Varicose Veins

VARICOSE VEINS, a condition of the veins which mostly occurs in those parts of the blood-stream which are farthest from the heart, occupy a dependent position and are relatively unsup ported by surrounding tissues. Thus they are found, superficially, in the legs and thighs; in the lowest part of the bowel (piles; see HAEMORRHOIDS), and in the spermatic cord (varicocele). Any condition which hinders the return of blood from the veins is apt to cause their permanent dilatation ; thus is explained the occur rence of varicose veins in the leg from the wearing of a tight garter, and of piles as the result of the pressure of an ovarian tumour or of a pregnant uterus, or of disease of the liver.

Sometimes the trouble is begun by a direct injury

to the vein, which, by setting up inflammation, weakens the coats of the vein, which then yield under the pressure of the blood-stream. In the case of varicocele, the dilatation of the veins is probably of devel opmental origin ; many other causes are given, but not one of them appears satisfactory. Examination of a varicose vein shows that it is increased in length as well as in capacity, and that the valves are atrophied and functionless. In some parts of its course the vein has its coats much thickened, but at those places where there is most dilatation the walls are very thin. Veins thus affected give rise to pains and achings, and they are, moreover, liable to attacks of inflammation which end in clotting of the blood (thrombosis, q.v.). This is a dangerous condition, as a sudden or violent move ment is apt to cause the detachment of a piece of the clot, which, carried up to the brain or the lung, may cause sudden death. Less serious results of varicose veins are swelling of the parts below (oedema), ulceration and abscess.

As regards treatment, the wearing of a well-fitting elastic stock ing will prove beneficial in the case of a moderate dilatation of the veins of the leg ; the individual must avoid long standing and fatigue. It is well also to have the foot of the bed raised three or four inches, so that during the night the veins may be kept as empty as possible. If the case is more serious, the thinned veins threatening to give way, it will be advisable, provided the dilatations are fairly well localized, and the general condition of the patient permits, to excise the diseased parts, tying the cut ends of the veins, and closing the surface wounds with fine sutures. Should a varicose vein be plugged with clot, it will be

advisable to tie it high up where the coats are healthy, and to remove the lower part by dissection. This will render the person safe from the very serious risk of a piece of the clot being carried to the heart, and will also permanently rid him of his trouble. It may be said generally that any operative treatment for varicose veins in the lower extremity is best associated with the applica tion of a ligature upon the large surface vein just before it enters the common femoral vein below the fold of the groin. This operation removes the risk of the downward pressure of blood in the veins whose dilatation has rendered the valves useless. Re cently, a method of internal coagulation by means of injections (e.g., salicylic acid) into the vein has been adopted with suc cess.

In the case of a varicose vein being opened by accident or disease, it is quite possible for the individual to bleed to death. The first-aid treatment for the serious haemorrhage should consist in laying the patient on the floor, raising the limb upon the seat of a chair, and fixing a pad over the open vessel by a handkerchief or bandage.

Varicose veins of the spermatic cord

(varicocele) of the left side are met with in adolescents. The dilatation is, in all proba bility, of developmental origin, making its appearance at puberty. It is, as a rule, of no serious moment, and, unless present in an extreme degree, had best be treated merely by a suspension band age. If, however, it is causing real physical distress, it may be treated by excision of an inch or two of the bunch of dilated veins. The presence of varicocele is apt to cause inconvenience or even discomfort to men living in India or the tropics, but the Englishman who intends spending his life in temperate climes will do well to ignore a varicocele. It will become less and less noticeable as time goes on. (E. 0.) VARIETY THEATRE : see THEATRE.