Lower Limb Varicose Veins's Clinical Profile and Management

The lower limbs’ venous system has the pressure of posture, and blood has to be pushed against gravity into the heart cavity. This issue is generally approached either by a cautious approach or by surgical interference, all of which are constrained. Attempts to study different clinical manifestations of varicose veins are being made in the present study. The overall number of 50 varicose vein patients was analysed and the study results were reported. Varicosity veins of the lower limb is a fairly normal pathological entity. In the 20-50 age range, the condition is more common. The main modality of the procedure is surgery. The most common technique performed is Saphenofemoral flush ligation with stripping.


INTRODUCTION
Varicose veins are a widespread medical condition found in at least 10 percent of the general population [1]. Symptoms of varicose veins range from asymptomatic varicose veins to more extreme symptoms such as ulceration and bleeding. The care choices for Varicose Veins are Trendelenburg, Shaving, Subfascial Perforator Ligation, Laser, Sclerotherapy,

Subfascial Endoscopic Perforator Operation & Radiofrequency
Ablation. More invasive techniques have been substituted for minimally invasive treatments in the recent years [2][3][4]. The quest for more reliable ways to detect and treat varicose veins and to avoid and control their complications continues, and this thesis aims to study the spread, anatomy, clinical characteristics, various testing types, and the overall management of varicose veins in the lower limb.

AIMS AND OBJECTIVES
To study the distribution, anatomy and clinical symptoms of lower-limb varicose veins in rural areas. To efficiently study the different types of investigation and treatment of varicose veins in the lower limbs and to reduce complications.

MATERIALS AND METHODS
The study included all patients admitted with lower limb varicose veins from October 2014 to June 2016 in the surgical department of KIMS, Karad. Total number of patient included in the study were 50. The patients who were admitted to hospital & assessed by taking comprehensive history were included in the study after doing extensive clinical evaluation. The results have been reported in clinical proforma.

OBSERVATION & RESULTS
Varicose veins tend to be common in general populations, but the incidence of hospital attendance does not project a true occurrence fig. The hospital-populated population is only the tip of the iceberg. The epidemiological research may give the general population its true appearance. A total of 50 patients (55 numbers of organs) with primary varicose veins admitted to surgery at the Krishna Institute of Medical Sciences, Karad, were examined and the following findings were reported and analysed.
As shown in Fig. 1, out of a total of 50 patients, 16 (32%) cases were female. In contrast to western research, it is very poor. The females were seeking medication for complications because of varicosities rather than aesthetic causes. Probably Indian women cover their limbs with saree and are therefore, not too bothered by the presence of dilated veins.
As shown in Fig. 2, most of the patients were under 50 years in the study. Therefore, it cab be said that this is the disease that impacts the society's youth and bread-earning members.

DISCUSSION
Lower extremity varicosity is a typical clinical concern. Varicosity often starts early in life, but due to venous hypertension take a silent path for a variable period of time before symptoms occur.
Recent trends like Endovenous laser ablation, Endovenous radio frequency ablation, SEPS, Endovenous LSV stripping and valve grafting have revolutionized the patient care. The great saphenous vein, in the thigh has branches of medial femoral cutaneous nerve accompanying and in the distal two-thirds of the calf, saphenous nerve is anterior to the vein. Lymphatics are its close accompaniments throughout the course of the vein [5,6].

Fig. 2. Age distribution
The lower limb veins carry deoxygenated blood towards the heart. These are the low-pressure channels having larger cross sectional area. . In case of varicose veins due to reflux of blood / obstruction in the superficial or deep veins the pressure in the superficial veins fails to fall and is sustained even during walking. This sustained rise in the pressure of superficial venous system is known as ambulatory venous hypertension and this eventually leads to skin changes seen in venous disorders.
Bleeding from varicose veins may be more common than generally thought. The initial treatment of bleeding episodes should consist of compression of the bleeding vessel rather than suture ligation. Injection Sclerotherapy can than be performed for permanent obliteration of the thin walled veins and prevention of further bleeding. Treatment should address the entire incompetent venous system rather than just the bleeding site [12]. According to Pares et al. [13] incompetent superficial veins and perforators should be thoroughly removed to prevent the tendency toward recurrence. Veins that have the potential to develop varicosities should also be removed, with particular attention directed to the smaller dilated tributaries in the thighs. Calves and feet. Special care should be taken not to damage or destroy normal competent greater or lesser saphenous veins, because they may be needed for future vascular bypass operations.

Age in Years
The study also concluded that lower limb symptoms are extremely common in the general population, whether varices are present or not. Significant proportion of the patients request treatment for cosmetic reasons only. Hence, a detailed assessment is needed before treatment. Failure to assess the patients adequately will result in poor patient satisfaction and possibly wrong procedure performed. In the age range aged 20-50 years, varicose veins are more prevalent [14,15]. Therefore it affects social issues of bread-earning members of society. In the present study, about 80 percent of the patients were in this age group.

CONCLUSION
Our research reveals that the varicose veins in lower limbs is greater in younger age groups. The family history of lower limb varicose veins is an significant risk factor for the occurrence of lower limb varicose veins. Long standing jobs are important predictive factors in the development of varicose veins of the lower limbs. Varicose veins mostly include the long saphenous system due to saphenofemoral and perforator negligence. Much patients have varicose vein complications. Duplex ultrasound is the examination of choice.

CONSENT
It is not applicable.