8/7/2019 The clinical finding of varicose veins

http://slidepdf.com/reader/full/the-clinical-finding-of-varicose-veins 1/2

8/7/2019 The clinical finding of varicose veins

http://slidepdf.com/reader/full/the-clinical-finding-of-varicose-veins 2/2

 

At times, the degree or venous hypertension does not correlate to the clinical findings. The

presence and size of visible varicosities are not reliable indicators of the volume or pressure of 

venous reflux. A vein that is confined or buried beneath subcutaneous tissue can carry massive

amounts of high-pressure reflux without being visible at all. Conversely, even a small increase in

pressure can eventually produce massive dilatation of an otherwise normal superficial vein that

carries very little flow.

In contrast to the superficial veins, the deep veins do not become excessively distended. Theycan withstand the increased pressure because of their construction and the confining fascia.

Etiology

The inciting etiology of superficial valvular insufficiency is often difficult to determine because theclinical manifestations of venous hypertension are delayed. The original cause can be classifiedas primary, secondary, and congenital

Primary: Valvular insufficiency of the superficial veins, most commonly at the saphenousfemoral junction.

Secondary

y Mainly caused by deep vein thrombosis (DVT) that leads to chronic deep venous

obstruction or valvular insufficiency. Long-term clinical sequelae from this have been

called the postthrombotic syndrome.

y Catheter-associated DVTs are also included.

y Pregnancy-induced and progesterone-induced venous wall and valve weakness

worsened by expanded circulating blood volume and enlarged uterus compresses the

inferior vena cava and venous return from the lower extremities.

y Trauma

Congenital: This includes any venous malformations. A few examples are listed as follows:

y Klippel-Trenaunay variants

y Avalvulia