B. Duplex imaging
D. Radio – labeled fibrinogen study
Ans:B. Duplex imaging.
Varicose veins is shown in the image.
- Congenital absence or incompetence of valves
- Inheritance with FOXC2 gene
- Klippel-Trenuanay syndrome
- Congenital AV fistula
- Cutaneous hemangiomas
- Hypertrophy of involved limb
- Absence of deep venous system
- Recurrent thrombophlebitis
- Occupational – prolonged standing
- Obstruction to venous return – abdominal tumors, retroperitoneal fibrosis
- Iliac vein thrombosis
- Lipodermatosclerosis(brawny induration) pigmentation, thickening, chronic inflammation and induration of skin in calf muscle and around ankle.
- To assess the competence of SFJ
- Patient lies flat, elevate the leg and gently empty the veins, palpate the SFJ and ask the patient to stand whilst maintaining pressure
- If the veins do not refill SFJ is incompetent
- If the veins do refill SFJ may or may not be incompetent, presence of distal incompetent perforators.
Cough impulse (Morrisey’s test)
- Locate the saphenofemoral junction(2-4cm inferolateral to pubic tubercle) and ask the pt to cough
- Impulse or fluid thrill felt indicates saphenofemoral incompetence.
Modified Perthes Test:
- Ask the pt to stand and tourniquet is applied at SF junction and ask to walk
- Superficial veins become prominent – indicate deep vein thrombosis.
Three tourniquet test
- To find the site of incompeter“: perforator
- Tourniquets at SFJ, above knee level, below knee level
- Detect the perforators
- Duplex Ultrasound imaging – gold standard
- Doppler examination – only when duplex is not available
- Phlebography – not needed in primary venous insufficiency. Only performed as preoperative adjuncts when deep venous reconstruction is being planned
- Ascending phlebography – differentiates primary from secondary insufficiency
- Descending phlebography – identifies specific valvular incompetence suspected on B mode scanning.
- Calcium dobesilate
- Trendelenburg’s operation (juxta femoral flush ligation + stripping the varicose vein) for SFJ incompetency
- Subfacial ligation of Cockett and Dodd :perforator incompetence with SF competency
- VNUS closure(ablation catheter introduced into the SF junction and slowly with drawn)
- TRIVEX – veins identified by subcutaneous illumination; injection of fluid & superficial veins are sucked
- Endo venous laser ablation(EVLA)