter blood thinner like Aspirin.
You may need to have blood tests often to see how well the blood thinners are working.

It is also recommended that you
prop up or elevate your leg when possible,
use a heating pad,
take walks, and
wear tight-fitting stockings.
These measures may help reduce the pain and swelling that can happen with DVT.

Rarely a vena cava filter may be inserted into a vein to help prevent blood clots from traveling to the lungs. This device is usually only used if a person is at high risk for pulmonary embolism and is not able to take blood thinners.
It may also be used if you have DVT that comes back again or you had a pulmonary embolism while taking blood thinners.

What is the Complication of Deep Vein Thrombosis?
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Deep vein thrombosis in itself is not that serious. The danger occurs when the blood clot or a part of it breaks off and travels to the lungs where it can block an artery. This complication is called pulmonary embolism. It is a life-threatening situation and often ends in fatalities. Emergency medical attention is imperative.
Dislodged clots can travel to other areas and cause stroke or damage to organs depending on where they get lodged.
DVT can also cause long-lasting problems.
DVT may damage the vein and cause the leg to ache, swell, and change color.
It can also cause leg sores.

How can Deep Vein Thrombosis be prevented?
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There are things you can do to prevent deep vein thrombosis.
Many doctors recommend that you
1.wear compression stockings during a journey longer than 8 hours.
2. avoid sitting in a cramped position for too long
3.Wriggle your toes and move your ankles and knees
4.Massage muscles of the lower limbs
5.Don't cross your legs or sit on the edge of your seat
6.Get up and walk along the aisle at least once an hour
7.Wear loose clothing
8.Avoid stockings or socks with tight bands
9.Drink plenty of water
10.Avoid alcohol & caffeine
11.Don't smoke
12.Wear special support stockings designed for travelling

On long flights, walk up and down the aisle hourly, flex and point your feet every 20 minutes while sitting, drink plenty of water, and avoid alcohol and beverages with caffeine.