1. Venous Disease

2. Varicose Vein

3. Introduction: Dilated tortuous veins 5% of adult population
Equal gender prevalence
Family history

5. Pathology: Incompetence of the venous valves
Primary venous incompetence
Secondary venous incompetence

6. Clinical manifestations:
Unsightly appearance
Discomfort and aching at the end of the day
Ankle swelling towards the end of the day
Complications:
Itching and eczema
Lipodermatosclerosis
Venous ulceration

7. Venous Eczema (stasis dermatitis):

8. Lipodermatosclerosis:

9. Venous Ulcer:

10. On examination: Great or small saphenous vein
Incompetent saphenofemoral junction or incompetent perforators
Exclude DVT or deep vein incompetence

11. Investigations: Usually diagnosed clinically
Investigations done to confirm and exclude
Duplex ultrasound
Venography
Abdominal and/or pelvic imaging

12. I- Conservative Treatment:
Reassurance
Elastic compression stockings
Avoid prolong standing and change of occupation may be required
Periodic elevation of the feet

13. II- Injection sclerotherapy:
Sodium tetradecyl sulfate (STD)

14. III- Surgical Treatment:
Indications for surgery:
Symptomatic varicose veins
Complicated or bleeding varicose veins
Large varicose veins
Cosmetic purposes
Surgical options include:
Ligation and stripping of the saphenous vein
Multiple subfacial perforator ligation
Combination of both.
Complications of varicose vein surgery:
Nerve injury (saphenous nerve and sural nerve)
Recurrence

15. Varicose vein stripping:

16. IV- New Techniques: Radiofrequency Ablation
Endovascular laser ablation.

17. Deep Vein Incompetence

18. Pathology:

19. Clinical presentation
Leg swelling,
Discomfort on walking,
Edema,
Varicose veins (which may not be present),
Ankle flare (small varices),
Lipodermatosclerosis
Ulceration

20. Post Phlebetic syndrome:

21. Investigations:
Duplex ultrasound
Venography.

22. I- Conservative Treatment:
Elastic compression stockings
Avoid prolong standing and change of occupation may be required
Periodic elevation of the feet
Exercise of the calf muscles

23. II- Surgical Treatment:
Venous bypass procedures (e.g. Palma procedure)
Venous valve reconstruction
Venous valve transposition

24. Venous Ulceration

25. Differential diagnosis of leg ulcers:
Venous disease: deep vein incompetence
Arterial ischemia
Rheumatoid ulcer
Traumatic ulcer
Neuropathic ulcer (diabetic)
Neoplastic ulcer (squamous cell carcinoma and basal cell carcinoma).

26. Etiolgy: Not fully understood Ambulatory venous hypertension
Due to valve incompetence:
Incompetent superficial veins
Incompetent perforator veins
Incompetent or obstructed deep veins

27. Clinical examination Site: gaiter region (between calf and ankle)
Size: usually large
Depth: usually superficial
Edges: gently sloping edges
Base: granulation tissue + slough and exudates
Discharge: pus occasionally blood
Surrounding tissue: features of chronic venous disease
Local lymph nodes: enlarged (superadded infection)
Movement of ankle joint: restricted due to pain

28. Venous Ulcer:

29. Investigations: Swab and culture from the ulcer Duplex ultrasound
Venography

30. I- conservative Treatment:
multilayered elastic compression bandaging system,
avoid prolong standing,
periodic leg elevation

31. Multilayer elastic compression

32. II- Surgical Treatment:
Surgery for the cause of the venous ulcer (varicose vein, DVT or chronic venous insufficiency)
Perforator vein subfacial ligation
Skin graft to the ulcer after dealing with the underlying cause

33. Superficial Thrombophlebitis

34. Etiology: External trauma,
Venepunctures and infusions of hyperosmolar solutions and drugs.
Intravenous cannula
Some systemic diseases: buerger’s disease, and malignancy,
Coagulation disorders: polycythaemia, thrombocytosis and sickle cell disease

35. Examination: Treatment:: Overlying skin erythematous
Palpable and tender superficial vein
Treatment::
Reassurance
NSAIDs
Warm massage

37. Superficial thrombophlebitis

38. Thank You