What is Vascular surgery? 

Introduction

Varicose veins are twisted, tortuous or long. Dilated and tortuous veins are present, usually close to the skin surface in the leg.  

They occur commonly due to standing for a long time. There is also a genetic predisposition to varicose veins.

Size (unless very large) alone does not indicate abnormality because size can vary depending on ambient temperature and hormonal factors in women. Normal superficial veins may appear to be prominent in lean individuals.

In an obese person, varicose veins may be concealed. Varicose veins can be divided into trunk, telangiectasia and reticular.

Telangiectasia is also referred to as spider veins, starbursts, thread veins or matted veins. Most varicose veins are primary; Secondary varicose veins are associated with deep vein thrombosis and occlusion, pelvic tumours, or arteriovenous fistulae. 

Risk factors of varicose veins

The predisposing factors of varicose veins are

• Prolonged standing
• Pregnancy
• Obesity
• Family history

Clinical Features of varicose veins

Patients with varicose veins present with the following symptoms.

•  Cosmetic issues
• Aching and itching
• Skin ulcers, thrombophlebitis and bleeding.  

Examination

The patient is examined

• To check which system is involved, the long saphenous or short saphenous veins  
• To look for skin changes.  
• To assess perforator vein incompetence.

Investigation for varicose veins

Investigative procedures include a venous Doppler ultrasonography test of the leg to identify varicose veins.  

The non-invasive procedure called Doppler ultrasonography employs sound waves to examine blood flow through vein valves. An ultrasound of the leg helps find blood clots.

Vascular surgery procedures

The following are examples of vascular surgery.

• Angioplasty
• Arteriovenous fistula
• Carotid endarterectomy
• Endovascular stent graft
• Endovascular thrombolysis.

Complications of vascular surgery (Varicose veins)

Vascular surgery complications are listed below.

• Neurological damage, which means the nerves at the site of the procedure can get injured.
• Bleeding and clotting manifestation
• Infections.

Treatment for varicose veins

Compression hosiery, endovenous laser ablation, radiofrequency ablation, conventional operation, subfascial endoscopic perforator surgery and sclerotherapy are treatment options for varicose veins.  

Sclerotherapy – Sclerotherapy liquid or a foaming agent can be given. Liquid sclerotherapy can cause venous occlusion, which is an inflammatory reaction.  

Foam sclerotherapy – Adverse events associated with foam sclerotherapy include visual disturbance, skin ulceration, vein thrombosis, thrombophlebitis, local neurological injury and skin pigmentation.

Sclerotherapy is the targeted elimination of intracutaneous, subcutaneous and transfascial varicose veins (perforating veins) as well as obliteration of subfascial varicose veins. With duplex-guide injection sclerotherapy and foam sclerotherapy can be done with more certainty.

Conventional surgery entails saphenous femoral ligation and perforator (incompetent) ligation are done under anaesthesia of choice.  

Radiofrequency ablation – This is a recent technique which involves obliteration of the dilated venous lumen and thus occludes varix. It is a minimally invasive technique done under anaesthesia. There is less pain compared to conventional surgery, and also it is minimally invasive. Postoperative convalescence is much lesser.  

The procedure is more expensive, and complications, if present, include skin ulcers and occlusion of the deep veins.  

Conclusion

Vascular surgeries are commonly done to fix blood vessel diseases. They are microscopic procedures that need the expertise of a vascular surgeon.

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