الفهرس 
Anatomy and Physiology of Veins of the Lower LimbOnly 14 pages are availabe for public view
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Abstract
Varicose veins are enlarged, tortuous, subcutaneous veins that commonly occur in the legs.
The principal superficial leg veins are the great saphenous vein (GSV), which ascends the inner side of the leg from the inner arch of the foot up to the femoral vein, and the small saphenous vein (SSV), which runs from the outer arch of the foot up to the popliteal vein via the back of the leg ).
Veins carry deoxygenated blood from the body back to the heart to be oxygenated and recirculated around the body.
Blood from the legs must travel against gravity to reach the heart. This movement is helped by contractions of the lower leg muscles and the elasticity of the vein walls, which act together to pump the blood upwards. Valves positioned along the length of the vein close as the blood is pumped through them to prevent blood flowing backwards during muscle relaxation
Risk factors associated with venous disease include previous deep venous thrombosis (DVT), obesity, pregnancy, family history and posture (e.g. standing for long periods of time) ).
Varicosities are manifestations of chronic venous disease (CVD), which includes various other venous abnormalities, such as dilated intradermal veins, spider veins, reticular veins, and telangiectasia. Although varicose veins have long been thought to be a simple cosmetic nuisance, they can actually be the source of more serious complications, including pain and discomfort that can lead to missed work days, a lower quality of life .
Varicose veins are common in many populations, with prevalence rates generally ranging 10.4-23.0% in men and 29.5-39.0% in women. One large U.S. cohort study found the biannual incidence of varicose veins to be 2% in men and 3% in women. The same study suggested that 2.0% of men and 2.6% of women would develop varicose veins over a 2-year period
Conservative therapy attempts to limit disease progression. A clinician may advise lifestyle changes, including physical exercise and weight loss, to promote circulation. Patients are also discouraged from prolonged sitting or standing and advised to elevate the affected limbs whenever possible to reduce pressure on impaired vein valves. Compression stockings provide relief for varicose vein symptoms, such as pain and swelling, while improving venous hemodynamics ).
Sclerotherapy usually occurs as an outpatient procedure under local anesthetic. The procedure involves the injection of a liquid chemical (sclerosant) into the abnormal vein to initiate inflammation, occlusion, and scarring . The damaged vein collapses and eventually fades. Ultrasound-guided sclerotherapy allows the sclerosant to be injected directly into the GSV to treat larger and deeper varicosities. Foam sclerotherapy mixes air or gas with the sclerosant to produce foam, allowing a small amount of sclerosant to cover a larger surface area by displacing blood within the vein. Sclerosant can be delivered into the vein by a catheter, allowing targeted and selective treatment ).
Ambulatory phlebectomy involves removing abnormal veins below the saphenofemoral junction (SFJ) and saphenopopliteal junction (SPJ), not including the GSV or SSV. This outpatient procedure is best used on larger veins without venous reflux. Under local anesthetic, small incisions are made in the skin and large surface varicosities are extracted using a phlebectomy hook
Junction ligation with or without vein stripping is generally appropriate when the GSV and SSV have reflux or incompetence is demonstrated on duplex scanning. This intervention is generally performed as an inpatient procedure under general anesthetic. Junction ligation involves tying off the vessel at the SFJ or SPJ. Ligation alone usually leads to high rates of varicose vein recurrence; therefore, patients often require after-care treatment, such as sclerotherapy. In most cases, ligation is accompanied by GSV stripping and is generally regarded as the treatment of choice for varicose veins . Following ligation of the GSV and tributary veins, an incision is made in the patient’s groin and knee or ankle. Next, a stripper is inserted into the vein and passed either down from the groin to the knee or up from the ankle to the groin. The end of the GSV is tied onto the stripper, which is gently withdrawn, removing the vein with it
Two endovenous treatments include radiofrequency ablation (RFA) and endovenous laser therapy (ELT). Both treatments involve inserting a heat-generating laser fiber or catheter into the incompetent saphenous vein, positioned just below the SFJ or SPJ. Heat is generated through laser (ELT) or radiofrequency (RFA) energy, and as the fiber or catheter is slowly removed down the length of the vein, endothelial and venous wall damage occurs, causing contraction of the vein wall and ultimately destruction of the vessel