Treatment. The treatment of varix may be palliative or curative, but whichever is followed, endeavor first to remove the cause.
In palliative treatment, attend to the general health, keep up the force and activity of the circulation, and prevent constipation. Recommend the patient to exercise in the open air and to lie down, if possible, every afternoon. Locally, in varix of the leg, order a flannel bandage to support the vein and drive the blood into the deeper vessels which have muscular support. (For technic, see chapter on bandaging).
The curative or operative treatment of varicose veins consists of performing a resection of the internal saphenous vein of one or two inches, near the saphenous opening into the femoral. This is known as the Trendelenburg method. About 90 per cent of all cases can be cured by this method. The operation can be performed under local anesthesia and presents no difficulties.
Another procedure is known as Schede’s method. This consists of making a circular incision around the leg just below the knee joint, and in tying all the superficial veins thus exposed.
Mayo’s operation consists of the total extirpation of the internal saphenous vein from the saphenous opening to the internal malleolus. A small incision is made high up, and at a distance of from 8 to 10 inches, a second incision is made, and in this manner the entire vein is removed by making several incisions.
The patient should remain in bed about three weeks following an operation of this kind and afterwards an elastic stocking, or an ideal bandage, should be worn for a considerable time.
Phlebitis, or inflammation of a vein, may be plastic or purulent in nature. Plastic phlebitis, while occasionally due to gout, or to some other constitutional condition, usually arises from a wound or other injury, from the extension to the vein of a perivascular inflammation, or, in the portal region, from an embolus.
Varicose veins are particularly liable to phlebitis. When phlebitis begins, a thrombus forms because of the destruction of the endothelial coat, and this clot may be absorbed or organized.
Suppurative Phlebitis is a suppurative inflammation of the vein, arising by infection from suppurating perivascular tissues (infective thrombophlebitis). It is most frequently met with in cellulitis or phlegmonous erysipelas, but there are a great many other causes.
A thrombus forms, the vein wall suppurates, is softened and in part destroyed, and the clot becomes purulent. No bleeding occurs when the vein ruptures, as a barrier of clot keeps back the blood stream. The clot of suppurative phlebitis cannot be absorbed and cannot organize.