LBM 5 Swollen leg accompanied with redness and

pain
STEP 1
a) Varicose : is delated venose with tortuous hardened
channel of blood vessel on the lower leg.

STEP 2
1. Explain the anatomy and fisiology of vein and the
rule of vein valves!
2. What are the etiology of varicose vein?
3. What are the classification of varicose vein?
4. What is the patofisiology of varicose vein?
5. Why the predilection of varicose vein almost in
the leg?
6. Why the varicose showed after the second
pregnancy?
7. Why the patient had a profuse bleeding on the
affected limb?
8. Why the skin was brownish in color and hard
when palpated?
9. Why the people complain swelling redness and
pain in the right leg?
10. What is the relationship between obese and
varicose vein?
11. What is the relationship between the physical
examination in this scenario with varicose vein?
12. What are the risk factor of varicose vein?
13. How to prevent the varicose vein?
14. What is the treatment of the varicose vein?
15. What are the complication of varicose vein?
STEP 3
1. Explain the anatomy and fisiology of vein and the
rule of vein valves!

 Characteristic: Thin, collaps, have valve and not

elastic
Function:
Membantu dalam pemompaan darah ke atas,
tidak kembali lagi ke bawah
Superficial: terlihat dari luar, dekat permukaan
kulit (Contoh: v.saphena magna, v. Saphen
parva) punya katup
Profundal: cenderung tidak terlihat
Ketika bernafas, tekanannya negatif
VCS, VCI,
Yang mempengaruhi aliran balik vena: Gravitasi,
tekanan, sedotan jantung, saraf, pompa thoracal
abdominal, inspirasi.
2. What are the etiology of varicose vein?
Endogen: hormone (in the woman pragnancy,
example: estrogen volume darah meningkat,
angiotensinogen), genetic, insuficiensy of valve,
thrombus (karena plak, emboli udara)
Eksogen:
Kurang aktivitas, sering berdiri (pompa vena
tidak bekerja), penggunaan sepatu hak tinggi,
work hard.
3. What are the classification of varicose vein?
Pembagian (menurut etiologi)
Primer : karena kelemahan struktur vena
,akibatnyapelebaran pembuluh vena
Sekunder: oleh gangguan patologis vena, bisa
didapat kongenital, menyebabkan dilatasi,
kerusakan vena dalam akan menyebabkan
gangguan aliran darah menuju jantung.
Derajat:
C 0 : tidak ada kerusakan vena

 C 1 : Telangioektasis, diameter = 1- 2 mm
(vena superfisial)
C 2 : Varises vena , diameter > 2 mm
C 3 : Edem tanpa kelainan kulit
C 4 : Perubahan kulit (lipodermatosklerosis)
C 5 : ulkus sembuh
C 6 : ulkus aktif
CO- C3 : Kronis
C4-C6: Insufiency of vein
Pelebaran arteri: aneurisma
Pelebaran AORTA:
Berdasarkan Pf:
1. Keluhan samar- samar (bengkak, nyeri)
2. Pelebaran vena ,
Berdasarkan letak: Ven superfisial dan pofundal,
diameter berapa?
4. What is the patofisiology of varicose vein?
Adanya tekanan: berkontraksi, tekanan naik
Ada kerusakan katup:
Primer (akibat katupnya, bukan karena
pelebaran)
Sekunder (ada dilatasi, mengakibatkan
katupnya merengang, tidak rapat)
Kelemahan otot (pengaruh obese, tekanan
hidrostatis, volume darah, memperburuk
penyangga vena; lemaknya numpuk di sekitar
fasia, jd pembuluh darah sulit kembali)
5. Why the predilection of varicose vein almost in
the leg?
6. Why the varicose showed after the second
pregnancy?

7. Why the patient had a profuse bleeding on the

affected limb?
8. Why the skin was brownish in color and hard
when palpated?
9. Why the people complain swelling redness and
pain in the right leg?
10. What is the relationship between obese and
varicose vein?
11. What is the relationship between the physical
examination in this scenario with varicose vein?
12. What are the risk factor of varicose vein?
13. How to prevent the varicose vein?
14. What is the treatment of the varicose vein?
15. What are the complication of varicose vein?
16. What are the DDs of varicose vein?
17. What is the different between artery dilatation
and aorta dilatation?
18. Why the varicose vein can be happen in right
leg?
STEP 4

varicose

STEP 7
1. Explain the anatomy and fisiology of vein and the
rule of vein valves!
Venous Anatomy

Anatomic Classifications of the Venous System

The venous system can be broken down into four major classes. Insufficiencies can present in
any of these veins, and treatment can vary depending on the classification. It is important to
also understand the nervous system of the lower extremities before performing any laser vein
treatment.

Deep Venous System

These are primary veins that drain venous blood from the lower extremity. They include:

Common Femoral

Deep femoral

External Iliac

Femoral

Popliteal

Tibial (Anterior and Posterior)

Peroneal

Deep veins are located within the muscle fascia which allows a high volume and pressure of
blood to pass through the veins. They account for approximately 90-95% of venous blood
return to the heart. Deep veins can form deep vein thrombosis, or DVT, which is a dangerous
clot in the deep system.

Superficial Veins

Superficial veins serve to drain blood from the skin. Blood travels from the superficial veins
through the perforator veins to the deep veins. Superficial veins are located near the surface
of the skin, outside of the muscle fascia, and they account for approximately 5-10% of
venous blood return to the heart. There are two primary superficial veins:

Small Saphenous Vein (SSV)

Great Saphenous Vein (GSV)

The great saphenous vein is the longest vein in the body, running medially from the dorsal
vein in the foot up to the common femoral vein in the groin, where it empties. The point
where the GSV empties into the common femoral vein is called the Saphenofemoral Junction
(SFJ). A typical GSV contains an average of 7 valves throughout its entire length, and it is the
most common superficial vein to develop venous reflux.
The small saphenous vein originates at the back of the ankle near the outer malleous bone,
and usually runs up the back of the lower leg to the popliteal vein behind the knee.

Perforator Veins

Perforator veins connect superficial veins to deep veins. They contain one-way valves to
direct the blood from the superficial system to the deep system. Perforators include:

Cockett Perforators

Boyd's Perforators

Dodd's Perforators

Hunterian Perforator

Boyd's perforators are common sites for primary varicose veins. These veins connect the
GSV to the posterior tibial vein. Hunterian perforators connect the GSV to the superficial
femoral vein, and these are common causes of medial thigh varicosities.

Reticular Veins

Connect branch veins to any of the deep, superficial, or perforating veins

Physiology
Veins return blood to the heart. Over the course of a minute this volume is called the venous
return (VR). By the time blood has reached the veins its pressure has been reduced to
practically nothing. Because blood flows along its pressure gradient there are several
mechanisms that assist the flow.

Compliance
Veins are compliant (COM), that is, they stretch when filling with blood but, unlike elastic
arteries, recoil is minimal. Compliance(COM) is shown as the dashed outline around the
vein. The stretch is caused by the hydrostatic pressure ( HP block arrow) resulting
from blood pressure (BP) entering veins.

Compliant vessels (COM) have large diameters which means they have low peripheral
resistance (PR). This inverse relationship is shown by the dashed arrow between these two
factors. Also, low peripheral resistance is inversely related toflow as indicated by the
dashed arrow.
High compliance favors flow by providing little loss of pressure due to friction; the peripheral
resistance is small. However, compliance simultaneously does not favor flow because
the pressure gradient--flow arrow between the two BP acronyms--is kept small. In other
words, since less energy is lost to friction, the pressure at the downstream end of the vessel
will not have dropped much.

Mechanisms That Assist Flow in Veins

Valves
Many veins have one way valves that prevent the backflow of blood; a handy mechanism
especially in light of the low pressure gradient in veins. These are not shown on the model.

Contractions of Skeletal Muscles

Deep veins pass between skeletal muscles in the extremities. Contraction of these muscles
(Csm) presses on the veins causing forward movement of blood through the one way valves.
This is shown by the solid arrow (direct relationship) between Csm (i.e., contraction of
skeletal muscles) and venous return (VR).

Pleural Pressure
During inhalation, the pressure in the pleural cavities decreases causing the lungs to expand.
The veins entering the heart are affected by this pressure drop in the same manner as the
lungs; they expand. This pressure drop, due to decreased pleural pressure (Pp) at the end of
the great veins, decreases blood pressure (BP) at this location. This direct relationship is
shown by the solid arrow between these two factors. The term 'thoracic pump' is often applied
to this phenomenon.

(http://venacure-evlt.com/endovenous-laser-vein-treatment/procedure/venous-anatomy/)

Physiology of the venous system in the lower limbs

The main purpose of the venous system within the general circulation, is to carry oxygendepleted blood rich in cell metabolism waste back to the heart.
It is within the legs that the stresses are the greatest and the specific characteristics of the
venous system are the most important, since the venous system must move blood against
the force of gravity in the standing position .

A combination of two main actions ensures venous return in

the lower limbs:

Firstly, the presence of mobile anti-reflux valves and

the resistance of the vein walls allowing the blood to move
in one direction only : from the superficial to towards the
deep venous system and from the feet to the heart.
Secondly, a pump mechanism which activates and
maintains the blood flow through the veins.
The anti-reflux valves allow fluid to circulate in one direction only, making it possible to
maintain the normal direction of venous blood flow, even in the absence of pressure or
in the event of negative pressure and thereby prevent backflow of the blood.
Normal blood flow is directed from the superficial towards the deep system and from the
most distal part of the body towards the heart.

The pump mechanism mainly results from a combination of different forces:

The stimulation of the venous system of the foot
The muscle pump, more specifically, the muscles of the calf (leading to alternate
opening and closing of the valves): which is the main driving force behind the pump
mechanism,
The beating of the heart and the negative pressure due to the phenomenon of
aspiration from the abdominal cavity that occurs during deep breathing.

(http://www.urgo.co.uk/262-physiology-of-the-venous-system-in-the-lower-limbs)
2. What are the etiology of varicose vein?

Varicose veins are usually caused by weak vein walls and valves.
Weakened valves
Inside your veins are tiny one-way valves that open to let the blood through and then close to
prevent it flowing backwards.
Sometimes, the walls of the veins can become stretched and lose their elasticity, causing the
valves to weaken. If the valves do not function properly, this can cause the blood to leak and
flow backwards. If this happens, the blood will collect in your veins, which will become
swollen and enlarged.

The reasons why the walls of the veins stretch and valves in your veins weaken are not fully
understood. Some people develop the condition for no obvious or apparent reason.

(http://www.nhs.uk/Conditions/Varicose-veins/Pages/Causes.aspx)

3. What are the classification of varicose vein?

In order to standardize the reporting and treatment of the diverse manifestations of chronic
venous disorders, a comprehensive classification system (CEAP) has been developed to allow
uniform diagnosis and comparison of patient populations. Created by an international ad hoc
committee of the American Venous Forum in 1994, it has been endorsed throughout the
world and is now accepted standard for classifying chronic venous disorders.
The fundamentals of the CEAP classification include a description of the clinical class (C)
based upon objective signs, the etiology (E), the anatomical (A) distribution of reflux and
obstruction in the superficial, deep and perforating veins, and the underlying pathophysiology
(P), whether due to reflux or obstruction. (1)
Seven clinical categories are recognized as shown on the table below:
CEAP classification of chronic venous disease
Clinical classification
C0: no visible or palpable signs of venous disease
C1: telangiectasies or reticular veins
C2: varicose veins
C3: edema
C4a: pigmentation or eczema
C4b: lipodermatosclerosis or athrophie blanche
C5: healed venous ulcer
C6: active venous ulcer
S: symptomatic, including ache, pain, tightness, skin irritation, heaviness, and muscle cramps,
and other complaints attributable to venous dysfunction
A: asymptomatic

Etiological classification
Ec: congenital
Ep: primary
Es: secondary
En: no venous cause identified

Anatomical classification
As: superficial veins
Ap: perforating veins
Ad: deep veins
An: no venous location identified
Pathophysiology
Pr: reflux
Po: obstruction
Pr,o: reflux and obstruction
Pn: no venous pathophysiology identifiable

(http://www.sigvaris.com/en/scientific-corner/ceap-classification)

There are several types of varicose veins, such as:

Trunk varicose veins are near to the surface of the skin and are thick and knobbly.
They are usually visible, often quite long and can look unpleasant.
Reticular varicose veins are red and are sometimes grouped close together in a
network.
Telangiectasia varicose veins, also known as thread veins or spider veins, are small
clusters of blue or red veins that sometimes appear on your face or legs. They are
harmless and, unlike trunk varicose veins, do not bulge underneath the surface of the
skin.

(http://www.nhs.uk/Conditions/Varicose-veins/Pages/Whatarevaricoseveins.aspx)

4. What is the patofisiology of varicose vein?

Varicose veins and spider veins are normal veins that have dilated under the influence of
increased venous pressure.
In healthy veins, one-way valves direct the flow of venous blood upward and inward.
Blood is collected in superficial venous capillaries, flows into larger superficial veins, and
eventually passes through valves into the deep veins and then centrally to the heart and lungs.
Superficial veins are suprafascial, while deep veins are within the muscle fascia. Perforating
veins allow blood to pass from the superficial veins into the deep system.
Within muscle compartments, muscular contraction compresses deep veins and causes a
pumping action that can produce transient deep venous pressures as high as 5 atmospheres.
Deep veins can withstand this pressure because of their construction and because their
confining fascia prevents them from becoming excessively distended. In contrast to deep

veins, the venous pressure in superficial veins normally is very low. Exposure to high
pressures causes superficial veins of any size to become dilated and tortuous.
Perfectly normal veins dilate and become tortuous in response to continued high
pressure, as is observed in patients with dialysis shunts or with spontaneous arteriovenous
malformations. In a subset of patients with hereditary vein wall weakness, even normal
venous pressures produce varicose changes and venous insufficiency.
Elevated venous pressure most often is the result of venous insufficiency due to valve
incompetence in the deep or superficial veins. Varicose veins are the undesirable pathways by
which venous blood refluxes back into the congested extremity. Ablation of the varicose
pathways invariably improves overall venous circulation.
Chronically increased venous pressure can also be caused by outflow obstruction,
either from intravascular thrombosis or from extrinsic compression. In patients with outflow
obstruction, varicosities must not be ablated because they are an important bypass pathway
allowing blood to flow around the obstruction. Specific diagnostic tests can distinguish
between patients who will benefit from ablation of dilated superficial veins and those who
will be harmed by the same procedure.
Deep vein thrombosis initially produces an obstruction to outflow, but in most cases
the thrombosed vessel eventually recanalizes and becomes a valveless channel delivering
high pressures from above downward.
Most commonly, superficial venous valve failure results from excessive dilatation of a
vein from high pressure of reverse flow within the superficial venous system. Valve failure
can also result from direct trauma or from thrombotic valve injury. When exposed to high
pressure for a long enough period, superficial veins dilate so much that their delicate valve
leaflets no longer meet.
In the most common scenario, a single venous valve fails and creates a high-pressure
leak between the deep and superficial systems. High pressure within the superficial system
causes local dilatation, which leads to sequential failure (through over-stretching) of other
nearby valves in the superficial veins. After a series of valves have failed, the involved veins
are no longer capable of directing blood upward and inward. Without functioning valves,
venous blood flows in the direction of the pressure gradient: outward and downward into an
already congested leg.
As increasing numbers of valves fail under the strain, high pressure is communicated
into a widening network of dilated superficial veins in a recruitment phenomenon. Over time,
large numbers of incompetent superficial veins acquire the typical dilated and tortuous
appearance of varicosities.
Varicose veins of pregnancy most often are caused by hormonal changes that render
the vein wall and the valves themselves more pliable. The sudden appearance of new dilated

varicosities during pregnancy still warrants a full evaluation because of the possibility that
these may be new bypass pathways related to acute deep vein thrombosis.
The sequelae of venous insufficiency are related to the venous pressure and to the
volume of venous blood that is carried in a retrograde direction through incompetent veins.
Unfortunately, the presence and size of visible varicosities are not reliable indicators of the
volume or pressure of venous reflux. A vein that is confined within fascial planes or is 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.
(http://emedicine.medscape.com/article/1085530-overview#a0104)

5. Why the predilection of varicose vein almost in

the leg?
Most varicose and spider veins appear in the legs due to the pressure of body weight, force of
gravity, and task of carrying blood from the bottom of the body up to the heart.
Compared with other veins in the body, leg veins have the toughest job of carrying blood
back to the heart. They endure the most pressure. This pressure can be stronger than the oneway valves in the veins.
(http://www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spiderveins.cfm#E)

6. Why the varicose showed after the second

pregnancy?
women are much more likely to develop varicose veins during their pregnancy than at any
other time in their lives. A pregnant woman has much more blood in her body, compared to
when she is not pregnant - this places extra pressure on the circulatory system. A change in
hormone levels and hormone balance can also lead to a relaxation of the blood vessel walls.
Both
these
factors
raise
the
risk
of
having
varicose
veins.
As the uterus (womb) grows there is more pressure on the veins in the mother's pelvic area.
In the majority of cases, the varicose veins go away after the pregnancy is over (not always
and/or sometimes not all of them)
(http://www.medicalnewstoday.com/articles/240129.php)

Varises terjadi karena ada kelemahan pada dinding otot pembuluh darah atau ada gangguan
pada klep vena, sehingga peredaran darah jadi tak lancar. Namun pada wanita hamil,
kemunculan varises biasanya dikaitkan dengan perubahan hormonal.
Seperti diketahui, saat hamil terjadi peningkatan hormon progesteron yang mengakibatkan
perubahan fisik dan psikis. Payudara ibu akan membesar, tubuh terasa lemas, pusing, mual,
muntah, dan lainnya. Berbarengan dengan itu, elastisitas pembuluh darah, arteri maupun
vena, semakin bertambah lentur. Akibatnya, pembuluh darah, terutama vena, jadi
tambah besar dan melebar.
Sebenarnya, pelebaran pembuluh darah ini sangat bermanfaat untuk menyuplai bahan
makanan ke janin. Dengan pembuluh darah yang semakin lebar, transportasi makanan ke
janin akan semakin lancar, sehingga pertumbuhan janin pun lebih optimal.
Hanya, terkadang aliran darah dari anggota gerak bawah, yaitu kaki, juga panggul seperti
anus dan vagina, tidak dapat berbalik dengan lancar ke atas (jantung).
Hal ini disebabkan oleh tekanan yang lebih kuat akibat pembesaran rahim, disebut efek
mekanik yang membuat bendungan, sehingga menghambat jalannya darah dan
terjadilah pelebaran vena, disebut dengan varises.
Dikatakan bahwa, risiko varises semakin besar terjadi pada wanita yang pernah hamil dan
melahirkan anak lebih dari 2 kali, juga pada wanita hamil usia di atas 40 tahun.
Sebabnya, arteriosclerosis (penebalan dinding pembuluh darah) yang dialami mereka,
berdampak pada dinding pembuluh darah yang kehilangan daya lentur/elastisitasnya.
Kekakuan ini akan menghambat aliran vena sehingga memudahkan varises muncul.
Risiko varises yang parah akan semakin besar pada ibu hamil yang terlalu lama berdiri atau
duduk. Misalnya, ibu hamil yang bekerja sebagai sales promotion girl (SPG), harus berdiri
sepanjang hari. Juga, ibu hamil yang bekerja sebagai sekretaris dimana harus duduk terusmenerus.
Bila varisesnya berat, dikhawatirkan ibu akan mengalami perdarahan hebat saat bersalin.
Bila tertekan tubuh janin yang akan lahir, maka gesekannya dapat membuat varises
pecah dan mengeluarkan darah. Tak hanya tertekan tubuh janin, saat mengejan pun bisa
saja pembuluh darah pecah karena otot-otot di seputar vagina menegang dan keras.
Perdarahan hebat ini bisa berdampak, ibu kehilangan banyak darah, lemas, sulit bekerja sama
sehingga persalinan menjadi lebih lama. Persalinan lama dikhawatirkan akan membahayakan
keselamatan ibu juga janin.
Dr Masdulhag SpOG , http://www.hariansumutpos.com/arsip/?p=23984

7. Why the patient had a profuse bleeding on the

affected limb?
The skin over the veins becomes thin and easily injured. When an injury occurs, there
can be significant blood loss.
(http://www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spiderveins.cfm#E)

8. Why the skin was brownish in color and hard

when palpated?
Perubahan kulit di kaki juga dapat dilihat karena kapiler proliferasi, nekrosis lemak, dan
fibrosis dari jaringan kulit dan subkutan. Kulit tampak kemerahan atau cokelat karena
deposisi (proses pengkristalan karena mengalami pengerasan) hemosiderin.
-

COKLAT:

Insuffisiensi katup vena superficial atau profunda Regurgitasi aliran darah

(kemabali ke bawah) akumulasi tekanan tinggi kapiler dan vv. Kecil
rusak eritrosit ikut bocor ke jaringan timbulkan warna coklat.

PERABAAN KERAS:
Varises yang terus progress dinding vena semakin rapuh endotel rentan cedera
trauma minor bisa akibatkan cedera endotel peningkatan
permeabilitasnya;gangguan ekskresi vasodilator yang diproduksinya molekul
trombosit yangselalu ada dekaat dinding pembuluh mudah mengendap sebabkan
thrombus hasilkan sumbatan reaksi peradangan.

9. Why the people complain swelling redness and

pain in the right leg?

Hubungan peradangan:
Insuffisiensi vena kronik Akumulasi darah di ekstremitas bawah P nya tinggi
cairan plasma bocor ke jaringan interstisial protein fibrinogen buat barrier antara
jaringan dengan dinding vaskuler peradangan ; halangi pertukaran nutrisi, oksigen

dengan zat2 sisa pembakaran sel nutrisi terhambat;zat sampah akumulasi

kerusakan sel peradanganbisa jadi dermatitis stasis, lipodermatosclerosis atau
bahkan ulcer hiperpigmentasi menetap.
LDS literally means "scarring of the skin and fat" and is a slow process that occurs
over a number of years.
(http://www.simondodds.com/Venous/LDS.htm)

10. What is the relationship between obese and

varicose vein?
Being overweight or obese can put extra pressure on your veins. This can lead to varicose
veins. Excessive weight increases the pressure on the veins of the legs and aggravates the
condition.
(http://www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spiderveins.cfm#E)

11. What is the relationship between the physical

examination in this scenario with varicose vein?
12. What are the risk factor of varicose vein?
A number of things can increase your likelihood of developing varicose veins, including:

gender

genetics

age

being overweight

occupation

being pregnant

other conditions

Gender
Women are more likely to be affected by varicose veins than men. Research suggests this
may be because female hormones tend to relax the walls of veins, making the valves more
prone to leaking. Hormones are chemicals produced by the body.

Genetics
Your risk of developing varicose veins is increased if a close family member has the
condition. This suggests varicose veins may be partly caused by your genes (the units of
genetic material you inherit from your parents).

Age
As you get older, your veins start to lose their elasticity and the valves inside them stop
working as well.
Being overweight
Being overweight puts extra pressure on your veins, which means they have to work harder to
send the blood back to your heart. This can put increased pressure on the valves, making
them more prone to leaking. The impact of body weight on the development of varicose veins
appears to be more significant in women.

Occupation
Some research suggests jobs that require long periods of standing may increase your risk of
getting varicose veins. This is because your blood does not flow as easily when you are
standing for long periods of time.

Pregnancy
During pregnancy, the amount of blood increases to help support the developing baby. This
puts extra strain on your veins.
Increased hormone levels during pregnancy also cause the muscular walls of the blood
vessels to relax, which also increases your risk.
Varicose veins may also develop as the womb (uterus) begins to grow. As the womb expands
it puts pressure on veins in your pelvic area, which can sometimes cause them to become
varicose.
Although being pregnant can increase your risk of developing varicose veins, most women
find their veins significant improve after the baby is born.

Other conditions
In rare cases, varicose veins are caused by other conditions. These include

a previous blood clot

a swelling or tumour in the pelvis

abnormal blood vessels

(http://www.nhs.uk/Conditions/Varicose-veins/Pages/Causes.aspx)

13. How to prevent the varicose vein?

Exercise: Walking is a great way to increase blood flow in the legs.

Lose weight: Shedding excess pounds takes unnecessary pressure off veins in the
legs.
Wear compression stockings.
Avoid high heels: Stick with low-heeled shoes that give the calf muscles a better
workout, which can help give you healthier veins.
Elevate legs: Take 3 or 4 daily breaks (10 to 15 minutes) to elevate the legs above the
level of the heart (e.g., lie down with legs resting on 3 or 4 pillows).
Avoid long periods of sitting or standing: Make a point to change position
frequently to encourage blood flow.

(http://bodyandhealth.canada.com/condition_info_details.asp?
channel_id=0&relation_id=0&disease_id=216&page_no=2)

14. What is the treatment of the varicose vein?

Your doctor may suggest that you take the following self-care steps to help manage varicose
veins:

Wear compression stockings to decrease swelling. They gently squeeze your legs to
move blood up your legs.

Do not sit or stand for long periods. Even moving your legs slightly helps keep the
blood flowing.

Raise your legs above your heart three or four times a day for 15 minutes at a time.

Care for wounds in you have any open sores or infections. Your health care provider
can show you how.
Lose weight if you are overweight.
Get more exercise. This can help you keep off weight and help move blood up your
legs. Walking or swimming are good options.

If you have dry or cracked skin on your legs, moisturizing may help. However, some
skin care treatments can make the problem worse. Talk to your health care provider
before using any lotions, creams or antibiotic ointments. Your provider can recommend
lotions that can help.

If your condition is severe, your doctor may recommend the following treatments:

Laser therapy: Strong bursts of light are projected on smaller varicose veins, making
them disappear.

Sclerotherapy: Salt water or a chemical solution is injected into the vein. The vein
hardens and disappears.

Ablation: Heat is used to close off and destroy the vein. The vein disappears over
time.

Vein stripping: Small surgical cuts are made in the leg near the damaged vein. The
vein is removed through one of the cuts.

Valve repair: A small incision is made in the leg and the damaged valve is repaired.

Bypass: This is surgery to reroute blood flow around the blocked vein. A tube or
blood vessel taken from your body is used to make a detour around, or bypass, the
damaged vein.

Angioplasty and stenting: This is a procedure to open a narrowed or blocked vein.

Angioplasty uses a tiny medical balloon to widen the blocked vein. The balloon presses
against the inside wall of the vein to open it and improve blood flow. A tiny metal mesh
tube called a stent is then placed inside the vein to prevent it from narrowing again.

(http://www.drugs.com/enc/varicose-veins-and-venous-insufficiency.html)

15. What are the complication of varicose vein?

Varicose veins can lead to dermatitis (der-ma-TI-tis), an itchy rash. If you have
varicose veins in your legs, dermatitis may affect your lower leg or ankle.
Dermatitis can cause bleeding or skin ulcers (sores) if the skin is scratched or
irritated.
Varicose veins also can lead to a condition called superficial thrombophlebitis
(THROM-bo-fleh-BI-tis). Thrombophlebitis is a blood clot in a vein. Superficial
thrombophlebitis means that the blood clot occurs in a vein close to the surface of
the skin. This type of blood clot may cause pain and other problems in the affected
area.
(http://www.nhlbi.nih.gov/health/health-topics/topics/vv/signs.html)

Varicose veins can cause complications because they stop your blood from flowing
properly. Most people who have varicose veins will not develop complications, but if you
do, it will usually be several years after your varicose veins first appear.
Some possible complications of varicose veins are explained below.
Bleeding
Varicose veins near the surface of your skin can sometimes bleed if you cut or bump your leg.
The bleeding may be difficult to stop. You should lie down, raise your leg and apply direct
pressure to the wound. Seek immediate medical advice if this does not stop the bleeding.
Thrombophlebitis
Thrombophlebitis is inflammation (swelling) of the veins in your leg caused by blood clots
forming in the vein. This can occur within your varicose veins and it can:

be painful

look red

feel warm

When thrombophlebitis occurs in one of the superficial veins in your leg it is known as
superficial thrombophlebitis. A superficial vein is a vein located just under the surface of your
skin.
Like varicose veins, thrombophlebitis can be treated with compression stockings. In some
cases, non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen, may be prescribed.
Chronic venous insufficiency
If the blood in your veins does not flow properly, it can interfere with the way your skin
exchanges oxygen, nutrients and waste products with your blood. If the exchange is disrupted
over a long period of time it is known as chronic venous insufficiency.
Chronic venous insufficiency can sometimes cause other conditions to develop, including
those described below.
Varicose eczema
Varicose eczema is a condition that causes your skin to become red, scaly and flaky. You may
also develop blisters and crusting of your skin.
This condition is often permanent.

Lipodermatosclerosis
Lipodermatosclerosis causes your skin to become hardened and tight, and you may find that
it turns a red or brown colour. The condition usually affects the calf area.
Venous ulcers
A venous ulcer develops when there is increased pressure in the veins of your lower leg. This
causes fluid to seep from your vein and collect under the skin. The fluid can cause the skin to
thicken, swell and eventually break down to form an ulcer. Venous ulcers most commonly
form in the ankle area.
You should see your GP immediately if you notice any unusual changes in your skin, such as
those mentioned above. These conditions can usually be easily treated, but it is important you
receive treatment as soon as possible.

(http://www.nhs.uk/Conditions/Varicose-veins/Pages/Complications.aspx)

Bleeding - varicose veins near the skin may bleed if the patient's skin is cut or he/she
bumps their leg. The bleeding may go on for much longer than normal. If this occurs, the
patient should lie down, raise their leg and apply pressure directly onto the bleeding area. If
the bleeding continues, get medical help.

Thrombophlebitis - blood clots form in the vein of the leg, causing inflammation of
the vein. The affected area can feel warm, may look red, and might also be painful.
Treatment usually involves wearing compression stockings. For pain, the doctor may
prescribe a suitable painkiller.

Chronic venous insufficiency - this is when the skin does not exchange oxygen,
nutrients and waste products with the blood properly, because the blood flow is weak. If
this occurs over the long-term, it is called chronic venous insufficiency.
People with chronic venous insufficiency may develop
lipodermatosclerosis (hard and tight skin), and venous ulcers.
(http://www.medicalnewstoday.com/articles/240129.php)

16. What are the DDs of varicose vein?

Cellulitis
Osler-Weber-Rendu Syndrome
Stasis Dermatitis

varicose

eczema,

(http://emedicine.medscape.com/article/1085530-differential)
17. What is the different between artery dilatation
and aorta dilatation?
18. Why the varicose vein can be happen in right
leg?