In varicose veins there is a dilatation of the calibre of the veins
and their valves are insufficient. The walls are irregularly thinned,
lengthened and tortuous.
=Osteopathic Etiology= and =Pathology=.—The =internal saphenous= is
the vein most frequently affected, although any vein throughout the
body may become varicose. Commonly, varicose veins occur in the lower
extremities and occasionally in the arms.
The =valvular insufficiency= is caused by stretching of the wall
of the vein, thus separating the thin, free edges and leaving an
interspace that allows regurgitation of the blood. The valves becoming
insufficient, the column of blood in the veins has no support against
gravity, and being interrupted in its course does not flow normally
into collateral channels. The walls of the veins become thin, as does
also the adjacent skin, thus increasing the danger of a rupture, either
external or subcutaneous.
Varicose veins are most frequently found in females, following
uterine enlargements. The condition may be due to any obstruction
or constriction that prevents the free return of blood from the
veins, such as dislocations of the hip, either slight or complete,
dislocations of innominata, contractions of adductor magnus muscle
affecting femoral vein, prolapse of diaphragm obstructing vena
cava, tissue constrictions about the saphenous opening, garters,
and, in fact, anything that might impede the free venous flow. The
tendency to varicose veins increases as age advances, and many cases
are found among people of middle life who have been accustomed to
standing a great deal. Injuries to the pelvis, thigh or leg, lessening
the nutrition to the leg, or injuries to the nerves, as vertebral
dislocations in the lower dorsal or lumbar regions (the fourth lumbar
especially) may be causes of varicose veins. Pregnancy or tumors
in the abdomen or pelvis, causing pressure upon the iliac veins,
are occasionally causes. Distention of the sigmoid flexure, causing
pressure upon the left iliac vein, or distention of the cecum; pressing
upon the right iliac vein, are fruitful sources, as are also diseases
of the heart and lungs. Varicose veins of the upper extremities are due
to occupations requiring overuse of the arms.
=Complications.=—Varicocele, hemorrhoids, labial varix in the female,
varix over pubes, ulceration and eczema due to disturbances of
nutrition, edema and thrombus.
=Symptoms.=—=Lower Extremities.=—Cramping pains in the limbs upon
rising. Fullness and heaviness of the limbs. Inspection may reveal
superficial varicose veins near the saphenous opening, upon the
external thigh, in the popliteal space, upon the external leg or behind
the ankles. Edema and congestion of the foot and ankles occur in a few
cases. Pain is quite a prominent symptom, due to pressure upon the
nerve fibres. Eczema and itching are due to disturbed innervation and
blood supply to the skin. Ulceration may occur, due to the bursting of
a vein.
=Upper Extremities.=—Before the varicosity appears there is usually
pain or a feeling as of a sprain in the involved region of the arm. The
pain is usually confined to a muscle or group of muscles.
=Treatment.=—The majority of cases are due to disorders about the
pelvis, hip or thigh, and the treatment resolves itself into the
removal of these obstructions or constrictions. Occasionally cases are
caused by partial dislocations of the hip joint, which can be easily
overlooked during a hurried examination. The slipping of an innominatum
is an important factor. Rest in a recumbent position, attention to the
general health, and especial attention to the bowels and liver, are
essential in acute attacks. Occasionally the heart and lungs are at
fault. Treatment twice per week should consist of removing any of the
numerous causes of the condition, and spinal treatment as well; then
the leg should receive special attention. Remember, thrombi may form
and the vein must, under no circumstances, be touched in the treatment.
Begin by carefully rotating the leg to stretch contracted tissue about
the saphenous opening, then separate the tendons of the popliteal space
and follow the course of the vein to the abdomen and relax tissue about
it. Keep patient off the feet as much as possible and elevate the leg
when sitting.
In rupture of varicose veins the hemorrhage can be arrested by
elevating the limb and applying pressure with the fingers, above and
below the wound, until a compress and bandage can be applied. The
support of the varicose veins by elastic stockings will ease the
pain and prevent edema in many cases, but, as a rule, it is a direct
hindrance to the circulation on account of the necessity of having the
stocking fit closely. Surgical operations are rarely indicated.