Varicose Veins

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Varicose Veins

• Rumi Faizer, MD, RPVI, FRCPS(C)

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Overview

• Varicose Vein Prevalence and Disease Impact
• Normal Venous Anatomy and Physiology
• Underlying Venous Pathology
• Presentations of Disease
• Correct Diagnosis
• Treatment Options

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Varicose Vein Prevalence

• Affects 50 of people gt50 yrs old
• 15-25 of all adults
• Cost to society of 1 million work day per year
• 70 of women have abnormal leg veins by age 65
• 4 of people over 65 have venous ulcers

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Varicose Vein Risk Factors

• Family History (90 if both parents, 62 for
  females if one parent)
• Female Gender
• Pregnancy (Often develop in 1st Trimester)
• Occupation (long standing)
• Trauma
• Obesity
• Previous DVT

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Normal Venous Anatomy and Physiology
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Underlying Pathology
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Presentations of Disease

• CEAP Classification
• Clinical
• 0 No Visible Signs
• 1 Telangectasias (lt1mm), reticular Veins (lt3 mm)
• 2 Varicose Veins (gt 3mm)
• 3 Edema without skin changes
• 4 Skin Changes (pigmentation, eczema)
• 5 Healed ulcer
• 6 Active Ulcer
• Etiologic
• Congenital
• Primary (unknown cause)
• Secondary (post-thrombotic)
• Anatomic
• Deep
• Superficial
• Perforator
• Pathophysiologic
• Reflux

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Correct Diagnosis

• Asymptomatic
• The worst thing you can do is leave them
  alone
• Pain
• Burning
• Itching
• Aching
• Edema
• Tired Legs
• Bleeding
• Superficial Thrombophlebitis
• Cosmetic/Body image

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Correct Diagnosis

• Standing Venous Reflux U/S
• Evaluate
• Deep
• Superficial
• Perforators
• Look for Source of Reflux and Sites of
  Obstruction
• Look for Deepest and Highest source of problem

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Treatment

• Nothing
• Stockings
• Meds
• Vein stripping
• Endovein
• Sclerotherapy

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Treatment

• Asymptomatic
• Consider compression stockings to prevent
  progression
• Consider hyper-coagulable w/u as increased hx of
  DVT
• Symptomatic
• Deep system involved
• compression therapy
• Consider Pentoxyfylline (Trental)
• Superficial System
• Most insurers require trial of compression
  therapy
• Intervene on highest source of reflux
• Laser or Radiofrequency ablation if not too
  superficial
• Perforator
• Ultrasound guided ligation
• Ultrasound guided ablation
• None
• Local phlebectomy
• Sclerotherapy

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Summary

• Varicose veun disorders are highly prevalent can
  can be a cause for significant concern
• Correct treatment is all about correct evaluation
• Treatment advances in therapy for superficial
  vein and perforator vein disease much better
  tolerated than they were a few years ago
• Thank you!