SURGICAL OUTCOMES OF VARICOSE VEINS AT UNIVERSAL COLLEGE OF MEDICAL SCIENCES,

ORIGINAL ARTICLE BHAIRAHAWA ,NEPAL.

Santosh Shah, Sumod Koirala, Saroj Pradhan, Ashok Pradhan

SURGICAL OUTCOMES OF VARICOSE VEINS AT UNIVERSAL COLLEGE

OF MEDICAL SCIENCES, BHAIRAHAWA ,NEPAL.
Santosh Shah1, Sumod Koirala2, Saroj Pradhan2 Ashok Pradhan2

ABSTRACT

INTRODUCTION:

This study was conducted to analyse the surgical outcomes of varicose vein at Universal College of Medical Sciences
(UCMS), Bhairahawa.

MATERIALS AND METHODS:

A hospital based prospective study done at UCMS, Bhairahwa, Nepal over the period of one year, where all the patients
who had lower limb varicose vein underwent surgery were analyzed.
RESULTS:
A total of 25 cases of varicose vein were operated at UCMS from August 2015 to July 2016. The post-operative
complications like pain, wound abscess, aching, itching were minimal.
CONCLUSION:
Surgical treatment by SFJ ligation with stripping long and short saphenous vein is an established effective treatment of
varicose vein in our center with minimal post-operative complications.
KEY WORDS:

Varicose vein, stripping long and short saphenous vein.

1. Asst. Professor, Department of Surgery, Cardiothoracic & Vascular Surgery (CTVS), Universal College of Medical
Sciences, Bhairahawa, Nepal

2. PG Resident, Department of Surgery, Universal College of Medical Sciences, Bhairahawa, Nepal

For correspondence:
Dr. Santosh Shah, M.Ch (CTVS)
Asst. Professor,
Cardiothoracic & Vascular Surgery (CTVS)
Department of Surgery,
Universal College of Medical Sciences,
Bhairahawa, Nepal
Email: [email protected]

Journal of Universal College of Medical Sciences (2016) Vol.04 No.02 Issue 14 14

 SURGICAL OUTCOMES OF VARICOSE VEINS AT UNIVERSAL COLLEGE OF MEDICAL SCIENCES,
ORIGINAL ARTICLE BHAIRAHAWA ,NEPAL.
Santosh Shah, Sumod Koirala, Saroj Pradhan, Ashok Pradhan

INTRODUCTION: some of the occupations to the disease which have been shown
in table no 2. All the patients were examined clinically.
According to the World Health Organization, varicosities are Necessary tests and investigations were done. Diagnosis was
defined as saccular or cylindrical widened superficial veins, further confirmed with duplex ultrasonography. Though
where the widening may be circumscribed or segmental. In different types of treatment are available, SFJ(sapheno -
general, the dilatation of the veins is associated with femoral junction) ligation and LSV (long saphenous vein)
tortousities .Varicose veins are common in females but onset stripping are the commonest surgical procedures in this study.
of the disease is earlier in males. The incidence is about 20 - The incidence is more in males, consisting 70.37%; and in
25%of the adult female population and 10 - 15% of men in females 29.63%.In this study right side is affected in33.33%
western countries1. and left 33.33%. Bilateral limbs are affected in33.33%. In the
operated cases, males comprised of 76% and females 24%.In
Primary varicose veins: the post-operative period, no any complications like
haemorrhage, haematoma, or infection were noted.
They occur as result of congenital weakness in the vessel wall.
It can also be due to muscular weakness or due to congenital
absence of valves. Primary varicosity can also be familial.
These factors, in addition to prolonged standing, help in the
development of the varicose veins. Varicosity is the penalty
for verticality against gravity. Klippel -Trenaunay syndrome
is a congenital venous abnormality wherein superficial and
deep veins do not have any valves. It is also called as “
valveless syndrome”
Secondary varicose veins:
Women are more prone for varicose veins because of the
following reasons:

1. Pregnancy and pelvic tumours. Table: 1 Surgical procedure for lower limb varicose veins

2. Pills (oral contraceptive pills) alter the viscosity of blood. Name of the surgical procedure undertaken Number of cases

SFJ flush ligation + L SV stripping + Local 15

3. Progesterone dilates vessel wall. avulsion

4. Congenital arterio -venous fistula increases blood flow and Ligation of varicosed vein and stripping 5
increases venous pressure. SSV local avulsion + Ligation of perforators 1

5. Deep vein thrombosis can result in destruction of valves SSV ligation + Local avulsion 1

resulting in varicose veins. Trendelenburg’s operation 1

SFJ flush ligation + Local avulsion 1

Spider veins are similar to varicose veins, but they are smaller.
They are often red or blue and are closer to the surface of the Multiple 8 tab phlebotomy 1
skin than varicose veins. They can look like tree branches and
spider webs with their short jagged lines. Spider veins can be
found on the legs and face. They can cover either a very small Table: 2 - Occupation wise prevalence of lower limb varicose
or very large area of skin. Chronic venous insufficiency may veins
result in feeling of heaviness, tendency for swelling, leg pain,
and leg ulcer. The prevalence of varicose veins in different
countries is different. Patient’s occupation Number of cases

MATERIALS AND METHODS: cook 9

All patients of varicose veins of lower limb who had attended Security guard/Police man 7
the OPD of cardiovascular and thoracic surgery department, Farmer 4
UCMS, Bhairahawa, from August 2015 to July 2016 were
included in this study. A total of 27 patients had attended the Others 7
OPD. Age and sex wise prevalence has been shown in the
column graph below. There was greater predisposition of

Journal of Universal College of Medical Sciences (2016) Vol.04 No.02 Issue 14 15

 SURGICAL OUTCOMES OF VARICOSE VEINS AT UNIVERSAL COLLEGE OF MEDICAL SCIENCES,
ORIGINAL ARTICLE BHAIRAHAWA ,NEPAL.
Santosh Shah, Sumod Koirala, Saroj Pradhan, Ashok Pradhan

RESULTS: the great majority of patients7.The surgical procedures we had

undertaken is represented in Table no: 1.
A total of 27 cases of varicose veins of the lower limb had
attended in the out-patient department of cardiovascular and CONCLUSION:
thoracic surgery, UCMS, Bhairahawa; and 25 cases were
operated from 2015 to 2016.The post-operative complications Varicose vein is a chronic morbid condition. Though newer
like pain, wound abscess, aching, itching were minimal. techniques like Endovenous Laser Treatment (EVLT),
Transilluminated Powered Phlebectomy, and Radio-
DISCUSSION: Frequency Ablation (RFA) are available, surgical treatment by
stripping of the long and short saphenous veins with the
Disease of the venous system is a major problem affecting ligation of SFJ is an established effective treatment of varicose
western societies resulting in considerable morbidity in the veins in our center. Patients were followed-up regularly in the
population and cost to the health services. Also, in many out-patient department for detection of any recurrent or
countries, varicose veins are probably the commonest residual varicosities. The Framingham Study of Boston
disorder presenting to the general surgeons2. University suggests that increased physical activity and
weight control may help to prevent varicose veins among
The surgical treatment of varicose veins can be achieved in adults at high risk and reduce the overall risk of atherosclerotic
different ways like:- cardiovascular disease as well8.
i) Trendelenburg's operation + stripping + phlebectomies
of remaining varicosities. REFERENCES:
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Veinsand Chronic Venous Insufficiency in men and women in the
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This may be true when the LSV is left in situ, but it does not saphanous vein in the treatment of primary Varicose Veins. Br
explain the incidence of reflux where the LSV is stripped. JSurg1992; 79: 889-93.
Stripping the LSV to the upper calf does not result in a higher
incidence of injury to the saphenous nerve5. In the post- 7. Compbell WB, Vijay KA, Collin TW. Outcome of varicose vein
surgeryat 10 years: Clinical findings, symptoms and patient
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satisfaction. Ann Royal Col Surg2003; 85(1):52-7
combining LSV stripping with SFJ ligation. SFJ ligation is the
commonest cause of recurrence6.The principal outcome 8. Brand FN, Dannenberg AL, Abbott RD, Kannel WB.
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great saphenous vein(technical success) and improvement in J Prev Med 1988;4(2): 96-101.
disease-specific quality of life 3 months after treatment
(clinical success).Therefore we recommend bilateral
operation to some patients when indicated. Although some
recurrence of varicose veins is frequent at 10-years after
operation, surgery provides long-term relief of symptoms in

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