European Journal of Molecular & Clinical Medicine

Introduction: The Venous Clinical Severity Score (VCSS) was designed to give more strength
to CEAP classification and to provide a method for serial assessment particularly to CEAP clinical
class 4 and class 6. Even though the VCSS has been very useful, several areas of deficiency are
also noted over time. VCSS was again revised by American Venous Forum with an intention to
improve the VCSS, and also by preserving its strengths. Aim of the Study: To Compare VSS
system with CEAP system postoperatively in assessing the outcome of varicose veins surgery.
Methodology: A Prospective Longitudinal Clinical Study done in 30 patients from November
2019 to June 2021in the Department of General Surgery, Narayana Medical College and Hospital,
Nellore. Duplex ultrasound for each patient to assess the following CEAP clinical class, CEAP 18-
point clinical score, VCSS, VDS. Patients were followed up in the post-operative period for 6
weeks and 6 months and CEAP class, CEAP score, VCSS score and VDS will be recorded to
assess the venous outcome at 6 weeks, 6 months. Results

Background: Visible varicose veins of the leg affect approximately 25–30 per cent of adult women and 15 per cent of men. The present study assessed outcome of management of varicose veins.
Materials & Methods: 84 cases of varicose veins of both genderscomprises of conservative (Group I) and surgical procedures (Group II). Venous clinical severity score [VCSS] and venous disability score [VDS] were assessed.
Results: Out of 84 patients, males were 44 and females were 40. Side involved was left was 15, right side in 16 and both in 10 cases in group I and 11, 18 and 12 in group II. Duration of hospital stay was 5-10 days in 41, 10-15 days in 0, 15-20 days in 0 in group I and in 34, 4 and 3 days in group II. VCSS was mild in 14, moderate in 16 and severe in 11 cases in group I and 10, 22 and 9 in group II. VRS was mild in 15, moderate in 14 and severe in 12 patients in group I and 11, 16 and 14 in group II respectively. The difference was significant (P< 0.05). Aching was absent in 16 in group I and 21 in group II, heaviness in 18 in group I and 23 in group II, itching 19 in group I and 25 in group II and swelling 17 in group I and 28 in group II. The difference was significant (P< 0.05).
Conclusion: Surgical management found to be effective as compared to conservative management in patients with varicose veins. 

Background: Varicose veins are a frequently encountered surgical problem in today’s practice. Ligation of the Sapheno-Femoral junction (SFJ) in Flush with the femoral vein after ligating and dividing the known and unknown tributaries is a time tested method of treating Sapheno-Femoral incompetence in primary varicose veins.
Material and Methods: This study was conducted in Department of Anatomy. The duration of study was over a period of one and half year. On the basis of inclusion and exclusion criteria, total of 120 cases of SFJ incompetence were included in this study. Results: In our study we were included total 120 no. of participants. Among all, 93.4% were male rest were female. In the USG finding, 88.4% participants were showing SFJ below the pubic tubercle and in 11.6% participants was marked at the level with pubic tubercle. This study also showed that anatomical subtypes of SFJ which were found 93.4% subtype I, 5% subtypes H & rest Subtype S. In this study, nobody had postoperative complications and good cosmetic outcome.
Conclusion: It can be concluded that thorough knowledge of all the anatomical variations of the SFJ is mandatory for efficient management of varicose vein and safety of SFJ.

Background: Varicose veins of the lower limbs are the most common vascular disorder affecting human beings. Although venous ulceration is a benign condition, there is considerable morbidity due to recurrent cellulitis, phlebitis and stiffness of joints. Present study was aimed to study venous ulcers occurring in patients with varicose veins & response to various modalities of treatment at a tertiary hospital.
Material and Methods: Present study was hospital based, prospective, observational study, conducted in patients with venous ulceration in the leg due to varicose veins, willing to participate & follow up.
Results: In present study 32 patients were included. All patients were male. age ranged between 28 to 70 yrs. Majority of were from 40-49 years age group (31.25%) & duration of illness was 1-5 years (53.13%). Apart from ulcer & varicose veins (100.00%), common complaints were itching (31.25%), pain (28.13%) & pedal oedema (9.38%). Four patients (12.50%) had bilateral disease Fascial defects due to perforator incompetence was clinically well palpable in all patients with below knee perforators. Perthes’ test was negative in all patients and doppler (Duplex) assessment showed patent deep veins in all patients. All 32 patients (36 limbs) underwent Trendelenburg operation. Treatment modalities were Trendelenburg operation with stripping with stab avulsion (52.78%), Trendelenburg operation with stripping with subfascial ligation (36.11%), short saphenous vein ligation and stripping (5.56%) & excision of fibrous tissue and split skin grafting (5.56%).Post-operative complications in present Wound infection of the transverse groin incision was present in 2 patients.
Conclusion: In cases of venous ulcers occurring in patients with varicose veins, meticulous clinical assessment leads to successful treatment. Conservative treatment of venous ulceration should be tried before embarking on surgery which is the definitive treatment.

Background: Varicose veins affect 20–30% of adults. If symptoms persist, the main treatment options are sclerotherapy, surgery (usually stripping and ligation of the long or short saphenous veins and phlebectomies), and ablation (by laser or radiofrequency ablation). Present study was aimed to compare the efficacy of treatment of varicose veins with Saphenofemoral ligation and Foam sclerotherapy compared to Saphenofemoral ligation and stripping.
Material and Methods: Present study was single-center, prospective, comparative, study, conducted in patients of either gender with varicose veins of the lower limbs, including those with venous ulcers. Patients were randomly allocated to group 1(SF ligation with foam sclerotherapy) &group 2 (SF ligation and stripping).
Results: The demographic data of the patients included in this study showed no significant difference between both groups in terms of age and sex. The time taken to complete treatment was shorter in the foam sclerotherapy plus SFJ ligation group: 40 vs. 55 min. The rate of longer-term (>30 days) ulcer healing rate in the case series ranged from 75 to 85%. 6 (85.7%) of 7 ulcers healed in the foam sclerotherapy group compared with 6 (75%) of 8 in the SF ligation and stripping group. At 3 months, median CEAP class dropped from four preoperatively to one following treatment in both groups. 1 patient out of 25 treated by foam sclerotherapy reported venous recanalization at one year after treatment. Median time to return to normal activities was significantly reduced in the foam sclerotherapy group (4 days) compared to the surgical group (9 days). Rates of thrombophlebitis was 16%.skin staining/pigmentation at 8%, and pain at the site of injection ranged was 28%.
Conclusion: Treatment of varicose veins with Foam sclerotherapy instead of stripping and avulsions reduces the operative and post operative recovery time.

Background:To study the distribution, pathology, clinical features, various mod es of
investigations and overall management of varicose veins of lower limbs.
Materials and Methods: The study was carried out Govt Medical College/General
Hospital, Suryapet from October 2021– March 2022 to evaluate the ―Clinical
presentation and management of varicose vein in lower limbs. 50 cases of varicose veins
of lower limbs were presented and analysed in our study. Fifty cases of varicose veins of
the lower limb have been studied in detail.
Results: Varicosity of the lower limb is a common clinical entity. The number of cases
reporting to the hospital is much less than the real incidence; because in the absence of
symptoms due to varicose veins patients do not seek treatment in our country. The
commonest age group of patients suffering from varicose veins is 41 to 50 years. Most of
the patient presented to the hospital for one or the other complications and not for
cosmetic reasons. The majority of the patients were male. A definite relationship exists
between the occupation and the incidence of varicose veins as most of our patients are
workers standing for longer duration. The involvement of long saphenous system is
more common than the short saphenous system. Left limb is affected more common.
The cause for the same is not known but could be attributed to the longer course
traversed by the left iliac veins. Clinical examination has a high predictive accuracy. It
gives sufficient information to treat the patients in centres where colour Doppler is not
available or affordable. The use of colour Doppler is a valuable supplement to clinical
examination for effective treatment of varicose veins and its use is strongly
recommended to prevent recurrences and reduce morbidity as it is effective tool in
detecting venous incompetence and to rule out deep vein thrombosis. SPJ junction and
perforators are highly variable and should always be marked pre- operatively using
USG Doppler. Operative line of treatment is a primary procedure in the management of
varicose veins of lower limbs.Venous ulcer heals well after surgery. Surgery is a quality
modality for varicose veins patients with ulcer with low recurrence rate. Complications
are negligible if cases are meticulously selected and operated. The present procedures
enable the patient to lead almost normal life after surgery with few recoverable
morbidities.
Conclusion: There is need for general health education and awareness about varicose
veins in the society in order to achieve timely treatment with good outcome and to
reduce the morbidity.

Background: Varicose veins of the lower limbs are the most common vascular disorder affecting human beings. Although venous ulceration is a benign condition, there is considerable morbidity due to recurrent cellulitis, phlebitis and stiffness of joints. Present study was aimed to study venous ulcers occurring in patients with varicose veins & response to various modalities of treatment at a tertiary hospital.
Material and Methods: Present study was hospital based, prospective, observational study, conducted in patients with venous ulceration in the leg due to varicose veins, willing to participate & follow up.
Results: In present study 32 patients were included. All patients were male. age ranged between 28 to 70 yrs. Majority of were from 40-49 years age group (31.25%) & duration of illness was 1-5 years (53.13%). Apart from ulcer & varicose veins (100.00%), common complaints were itching (31.25%), pain (28.13%) & pedal oedema (9.38%). Four patients (12.50%) had bilateral disease Fascial defects due to perforator incompetence was clinically well palpable in all patients with below knee perforators. Perthes’ test was negative in all patients and doppler (Duplex) assessment showed patent deep veins in all patients. All 32 patients (36 limbs) underwent Trendelenburg operation. Treatment modalities were Trendelenburg operation with stripping with stab avulsion (52.78%), Trendelenburg operation with stripping with subfascial ligation (36.11%), short saphenous vein ligation and stripping (5.56%) & excision of fibrous tissue and split skin grafting (5.56%).Post-operative complications in present Wound infection of the transverse groin incision was present in 2 patients.
Conclusion: In cases of venous ulcers occurring in patients with varicose veins, meticulous clinical assessment leads to successful treatment. Conservative treatment of venous ulceration should be tried before embarking on surgery which is the definitive treatment.

Varicose veins are veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg. Endovenous laser therapy (EVLT) is a popular treatment for varicose veins. The study aimed to assess improvement the occlusion rate in the treatment of patients with varicose veins. Patients and methods: this study involved 18 patients with lower limb varicose veins presented at Zagazig University Hospital. All patients were examined clinically to identify symptoms and signs related to venous diseases and duplex ultrasonography were performed. Evaluation was done after one week, one month, 2 months and 3 months following treatment. Results: All patients had improvement in VCSS after EVLA during the first, second and third follow up visits when compared with preoperative scores. The VCSS ranged from 5 to 15 before the procedure, with a mean of 8.89, ranged from 1 to 6 at the first follow up visit with a mean of 3.4, ranged from 1 to 5 at the second follow up visit with a mean of 2.5 and ranged from 0 to 4 at the third follow up visit with a mean of 1.6. CIVIQ in the legs of studied group: Pre-operative was14.42 ± 7.29 while after 6 month was 7.64 ± 4.62. Only Ecchymosis in 2 limbs (6%), Paresthesia at leg in 3 limbs (9%), Phlebitis 4 limbs (12%),Skin burn in one limb (3%)and Incomplete occlusion in one patient(4%). Conclusion: Higher energy EVLA of varicose veins showed faster recovery attributable to the decreased pain, immediate ambulation and faster return to everyday activities. Patients experienced symptom relief after the procedure with decrease the VCSS and CIVIQ in both.