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International Journal of Research in Pharmaceutical Sciences Anila K N et al., Int. J. Res. Pharm. Sci., 2021, 12(1), 832-836 ORIGINAL ARTICLE INTERNATIONAL JOURNAL OF RESEARCH IN PHARMACEUTICAL SCIENCES Published by JK Welfare & Pharmascope Foundation Journal Home Page: www.pharmascope.org/ijrps Short Review On Varicose Vein And Its Management Pranav N1, Anila K N*1, Riju.R.Menon2 1Department of pharmacy practice,Amrita school of pharmacy, Kochi, Amrita Vishwa Vidyapeetham, India 2Department of General surgery, AIMS, Kochi, Amrita Vishwa Vidyapeetham, India Article History: ABSTRACT Received on: 10 Sep 2020 Revised on: 25 Oct 2020 A varicose vein is a condition which affects a large number of people in Accepted on: 11 Nov 2020 Western countries and India especially, the northern areas. For curing this proper disease diagnosis, suficient care for patient and treatment strate- Keywords: gies are required, to control the symptoms and signs of varicose vein, the lavonoid group of drugs have been widely used for many years. Under this Varicose vein, group, Dalon is the most potent and eficient drug which can be used. This CEAP classiication, enhances the bioavailability and absorption from the gastrointestinal area. pathophysiology, Improved quality of patient’s life and eficacy makes this drug therapy more signs and symptoms, potent and signiicant. Some of the clinical studies have shown its better action risk factors, for increased venous tone, lymphatic drainage, decreases cosmetic disig- management, urement, inlammatory responses occur in microcirculation, protection from treatment free radicals and improved quality of life and eficacy. When compared with other available drugs like Polidocanol, Sotradecol, Asclera, Varithena, Sodium tetradecyl sulfate etc. .clinical beneits of Dalon is more. This drug is useful in the early stage and can be used in severe condition along with sclerother- apy, compression treatment and surgery. Increased patient’s quality of life and increased eficacy were observed in Dalon treated group. Thus it is efi- cacious as a standard therapy alone and also in combination with other con- servative treatment. *Corresponding Author widespread, and in western countries, nearly one- Name: Anila K N third of the adults are affected (Agarwal et al., 2016). Phone: In India, the prevalence of varicose vein seems to Email: [email protected] be high in northern India with approximately half of women (46.7%), and one-third of men (27.8%) ISSN: 0975-7538 were found (Agarwal et al., 2016). The factors which cause this condition are sustained venous hyperten- DOI: https://doi.org/10.26452/ijrps.v12i1.4190 sion, leading to failure of closure of venous valves, Production and Hosted by causing the veins to appear dilated. Women are Pharmascope.org most commonly affected than men, especially dur- © 2021 j All rights reserved. ing pregnancy and in people those stands for long hours. Age, sex, pregnancy, family history, obesity etc. are the factors that increase the risk of develop- INTRODUCTION ing varicose vein (Mulla and Pai, 2017). Varicose veins are supericial veins which get Anatomy enlarged and twisted typically under the skin in the legs, but also occur in other parts of the body. These Venous blood returns to the heart by a process veins become wider and allow lowing reversely. It called venous return against gravity; this takes usually occurs in the lower limb. This condition is place through the supericial and deep venous sys- 832 © International Journal of Research in Pharmaceutical Sciences Anila K N et al., Int. J. Res. Pharm. Sci., 2021, 12(1), 832-836 tem. They are divided as long saphenous veins and used. Hence it is useful in symptom relief, good small saphenous veins and (Mulla and Pai, 2017). compliance and easy way of administration (Gold- Long saphenous vein (SSV) starts from the medial man and Fronek, 1989). Risk factors of the varicose end of arch of dorsal venous, then anterior to the vein are Family history, Increasing age over 30, Pro- medial malleolus and enters the medial aspect of calf longed standing, Heavy lifting, Multiple pregnancies, and thigh, ends in the femoral vein at the Saphe- Limited physical activity, High blood pressure, obe- nofemoral junction Lateral end of the dorsal venous sity, sex (Heller and Evans, 2015). arch is from where the SSV originates, then through lateral malleolus and inally enter through the back Pathophysiology of the calf to reach the popliteal fossa (Rabe and Varicose veins are normal veins which get dilated Pannier, 2012). The supericial and non-supericial due to high venous pressure. Various compart- systems connect at numerous places with the help ment and chambers consist of deep and superi- of non-junction perforators (Goldman and Fronek, cial veins (Goldman and Fronek, 1989). These are 1989). divided by fascia covering the muscle of leg in the Histologically, the vein wall contains mainly three lower extremities. The prominent deep veins of layers:-the inner layers which are known as intima, the lower limb are popliteal and femoral vein. The media is the middle layer, and outer is the adven- venous blood lows return to the heart through the titious layer (Goldman and Fronek, 1989). The popliteal veins which is a single trunk, as well as outer layer is ibrous. The middle layer is hypertro- its continuation is the femoral vein then the com- phied with elastic ibres. With increasing age, the mon femoral vein, iliac vein and inally inferior vena structure of vein walls becomes more disorganized. cava (Goldman and Fronek, 1989). The great saphe- Adventitia merges with the perivenous connective nous vein is a large venous blood vessel arises from tissue (Goldman and Fronek, 1989). the dorsal venous arch and drains into the femoral vein and lesser into the popliteal vein (Santler and A comprehensive classiication system known as Goerge, 2017). The supericial compartment is CEAP classiication describes the varicose vein clini- a low-pressure chamber, and the deep compart- cally. Signs and symptoms of chronic venous disease ment is high-pressure chamber due to the action are standardized by using this classiication given in of calf muscle pumping venous blood back to the Table 1 (Santler and Goerge, 2017). heart (Santler and Goerge, 2017). Some of the signs and symptoms of varicose veins are Pain in the legs, cramping, swelling, Our body’s return of venous is against gravity and itching, heaviness, Paresthesia, hyperpigmentation, depends on the muscle pumps of the leg and calf. oedema, lipodermatosclerosis, ulceration, bleed- When pressure develops on the sole of the leg and ing (Jill et al., 2012); Manifestations occur as the increased muscular contractions in the fascial com- disease progresses, but on early stage, it is usu- partment of the calf lead to compressions of the ally asymptomatic. Microscopically the defect is sinusoidal intramuscular veins which leads to the due to the defect in the closing of the venous valve reach of blood to the deep system (Naoum et al., which results in the dilation, tortuous and elonga- 2007). The relux of blood is prevented by the clo- tion of veins (Goldman and Fronek, 1989). Sus- sure of valves which appear in greater density in the tained venous hypertension is one main factor in calf. Now, when systole happens, blood cannot enter the development of varicose vein, which is due to its the supericial vein system because of the closure of diameter enlargement of supericial veins which fur- junction and non-junction perforators (Naoum et al., ther leads to the valve incompetence (Goldman and 2007). This is due to the building up of external Fronek, 1989). pressure in the fascia and the muscles. When we are standing without any activity, the venous valves are Several other pathophysiological mechanisms can in the neutral position, blood enters from the arte- cause varicose vein such as (Naoum et al., 2007) rial side, and pressure again increases (Naoum et al., 1. structural changes of vein 2007). The valve opens and leads to the develop- ment of hydrostatic pressure. When we move com- 2. obstruction in venous outlow pression takes place in the deep veins and sinuses. 3. Inlammation and sheer stress. Blood moves cranially and caudally. But again, valve closure takes place, and division of the high pressure Treatments for the relief of severe symptoms gen- takes place into a series of low pressures. Pressure erally include surgical removal of the vein, scle- in the foot vein falls causes venous pooling and low- rotherapy, mechanical compression and drug ther- ers CHP causing oedema in the feet. Raised ambu- apy. Among these, drug therapy is the most widely latory venous pressure is one of the other causes. © International Journal of Research in Pharmaceutical Sciences 833 Anila K N et al., Int. J. Res. Pharm. Sci., 2021, 12(1), 832-836 Table 1: CEAP Classiication CEAP clinical score Description C0 Signs are not visible C1 Telangiectasia’s or reticular veins C2 Varicose vein >3mm in diameter C3 Oedema C4 discolouration of the skin and subcutaneous tissue: pigmentation, eczema, lipodermatosclerosis or Atrophy Blanche C5 Healed venous ulcer C6 Active venous ulcer This forms the reasons for the signs and symptoms This technique gives x-ray imaging of the vein, which in chronic venous insuficiency (Santler and Goerge, is done by inserting the dye. Ascending venogra- 2017). phy is commonly used for this condition. Descend- Diagnosis ing venography is used to measure the function of valves in deep veins. It should not be used for peo- There are various diagnosing methods available for ple with CHF and pulmonary hypertension, kidney detecting the varicose vein. It can be diagnosed diseases etc (Feliciano and Dalsing, 2011). according to its history, clinical presentation and Phlebodynamometry duplex ultrasound is a diagnostic test which is usu- ally used (Feliciano and Dalsing, 2011). This is the method for measuring venous pressure intravascularly.
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