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VARICOSE VEINS AND THEIR DANGERS Causes and Treatment of a Common Disability
Caused in the main by obstruction of one kind or another, varicose veins are most likely to occur in persons who have to do a great deal of standing. In mild forms rest and support may be the only treatment required, but for a radical cure excision of the diseased veins is necessary.
A vein is said to be varicose (Latin varus, twisted) when it has become dilated tortuous and lengthened. Many veins can be thus affected, but by far the most common lesions are found in the legs, and this is particularly true of the internal and external saphenous veins. These veins have to return a very large volume of blood to the heart against gravity. They will be dealt with first. .
There is nearly always a congenital weakness of the walls or an irregularity in the valves. Such valves are unable to withstand any extra call upon the circulation, and so become affected after very slight strains or even without any obvious cause at all. Naturally, any condition which leads to frequent or permanent distension of these structures will result in the ultimate appearance of the condition of varix.
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The column of blood in a vein is supported by the valves two flaps which open in the direction of the flow, A, and close against it, B. Dilatation of the vein, C, makes the valves inefficient.
Obvious examples are found in those callings which involve long standing, but tight garters are also culpable, while the pressure exerted by a pregnant uterus is one of the most common starting-points of this condition among women. Other causes are found in the obstruction to and occlusion of deeper veins as a result of thrombosis, injury or growths. But, in any case, once this venous distension has occurred it renders the valves of the veins incompetent, so that the weight of the super incumbent blood is not supported but excites still further pressure and so creates a vicious circle.
Signs and Symptoms.
On examination these dilated vessels can be seen ramifying under the skin with a very twisted course. In marked cases there are large clusters which shine through the thin epidermis as bluish masses. Sometimes only the very tiny venules are obviously affected and these are, of course, less serious in that little can be done to correct their state. Symptoms may be absent, but a common complaint is that of a feeling of heaviness and weariness. Swelling of the ankle with oedema may be present. The congestion and stasis may lead to impairment of the nutrition of the skin, so that the slight rubbing of any area of irritation tends to render it eczematised. Even the smallest injury may prove the starting-point of a varicose ulcer (q.v.).
Danger Of Clotting.
A more serious sequel is thrombosis or clotting, which is very liable to appear even after a light blow as well as during any more serious infective illness If all goes well the clot may remain stationary and be come converted into fibrous tissue so that the lumen is occluded and the condition thus automatically cured. It may even become calcareous and so form the hard phleboliths or vein stones. Unfortunately the thrombosis may spread and fragments of clot may become detached, being carried round the blood stream as small solid particles or emboli which ultimately block a vessel in the lungs, kidneys or brain. Yet another possible complication is found in the fact that a dilated pouch may burst and give rise to an alarming flow of blood after it has received a blow or become involved in the ulceration.
Methods of testing the balancing power are important for certain occupations, such; as that of aeroplane pilot. One test consists in being whirled round in a revolving chair, observation being made as to whether or not this causes giddiness or discomfort or inability to walk straight. Other tests are the balancing of a rod on a flat board, and the ability to stand on one foot for 15 seconds. The power of balance may be impaired or lost in sevoral types of disease.
The result of a garter or other constricting band; the veins swell and their valves fail.
A woven elastic bandage should be put on before getting out of bed in the morning. Eczema or ulceration can be treated by applying Unna's gelatin paste. A layer of this is spread over the unhealthy portions of skin. A layer of gauze and paste may be used if deemed necessary. The final layer of paste is covered with gauze and with lint or cotton wool and the limb is then bandaged from below upwards.
Palliative Treatment.
The exigencies of life demand that palliative rather than radical treatment should often be preferred by the patients. For this it is absolutely essential to remove tight and constricting clothing and to avoid standing as much as possible. The legs should be elevated on a pillow at night or the foot of the bed raised. Gentle massage should consist of stroking movements only, these being performed only from the foot upwards and in such a direction as to aid the flow of blood. The bowels must be kept well open, the abdominal muscles kept firm and taut by special exercises (q.v.), and the general health attended to.
Many victims find it helpful to wear supports in the form of crepe bandages or elastic stockings. These must be applied first thing in the morning while the leg is not swollen, and so should be put on even while the patient. is lying in bed. They should not be so tight as to cause local anaemia and they should be sufficiently long to control all the veins involved, and be applied from the foot upwards.
Varicose veins can be obliterated by the injection of preparations of salicylic acid, sodium morrhuate, etc., into their lumen. As a result of the injection the lumen of the vein is closed by the mild inflammation set up in its wall. Other and more healthy veins take over its function. This treatment does not involve lying up and is painless, and in suitable cases very effective.
Radical Treatment.
Radical treatment consists in the excision of the distended vessels. In one operation the upper end of the internal saphenous vein and its local tributaries only are removed. In others, and particularly when the veins are lower in the leg, small portions can be removed. Under modern technique, however, it is more general to dissect out and excise all those vessels which are obviously affected.
Varicocele and Haemorrhoids.
There are yet two other groups of vessels which are not uncommonly affected by varix. The spermatic veins are often found in such a condition and particularly those on the left side. This constitutes the state known as varicocele (q.v. ), in which there can be felt a bunch of hard and distended veins in the scrotum. While many patients prefer to wear a suspensory bandage in order to lessen the aching pain, the only real treatment lies in operation, removal of the veins being effected through a short incision in the region of the junction of the scrotum and groin.
Haemorrhoids (q.v.), or piles, consist of a varicose condition of the veins surrounding the anus and the lower parts of the rectum, thus constituting external and internal piles respectively.
In any patient who suffers from severe and aggravated varicose veins of the legs, and particularly when the smaller vessels are implicated, the whole of the skin is badly nourished as a consequence of the venous and lymphatic congestion. The fine atrophic and shining appearance presented by the epidermis then means that any slight injury or abrasion is dangerous. A very chronic and indolent ulceration is liable to occur, for the skin cannot heal readily, neither is it able to combat the pyogenic organisms which gain entrance Such ulcers commonly ensue after venous thrombosis in the leg. Conditions of poverty bad feeding constipation and enfeebled health are contributory causes.
The only effective treatment is firmly to strap the ulcerated area by means of a circular bandage composed of an elastic, more or less waterproof plaster, which is wound on in spiral fashion and adheres closely to the ulcerated surface. No dressing, ointment or other substance is applied-the discharge is pent in and forms the best dressing. Badly varicose veins above the ulcer should be obliterated by injection or tied off. The patient carries on with his or her occupation. An alternative treatment is prolonged rest with applications, but this is not so effective.
A varicose vein may rupture and cause dangerous bleeding. The patient should be made to tie down and the limb'be raised, even higher than shown here if necessary. The bleeding spot should be quickly compressed with fingers or thumb.