Update in Diagnosis and Treatment for Varicose Veins (Part 1-2)

(This Self Study Series was prepared by Dr. Tse Cheuk Chad, Specialist in General Surgery, Vascular Surgeon.)

Etiology (EC,P,S,N)

Four categories in this classification are: Congenital, Primary, Secondary, and None. Arteriovenous malformations represent an obvious congenital (C) etiology, it may be the uncommon conditions such as avalvulia (hereditary absence of venous valves). Secondary (S) designates any known cause of venous abnormality. Most commonly, it indicates veins that have been affected by thrombosis. Primary (P) refers to all others such as primary valvular reflux. None (N) indicates for no evident etiology of CVD.

Anatomy (AS,P,D,N)

Simple designation of one (or more) of the three major lower extremity anatomic venous systems (superficial, perforating, and deep veins) is sufficient to localize the site of the abnormality and will probably affect the treatment recommendations.

Pathophysiology (PR,O,R-O,N)

The veins may occur either reflux (R), obstruction (O), or in combination (R-O). Reflux is defined as reverse flow with a duration of >0.5 second by duplex analysis. Meanwhile, obstruction is defined objectively by imaging or noninvasive testing. (N) indicates no abnormality detected.

Duplex Ultrasound

Duplex Ultrasound is B-mode ultrasound with colour Doppler, usually done by using a high frequency (7.5-10MHz) transducer. It is noninvasive, and has evolved to become the most important imaging study for patients with varicose veins. Colour flow scanners allow direct visual representation of flow with a change of colour from red to blue depending on the flow is toward or away from the probe. Reflux is best demonstrated with the patient in the standing position. The duplex examination is essential in planning for treatment, and also important to identify the specific points of reflux so that treatment is appropriate and reduces the chance of recurrence.

Summary

This classification is targeted at all forms of venous insufficiency. Physicians in general practice should be aware that CVD consists of a spectrum of clinical manifestations, ranging from simple telangiectasias, to the commonly seen varicose veins and the debilitating venous ulcers. The transition from one clinical stage to the other is progressive, but the deterioration rate and symptoms depends on the underlying etiology, anatomy and pathophysiology. In the presence of minimally invasive options in addition to conventional surgery in treating CVD, treatment can now be tailored to individual patients based on their clinical status and symptoms. In the next issue, minimally invasive options will be discussed further.

Reference information: http://veno.com.hk
It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your doctor for diagnosis and treatment.