Varicose Veins and Its Homeopathic Approach
Homeopathic Journal :: Volume: 4, Issue: 11, Sep 2011 (New Papers) - from Homeorizon.com
|Article Updated: Oct 20, 2011|
A vein is said to be varicose when it becomes dilated, elongated and therefore tortuous.
Varicosity is common with the superficial veins of the lower limbs. It is also frequent in some other situations eg. -
- Hemorrhoidal veins results - piles
- Spermatic veins results - varicose
- Oesophageal veins results - Oesophogeal veins.
- Morphological Factor: Varicosity is a penalty that man pays for his erect posture, the veins having to drain against gravity. The superficial veins, having little tissue to support them, have to suffer.
- Secondary varicose veins: are usually the result of venous obstruction or of condition which hamper venous return.eg.
- Pregnancy and tumours in the pelvis.
- Thrombosis of the deep veins.
- Congenital arterio - venous fistula (occurs below the age of 20 years)
- Primary varicose veins: These are very common and are due to defect of the valves. The valvular defects may be-
- Acquired (Due to infection in veins)
The defect may be-
In long standing cases there may be a combined varicosity of the long saphenous and short saphenous systems.
- In the spheno - femoral valve - ceasing varicosity of the long saphenous system.
- In the spheno - popliteal valve - causing varicosity of the short saphenous system.
- In the valve of communicating veins - causing a patchy varicosity in the neighborhood of the communicating veins.
- Usually a combination of the third with either of the first two.
- Hormonal Factor : Hormone progesterone gives an indication of the occurrence of this disease in females which causes the smooth muscle in the vein to relax.
The affected veins especially of lower extremities are dilated tortuous elongated and nodular. Intraluminal thrombosis and valvular deformities are often found.
There is variable fibro muscular thickening of the wall of the veins due to alternate dilatation and hypertrophy. Degeneration of the medial elastic tissue may occur which may be followed by ca lcified foci. Mural thrombosis is commonly present which may get organised and hyalinised leading to irregular intimal thickening.
- Eczema - chronic dermatitis.
- Ankle flare
- Varicose ulcers
- Talipes Equinus
- Saphena varix
- Calcification of Veins
- Lipodermato Sclerosis
Examination of Varicose Veins
- Age: Though varicose vein can affect all age group, yet people middle aged individuals are the usual suffers.
- Sex: Women are affected much more commonly in the ratio of 10:1
- Ethnic Group: Varicose vein are less commonly seen in primitive civilizations - the poor in Africa and Far East.
- Occupation: Certain jobs required prolonged standing from drivers, policemen, etc. and the persons involved in these jobs often suffer from varicose veins. Varicose veins may also occurs in individuals involved in excessive muscular contractions e.g. Rickshaw Pullers & Athletes.
- Pain with aching sensation felt in the whole leg or in the lower part of the leg particularly towards the end of the day.
- Pain gets worse when the patient stands up for a long time and is relieved when he lies down.
- Patient may complains of bursting pain while walking which indicates deep vein thrombosis.
- Night cramp also be present.
- The ankle may swell towards the end of the day and the skin of leg may be itching.
- Varicose ulcer may be seen on the medial Malleolus.
A few question should be asked/ Essential Queries:-
- Whether the patient is feeling difficulty in standing or walking, which indicates presence of deep vein thrombosis.
- The patient should asked if he has any other complaint than varicose vein itself.
- If the patient is suffering from constipation or a swelling in the abdomen it may be cause of secondary varicose vein.
Enquiry must be made if the patient had any injection treatment or operation for varicose veins. Any serious illness of previous complicated operation may cause deep vein thrombosis which is the cause of varicose vein now.
Women should be asked about obstetric history like details of previous pregnancies.
- Whether the patient suffered from "White leg" during previous pregnancies.
- If the patient had contraceptive pills for quite a long time as this may cause deep vein thrombosis.
It is not uncommon to find varicose veins to run in families. Patient's mother and sister may/might suffer from this disease.
Note, which vein has been varicose; long saphnous or short saphenous or both .
Swelling: It may be-
- Either localized due to - varicose veins affecting a segment of superficial vein or the whole trunk of a venous system - either long or short saphenous vein. Localized swelling also due to superficial thrombophlebitis.
- Generalized swelling of the leg is mostly due to deep vein thrombosis.
Skin of the limb-
- Colour - local redness is due to superficial thrombophlebitis generalized change of colour may be white (Phlegmasia alba dolens) is due to swollen limb from excessive oedema or lymphatic obstruction.
- When the skin of the limb becomes congested and blue due to deep vein thrombosis and this condition is called "Phlegmasia cerulea dolens."
The affected limb should be carefully inspected to note:
- If the skin is stretched and shiny due to oedema following deep vein thrombosis.
- If there is eczema or pigmentation of the skin affecting mostly the medial aspect of the lower part of the leg.
- If there is any ulceration often seen in the medial aspect of the lower part of the leg.
- Scar may be seen at the lower part of the leg which may be due to healed venous ulcer.
4. Patient should be asked to cough and it is noted whether there is any impluse on coughing at the saphenous opening (Saphena- Varix). This test is called as "Morrissey's test"
Examination of the varicose is very imp. The aim is to locate the incompetent valves communicating the superficial & deep veins.
With the patient lying the limb is elevated to drain out the veins. A tourniquet is applied on the sapheno - femoral junction at the fossa - ovalis (4 cm. below and lateral to the pubic tubercle), sufficiently tight to occlude the vein. The patient is now made to stand. The tourniquet in now released. If there is rapid filling of the veins from above, the Trendelenburg test is +ve. Which means that the saphenofemoral valve is incompetent. If this does not occurs the valve is competent and the test is -ve.
A further modification of this test may be applied with the tourniquet (or pressure) on the patient stands for a minute. If there is quick filling of the veins at different levels, It indicates incompetence of the communicating veins at these levels. It this does not occurs and the veins fill up only slowly the communicating veins are working normally.
A +ve Trendelenburg test in an indication for operative interferences.
This is applied for sapheno-femoral incompetence. The limb is elevated to empty the veins and the patient is asked to cough forcibly. It there is expansible wave in the veins the valve is incompetent.
This test in especially helpful in determining whether the deep veins are patent or not. A tourniquet is applied round the upper thigh sufficiently tight to occlude the long saphenous vein. With the tourniquet in postion, the patient is asked to walk for a few minutes. It the deep veins and the communicating veins are normal, the superficial veins shrink. If the superficial veins get dilated or remain unchanged, either the deep vein is blocked or the perforators below the tourniquet are incompetent.
In the advanced cases of varicosity a thrill can be felt by a finger placed over the fossaovalis when the most prominent part of the varicosity in topped with another finger.
The importance of auscultation is limited to the arteriovenous fistula, where a continuous machinery murmer may be heard.
Regional Lymph node
(Inguinal) are only enlarged if there is venous ulcer & this is infected.
Should also be examined.
- Pulsatilla nigricans
- Formica rufa
- Fluoricum acidum
- Arsenicum album
- Nux vomica
- Hammamelis virginica
- Atropha Belladona Glonoinum
- Magnetis - Polus - Australis
- Lachesis mutus
- Calcarea flourica
- Lycopodium clavatum
- Fluoric acid:- Varicose veins little blue, collection of veins in small spots, varicose of legs tend to ulceration flat naevus.
- Lycopodium clavatum: Swelling & enlargement of the veins, particularly those which are more or less imperfectly supplied with valves as in legs, particularly the right one; varicose of genital organs of labia during pregnancy, often of hepatic origin; naevi; erectile tumour.
- Pulsatilla nigricans: Disturbance of venous circulation; varicose veins in legs and about testicles of bluish hue with soreness and stinging pain; passive haemorrhage.
- Calc. Flour:- Varicose veins and their ulceration; vascular tumors with dilated blood vessels.
- Ferrum phos:- Varicose and haemorrhoids in young people; stool hard & difficult followed by backache throbbing pain.
MANAGEMENT & TREATMENT
A. Palliative Treatment
Support by elastic stocking or elastocrepe bandages and as far as practicable avoiding standing. A palliative treatment in indicated for-
- Varicosity associated with pregnancy.
- Patients awaiting operation.
- Patients unwilling or unfit for operation.
B. Medicinal Treatment
This is done by careful injections of Sclerosing agents into the dilated veins. It aims at intimal destruction followed by fibrosis and occlusion of the veins.
5% Ethanol - amine may be use. The injection should be made only at one site in one sitting and not more than 2 ml of the agent should be injected following the injection, a firm strapping of the limb is obligatory.
This treatment is effective in small patchy areas of varicosity- either in an original case or in one having small remnants following operation.
C. Surgical Treatment
A positive Trendelenbug test is an indication for operation. There are two type of operation.
- Ligation with stripping
(a) For sapheno-femoral incompetence.- A 'flush' sapheno-femoral ligation is done at the fossa ovalis, and the long saphenous vein is divided. This means that the ligature has to be put right at the sapheno femoral junction. Particular care must be taken to see that between the ligature and the sapheno-femoral junction there is no intervening tributary of the saphenous vein. For this purpose, the superficial epigastric, the superficial external pudendal, and the superficial circumflex iliac veins must be ligated and cut. Unless this is done, all the back-pressure from the femoral vein, via the incompetent valve, will be transmitted to these tributaries and cause tremendous varicosities in them.
(b) For sapheno-popliteal incompetence.- A 'flush' ligature is applied at the junction of the short saphenous vein with the popliteal vein at the popliteal fossa, and the short saphenous vein is divided.
(c) For incompetency of a communicating vein-The particular vein has to be exposed, ligated, and divided.
2. Ligation with Stripping-
This is particularly useful for those cases where incompetence of either of the saphenous veins is associated with that of perforators as well (i.e. majority of cases). After 'flush' ligation as above, a vein-stripper (Meyer's) is passed through the saphenous vein and the whole length of the vein is stripped out, tearing all its tributaries and perforators. Haemostasis is easily achieved by firm bandaging of the limb.
- TEXT BOOK OF SURGERY - DR. AK NAN
- TEXTBOOK OF SURGERY … DR. S. DAS
- CLINICAL SURGERY…. DR. S. DAS
- HOMOEOPATHIC MATERIA MEDICA. … WILLIAM BOERICKE
- THERAPEUTICS …. LILIENTHAL