RECENT ADVANCES IN THE MANAGEMENT OF PRIMARY VARICOSE VEINS

Abstract

V aricose veins are tortuous, widened veins in the subcutaneous tissues of the legs and are often easily visible. Varicose veins of the legs affect approximately 25% of the population and may have a substantial impact on patient’s health-related quality of life. A normal venous system depends on the integrity of valves, vein wall and the hemodynamics of venous blood flow. Normally the venous flow is a unidirectional and cephalad flow from the superficial veins through the perforators and into the deep system. In varicose veins this flow is disrupted resulting in stasis and venous hypertension. Several structural and functional changes have been observed in the vein wall and the valve cusp. The cause of valve failure in the saphenous system is not very clear. Till now primary structural changes in the valve cusp resulting in reflux from above downward were considered to be the sequence of events. This is the traditional descending valvular incompetence theory of Friedrich Trendelenburg. Recently it has been suggested that valvular incompetence is secondary to vein wall dilatation. Venous dilatation can develop below the valves. Reflux in saphenous system can proceed in an ascending fashion. This is the ascending valvular incompetence theory. Several predisposing factors are thought to contribute in the formation of varicose veins. Family history, age, gender and pregnancy are the most important.