Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

1518 Varicose Veins

differential diagnosis

n/a

management

■Cosmetic problem in most pts

■No risk of PE from varicose vein

■Some have a particular painful vein

■Compression stockings

➣Safe but not very effective

➣Provide some relief in a fraction of pts

Surgical Therapy

■>10 mm diameter – ligation and excision

■4–10 mm – stab avulsion

■1–4 mm – injection sclerotherapy

■<1 mm – laser treatment

Contraindications

■Severe deep venous occlusion

➣contraindication to excision of the superficial veins

➣superficial veins may be only drainage of leg

➣leg swelling and ulceration will worsen

Side Effects (of All Surgical Procedures)

■Ulceration of skin

■Superficial skin infection

■Recurrent varicosity (risk proportional to size)

specific therapy

n/a

follow-up

■None needed

complications and prognosis

■Rare patients have bleeding and ulceration

■Bleeding stops with gentle pressure

■Persistent ulceration is sign of chronic deep venous insuffici-

ency

■Prognosis is excellent with most treatments (or no treatment)