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Learning objectives To understand: Venous anatomy and physiology • The pathophysiology of venous hypertension • The clinical signi /f_i cance and management of super /f_i cial • venous re /f_l ux

Leiomyoma and leiomyosarcoma of the vein wall These are extremely rare tumours that are usually slow growing. They present with pain and a mass with signs of venous obstruction, e.g. oedema and distended veins. Duplex scanning, CT ( Figure 62.41 ) and magnetic...

Management Many patients with asymptomatic varicose veins do not progress - to develop complications, although a significant proportion do, and there is no clear confirmatory evidence that treating such patients prevents the development of future complications....

PEL VIC CONGESTION SYNDROME Pelvic congestion syndrome (PCS) is among the di ff erential diagnoses to be considered in female patients presenting with chronic pelvic pain and may be significantly underdiagnosed. PCS su ff erers are typically premenopausal, multip...

Pathology The thrombus commences as a platelet aggregate. Subse quently , fibrin and red cells form a mesh until the lumen of the vein wall occludes. The coralline thrombus then progresses Hulusi Behçet , 1889–1948, Turkish dermatologist, described a disease of...

Pathophysiology of ulceration The exact pathophysiology of ulcer development has not been established. Originally , it was thought that static blood within the superficial veins led to hypoxia, which caused tissue death (stasis ulcers). This was not confirmed b...

Prevention of recurrence Once an ulcer has healed the patient must be re-evaluated in an attempt to prevent recurrence. If not already performed, patients should undergo treatment for their superficial venous incompetence. Class 2 below-knee graduated compress...

Prognosis Nearly all venous ulcers can be healed, but, even in those who have successful ablation or wear their stockings religiously , - there is a 20–30% incidence of reulceration by 5 years. The greatest risk of reulceration is in the post-thrombotic leg....

Prophylaxis Prophylactic methods can be divided into mechanical and pharmacological. A variety of mechanical methods have been tried, but only the use of graduated elastic compression stockings and external pneumatic compression have been William Morrant Bak...

Signs The presence of tortuous dilated subcutaneous veins is usually clinically obvious. These are confined to the GSV and SSV systems in approximately 60% and 20% of cases, respectively . The distribution of varicosities may indicate which superficial axis i...

Symptoms Varicose veins frequently cause symptoms. Patients describe aching, heaviness, throbbing, burning or bursting over a ff ected areas and sometimes the whole limb. Such symptoms typically increase throughout the day or with prolonged standing, and are re...

THE ANATOMY OF THE VENOUS SYSTEM OF THE LOWER LIMB The venous system of the lower limb can be divided anatomi cally into the superficial venous system , which is located within the superficial tissues, and the deep venous system beneath the deep fascia of the ...

Treatment Deep vein thrombosis The management of DVT has in the past been focused upon reducing the risk of pulmonary embolus. Patients who are confirmed to have a DVT on duplex imaging should be rapidly anticoagulated with a ‘treatment dose’ of subcutaneous...

VENOUS ENTRAPMENT SYNDROMES The axillary vein and the popliteal vein are the two veins that are most commonly compressed. The former is compressed at the thoracic outlet between the �rst rib and the clavicle, where it usually presents as an axillary vein thr...

VENOUS INJURY Blunt or penetrating trauma almost always damages some small and medium-sized veins, which can be safely ignored or ligated without causing any problems. Larger axial venous recognised that these axial veins should be repaired whenever possible t...

VENOUS LEG ULCER V enous disease is responsible for around 85% of all chronic lower limb ulcers in resource-rich countries. Community-based prevalence is 0.1–0.3% in adults (2–4% in the elderly). V enous leg ulcer has a disproportionate cost to society , with...

VENOUS PATHOPHYSIOLOGY The purpose of the venous system is primarily to return blood back to the heart so that it can be delivered into the pulmonary circulation. The venous system contains approximately 60% of the total blood volume, with an average pressure...

VENOUS THROMBOEMBOLISM V enous thromboembolism (VTE) is an important condition within surgery , and autopsy studies suggest that it is the most common direct cause of death in surgical patients. V enous thrombosis is the formation of a semisolid coagulum wit...