Varicose Veins: Diagnosis

by Joseph Alpert, MD

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    00:00 The diagnosis of venous insufficiency and superficial varicosities is not difficult.

    00:07 The varicosities are usually very evident on just looking at the patient, particularly if they’re standing because the veins will fill and be very clearly seen.

    00:18 There’s often a very simple test to see whether these varicose veins fill from an internal source or an external source. And often one can do that by just compressing the vein at its origin and seeing how easily it fills. If you compress it low down and it doesn’t drain and continues to fill, it means it’s often connected to a deep venous insufficient system. Although you may remove it surgically, you still are stuck with the problem of internal deep venous insufficiency.

    00:53 For deep venous insufficiency, there’s a test known as the Trendelenburg Test in which one notices the dilation of the veins and the blueish colour that goes with poor drainage of the veins. You then lift the leg up – you put the patient on a table, lie them down and you lift the leg up and you see how quickly the vein drains. In other words, how quickly it disappears to obvious inspection. And, usually, if it takes more than three seconds, it means that there’s fairly extensive internal venous insufficiency.

    01:28 Of course, one can also image these with ultrasound and so forth. And very often, before one plans any kind of major vein surgery, a very careful ultrasound or even MRI study will be done to understand the full aspects of the anatomy.

    01:48 Therapy: for mild varicosities, simple surgery, elastic support stockings or leggings that compress the veins and prevent them from distending or dilating. In fact, this is often something I recommend to my patients who are going on long plane flights that they definitely wear elastic support stockings when taking a long plane flight. Something I do myself.

    02:12 I mentioned before sclerotherapy or scarring therapy consist of injecting of a sclerosing or fibrosing agent into the varicose vein. And it’s used mostly for small varicose veins and they just scar down and disappear.

    02:30 If they’re large and very unsightly, they may be removed surgically. And you still are going to have venous drainage from your leg because remember the venous system is redundant.

    02:42 There are many possible channels. So removing one vein doesn’t mean that the blood won’t get out of your leg.

    02:50 Chronic venous insufficiency is much more dangerous because this is a condition that can lead to deep venous thrombosis and pulmonary embolism and venous ulcers in necrotic areas of the skin.

    03:06 Compression therapy helps with the putting on of compressive dressings, elastic bandages that really compress the leg more powerfully than using elastic stockings.

    03:20 Often we will use medications such as aspirin to prevent a blood clot from forming. Aspirin is a mild blood thinner. Or pentoxifylline which actually improves the way red blood cells pass through the capillaries.

    03:35 And, of course, surgical therapy may be needed: skin grafting to cover ulcers.

    03:41 And recently a number of growth factors – biochemical growth factors – can be placed on ulcers or even given by injection. And there are now specialists who deal with venous disease and all of its complications.

    About the Lecture

    The lecture Varicose Veins: Diagnosis by Joseph Alpert, MD is from the course Venous Diseases.

    Included Quiz Questions

    1. Surgery.
    2. Infusions of iron salts.
    3. Acupuncture.
    4. Intravenous vitamin C.
    1. Ultrasound.
    2. CT scan without contrast.
    3. CT scan with contrast.
    4. Radiography.
    5. Angiography.
    1. Producing scar tissue.
    2. Increasing veins elasticity.
    3. Increasing venous compliance.
    4. Reducing blood flow.
    5. Thinning of blood.

    Author of lecture Varicose Veins: Diagnosis

     Joseph Alpert, MD

    Joseph Alpert, MD

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    Great lecture
    By Neuer M. on 16. November 2017 for Varicose Veins: Diagnosis

    Awesome Lecturing, great analysis and explanations. it made it real easy to follow.