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Varix Center

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Varix Center

Varix is a problem as old as the history of humanity.
Varices are significantly shown in some ancient Greek statues built 2500 years
ago. However, it was first defined in Ebers papyri in 1600 BC in a written
document. Today it is regarded as a widespread disease affecting 5 to 40
percent of people, lowering life quality and causing severe cosmetic problems,
though not life-threatening.

The estimation that minimum 5 million people in our
country have varices in different degrees is obviously true. Arterial blood
reaching our legs is sent to the lung as venous blood with the effect of
pumping in veins caused by the contracting of leg muscles, and gravity causes
the blood flowing upward to return back to our legs. The valves of the veins in
the leg permit the blood only to flow upward to the heart, and close to prevent
gravity from reversing this flow. If these valves are damaged due to some
genetic or acquired factors, the blood sent to the lungs flows back (reflux)
with the effect of gravity and build up in the veins of the leg. Due to the
increased pressure caused by this reflux in years, the veins in the leg swell,
expand and ultimately form varices.

Large varices (varicose veins)

They cause significant protrusion in the skin with
diameters between 4 – 15 mm, and often develop due to valvular incompetence in
a large superficial vein.

Medium sized varices (reticular veins)

They cause slight protrusion in the skin with diameters
between 2 – 4 mm, are green-red in color, and often develop due to valvular
incompetence in a smaller superficial vein.

Capillary varices (spider veins)

They do not protrude from the skin, have diameters
smaller than 1 – 4 mm, are red-purple in color, and often develop due to
valvular incompetence in one or several small superficial veins.

What are the symptoms of varix?

1. Edema: Often edema occurs in the ankle and the calf.
Edema occurs especially towards the evening due to prolonged standing, and is
not apparent when you get up in the morning.

2. Pain: It is a blunt and deep pain that develops due to
prolonged standing and imposes weight on the leg. Pain is relieved by lifting
the leg upward or lying for a while.

3. Itching: Itching accompanied by burning sensation and
throbbing may develop in and around the ankle especially when change of color

4. Night cramps, tiredness and tension: Restlessness in
legs and the feeling of not knowing where to place your feet which especially
occur after prolonged starting or long journeys may be signs of varix.

5. Thrombophlebitis: Thrombophlebitis is characterized by
post-traumatic or spontaneous clotting of enlarged bone structures and
superficial inflammation. The skin becomes red, hot and excessively sensitive.
It may disappear spontaneously or with treatment, but may relapse.

6. Skin changes: Changes may occur in a wide perspective
from color changes to open and non-healing lesions.

7. Bleeding: It is the only case that constitutes
urgency. Due to high pressure, varix bleedings may be serious. Bleeding is
generally stopped with sufficient compression.

What is the course of varix disease?

Complaints such as pain in the legs, cramps constantly
increasing within the day, leg ache especially in the first half of the night,
swelling in legs and ankles, feeling of heaviness in the legs, numbness and
prickling will disappear when treatment is initiated. Delaying the treatment
may cause non-healing leg lesions, thickening and hardening of the skin,
bleeding, inflammation (phlebitis) in progressed cases, accompanied by severe
pain and edema, constantly-increasing and -darkening spots, and as a result,
treatment becomes difficult, and symptoms may not be completely recovered
despite treatment.

Today, the clinical steps of varix development have been classified:

C0: Venous insufficiency does not have an apparent symptom.

C1: Spider and reticular veins are present.

C2: Varicose veins are present.

C3: Edema

C4a: There are dermal symptoms associated with venous insufficiency such as pigmentation and eczema.

C4b: There are dermal changes that we call lipodermatosclerosis and atrophie blanche.

C5: Healed venous ulcers in C4.

C6: There are active ulcers.

How is varix diagnosed?

Edema (swelling), change of skin color and presence of
venous ulcers which are clinical signs of chronic venous disease are generally
sufficient to diagnose venous hypertension without applying diagnostic methods.
However, in some suspicious cases, diagnostic methods are employed to finalize
the diagnosis and identify the exact cause (reflux, occlusion or venous pump
dysfunction), and to determine the exact location and level of the disease.
Today, three major diagnostic methods are preferred:

 1. Ultrasound

 2. Contrast venography

 3. Magnetic Resonance venography

 Today, diagnostic contrast venography has been replaced
by noninvasive methods like duplex ultrasonography and magnetic resonance (MR)
imaging. Other techniques are only employed when there are doubts as to the
diagnosis. Briefly, duplex ultrasonography has been a method continually used
in the clinic as an easy, reliable, repeatable, non-invasive and inexpensive
diagnostic method. In duplex ultrasonography, real-time anatomic views of deep
and superficial venous vessels and dynamic evaluation of the blood flows in
these vessels can be performed using sound waves, and the problem in the venous
system and its location can easily be determined.

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