Varicose veins

Varicose veins are unnatural, irregular, and permanently dilated veins which elongate and pursue a tortuous course. This condition is very common, and twenty per cent. of adults exhibit it in some degree in one region or another.

The causes of varicose veins are obstruction to venous return, and weakness of cardiac action, which lessens the propulsion of the blood stream.

Varicose veins may occur in any portion of the body, but are chiefly met with on the inner side of the lower extremity.

Varix in the leg is met with during and after pregnancy, and in persons who stand upon their feet for long periods.

It especially appears in the long saphenous vein, which, being subcutaneous, has no muscular aid in supporting the blood-column and in urging it on. The deep as well as the superficial veins may become varicose.

Varicose veins are in rare instances congenital; they are most often seen in the aged, but usually begin at the ages of twenty to forty.

A vein, under pressure, usually dilates more at one spot than at another, the distention being greatest back of a valve or near the mouth of a tributary. The valves become incompetent and the dilatation becomes still greater. The vein wall may become fibrous, but usually it is thin, and ruptures. The veins not only dilate, but they also become longer, and hence do not remain straight but twist and turn into a characteristic form.

Varicose veins are apt to cause edema, and the watery elements in the tissues cause eczema of the skin. When eczema is once inaugurated, excoriation is to be expected. Infection of the excoriated area produces inflammation, suppuration, and an ulcer.

The skin over varicose veins in the legs is often discolored by pigmentation due to the red cells having escaped from the vessel and then being broken up.

The tissues around a varicose vein become atrophied from pressure, and often a very large vein will be in evidence whose thin walls are in close contact with the skin, and in this condition, rupture and hemorrhage are probable. Varicose veins are apt to inflame and thrombosis frequently occurs.

Treatment. The treatment of varix may be palliative or curative, but whichever is followed, endeavor first to remove the cause.

In palliative treatment, attend to the general health, keep up the force and activity of the circulation, and prevent constipation. Recommend the patient to exercise in the open air and to lie down, if possible, every afternoon. Locally, in varix of the leg, order a flannel bandage to support the vein and drive the blood into the deeper vessels which have muscular support. (For technic, see chapter on bandaging).

The curative or operative treatment of varicose veins consists of performing a resection of the internal saphenous vein of one or two inches, near the saphenous opening into the femoral. This is known as the Trendelenburg  method. About 90 per cent of all cases can be cured by this method. The operation can be performed under local anesthesia and presents no difficulties.

Another procedure is known as Schede's  method. This consists of making a circular incision around the leg just below the knee joint, and in tying all the superficial veins thus exposed.

Mayo's  operation consists of the total extirpation of the internal saphenous vein from the saphenous opening to the internal malleolus. A small incision is made high up, and at a distance of from 8 to 10 inches, a second incision is made, and in this manner the entire vein is removed by making several incisions.

The patient should remain in bed about three weeks following an operation of this kind and afterwards an elastic stocking, or an ideal bandage, should be worn for a considerable time.