ROLE OF ULTRASOUND GUIDED FOAM SCLEROTHERAPY IN TREATMENT OF PRIMARY LOWER LIMB VARICOSE VEINS

Abstract

The veins are arranged in three patterns – superficial veins, deep veins, and perforating veins. Lower limb venous drainage is mediated by a very effective functioning unit composed of the veins of the lower limb, the competent valves, and the muscle pumps. The calf muscle pump is the most dominant component of this unit. The net effect of the calf muscle pump activity is to lower the pressure and volume of blood in the lower limb venous system and maintain it at an optimum level. The pathophysiology and cellular events in CVD and CVI are complex. Primarily, it is an inflammatory process involving the wall and the valves of the large axial and tributary veins. In turn, these changes affect the microcirculation and the dermal fibroblasts resulting in ulceration. The CEAP classification is now the universally accepted system of classification of CVD Varicose veins and their related problems are extremely common problems in clinical practice. Several risk factors such as advancing age, influence of gender, pregnancy, and positive family history have been identified in several studies. Varicose veins are dilated, tortuous and elongated veins located in the subcutaneous fat plane, 3 mm or more in caliber, measured at the erect posture and associated with valvular incompetence. Primary varicose veins are not the manifestation of any other pathology, unlike secondary and congenital varicose veins. The common symptoms of primary varicose veins are aching pain and discomfort along with serpiginous swelling. Cosmetic disfigurement on its own considered an an important indication for seeking treatment in a large number of patients. A subset of patients may be totally asymptomatic. The severity of symptoms is unrelated to the extent of the visible varices, nor does it correlate with the duplex scan findings. The common complications include SVT and bleeding. A small percentage of patients with primary varicose veins may progress to chronic venous insufficiency.