^1,3,4Assistant Professor, ⁵III^rd Year Resident, Department of General Surgery, Dr. D Y Patil Hospital and Research Centre, Pimpri, Pune Maharashtra Pincode- 411018, INDIA.

²Associate Professor, Department of General Surgery, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, INDIA.

Email: drnilu007@gmail.com, firoz10555@yahoo.com, visheshtamehan23@gmail.com, vidit.puri@gmail.com

OBSERVATIONS AND RESULTS

Table 1: Distribution of patients according to age and sex

Table NO.1 shows the distribution of patients in this study according to age and sex. There were eight females and forty four males in the study, which shows a male preponderance. There was one patient {1.9%}in age group between 21-30 years. Twelve patients were in the age group 31-40 years. Maximum patients {30.8%} were from the age group between 41-50 years followed by the age group between 31 to 40 years This denotes that most of the patients {<50%} of varicose vein disease seek surgical treatment in their middle age.This can be attributed to the complications like pain, discoloration and ulceration, which start after prolonged conservative measures. This can be an important socioeconomical fact, as individuals from this age group are the sole bread winners of their families. Any absenteeism from work because of disease or complication of the treatment can be disastrous to their family.

Table 2: Distribution of patients according to occupation

The above table No 2 shows the distribution of patients in this study according to their Occupation. Their were 20{38.5%} farmers, 8{15.4%} construction workers,6 labourers, 5{9.6%} were coolies. Remaining twenty percent patients were doing sedentary jobs like being housewife, students and office work. This clearly indicates that individuals involved in hard physical work are more prone to get varicose vein disease and its complications.

Table 3: Distribution of patients according to limb involvement

The above table shows the distribution of patients according to lower limb involvement. There were 29{58%} patients with unilateral lower limb involvement, whereas 21{42%} had bilateral lower limb involvement.

Table 4: distribution of patients according to presenting complaints

The above table{Table No.4}shows the complaints with which the patients presented. Forty seven {90.4%} presented with dilated veins, while 37 {69.2%} presented with skin changes. Dull aching night pain was a complaint in 26 patients. Twenty one{40.4%} presented with ulceration. Majority of patients presented with dilated veins and skin changes.

Table 5: Patients with comorbidities

Table number 5 shows the distribution of patients according to the comorbidities. Hypertension{21.2%} and Diabetes Mellitus {23.1%} were the comorbidities seen in the 50 patients of this study.

Table 6: Patients with previous deep vein thrombosis

The above table shows the number of patients with a history of deep vein thrombosis in the affected limb in the past. There was a history of deep vein thrombosis in 3{6%} out of 50 patients in the study.

Table 7: Distribution of patients according to surgeries performed

 The above table shows various types of surgical treatment the patients of this study.Out of the operated patients 40{80} had undergone ligation at saphenofemoral junction and stripping of the long saphenous vein .In patients the sapheno popliteal junction was ligated and remaining three ten the perforators were ligated.

Table 8: Distribution of patients according to complications

The above table shows the distribution of patients according to complications after various surgery. There were five patients have haematoma with two patients have delayed healing and three patients have post opertative pain and no recurrence in this study.

DISCUSSION

The observational study on the clinical profile of Varicose Vein Disease was conducted in the Department of Surgery of Dr. D. Y Patil Medical College and Hospital in Pimpri Pune. This study was planned with the aim to identify the various demographical, clinicopathological and occupation related factors in the causation of varicose vein disease in the population served by our centre. Two-third of the patients in our study were from the age group between 21 to 50 years. If the patients between 51 to 60 years are added then it becomes almost 90%.In a study done by Mulla et al., mean age of the study population was 45.6 years with a range of 21 to 70 years.³.Gad et al .found 90% of patients in the age group between 20 to 56years.⁴This age group is the backbone of any society. They are the breadwinner of family and any disease in this age group can affect the welfare of family. Morbidity due to varicose veins disease can lead to absenteeism from work and financial losses. Associated morbidities such as diabetes and hypertension, can further aggravate the problem. Diabetes Mellitus can be a detrimental actor in the outcome from surgical treatment of varicose vein disease. As the age advances, comorbidities start playing an important role in the outcome of surgery. In our study, out of 50 patients 42 were males, which shows a clear male preponderance. This could be explained by the fact that the males were involved in such occupations which needed prolonged standing. Our study had twenty farmers and twenty one construction workers. In astudy on the incidence of varicose veins in factory workers by Widmer et al., it was found that among the male and female factory workers, the incidence was higher in males.⁵ Secondly we believe that the female population in our society does not come with complaints of varicose veins of lower limb because the lower limbs are well covered in all ethnic dresses. Whereas the malepopulation become aware of the varicose veins because of persistentpainin calves due to engorged veins, dermatitis, and varicose ulcers. In the western world the male and female ratio of varicose veins is equal. Abramson et al. conducted a study in Jerusalem which showed four times higher incidence of varicose veins in females. They attributed the higher incidence to obesity in these females as the major contributory factorin the causation of varicose veins.⁶Our study had 29{58%} patients with unilateral varicose veins, whereas 21{42%|patients had bilateral involvement. Mishra et al. in a study of 60 patients, found 54 {90%} patients with unilateral involvement, which is a similar finding to our study. Presentation with involvement of unilateral limb does not rule out the possibility of of disease in other limb at a later date.⁷In our study the commonest symptom was pain which was seen in 47 out of 50 patients,. Thirty six{69%} patients presented with skin changes and 26 {50%}came for treatment of varicose veins with varicose ulcer. W.B. Campbell et al. in their study reported that 50% patients came for cosmetic reasons for the treatment of varicose veins. Varicose veins lead to disfigured lower limb due to unsightly tortuous dilated veins and stasis dermatitis with pigmentation. In our country pain is the most common presenting feature as shown in various studies.⁸ Obesity has a definite role in the causation of varicose vein disease. In determining factor in the etiology of varicose vein disease. Davies et al. have coined a term “Phlebesity”, in the description of varicose veins in obese in their review article. Clinical severity of venous insufficiency worsens in obese patients.⁹ Out of the 50 patients thirty three were operated and followed. Although the follow up was short,as the study period extended for 16 months .A long term follow up is necessary to asses the results of surgery. The most common surgery performed was Trendelenburg ligation at saphenofemoral junction with stripping of long saphenous vein and ligation of perforators. Gad et al. have studied the problem of recurrence after surgery and conclude that SFJ ligation with stripping has the lowest recurrence.⁴ Reason for recurrence could be progression of disease, anatomical anomaly overlooked at the initial surgery or neovascularization.¹⁰In our study average stay of patients was seven days,with a range between 6-10 days. Huded et al. reported that 40% of their patients stayed for 6-10 days.¹¹.Both studies have similar figures. Our study was conducted for a short period, hence the number was less and follow up was not adequate. We recommend long term studies to have better perspective of the varicose vein disease in our country. The problem of varicose vein is important as the patients can have prolonged morbidity and absenteeism from work.Newer advancement in the treatment of varicose veins are very expensive and are out of reach of all the patients. Therefore we will have to continue with the basic surgical treatment.

CONCLUSION

It is found that varicose vein disease with its associated sequelae brings the patient for treatment in our scenario. Long saphenous vein is the commonly affected part of the superficial venous system because of incompetency of the valve at SFJ. Although various etiological factors can be attributed to varicose vein disease but occupation and obesity remain the main factors. Accurate assessment of problem and adequate surgery will prevent recurrence.

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