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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 3  |  Issue : 2  |  Page : 49-51

Primary Varicose Veins on the Whole Body, Including Genital Area: A Case Report


Department of Cardio-Thoracic and Vascular Surgery (CTVS), Sawai Man Singh Medical College, Jaipur, Rajasthan, India

Date of Web Publication16-Jun-2015

Correspondence Address:
Dr. Ram Chandra Sherawat
E-1/A, Hari Nagar, Shastri Nagar, Jaipur - 302 016, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-449X.158879

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  Abstract 

Primary varicose veins are a common affliction of the extremities, whereas the whole body including the genitals are very rarely affected, for reasons not clearly understood. The literature has little references in regards to the number of cases and management these type varicose veins. Treatment of the upper and lower extremities is the ligation and stripping of the varicose veins but what we can done for chest, abdomen, back, and genital varicose veins, is a query. Here we present a case of a 20-year-old male with this unusual condition of primary varicose veins of the whole body with genitals. Diagnosis in our case was made by means of physical examination and venography. The patient was treated surgically by ligation and stripping of the varicose vein from the upper and lower extremities with excellent functional and cosmetic outcome, but left the chest, abdomen, back, and genital veins for laser or other methods, and the patient was referred to higher center for that treatment.

Keywords: Genitals varicose veins, ligation and stripping, whole body varicose veins


How to cite this article:
Sherawat RC, Sharma A, Dixit S, Sharan A, Sample S. Primary Varicose Veins on the Whole Body, Including Genital Area: A Case Report. Heart India 2015;3:49-51

How to cite this URL:
Sherawat RC, Sharma A, Dixit S, Sharan A, Sample S. Primary Varicose Veins on the Whole Body, Including Genital Area: A Case Report. Heart India [serial online] 2015 [cited 2019 Apr 24];3:49-51. Available from: http://www.heartindia.net/text.asp?2015/3/2/49/158879


  Introduction Top


Primary varicose veins of the whole body with genitals are extremely rare but if present, they are similar to the upper and lower extremity varicosities and are likely to have the same cause. The diagnosis of the whole body with genitals varicose veins can be made by means of a good history and physical examination, besides, noninvasive testing like color Doppler scanning is very helpful. Treatment is similar in the upper and lower limbs varicose veins, but different and difficult in the genital area and chest, back, and abdomen. Besides, sclerotherapy/radio ablation may be used as an alternative to surgery.


  Case Report Top


A healthy 20-year-old man reported to our hospital with chief complaints of long-standing multiple, soft, compressible cord like swellings (more than ten years duration) on the whole body including genitals which were progressively increasing in size and number for few months. Occasionally they were associated with pain and discomfort. Penile veins gave burning, stinging sensation with discomfort to patient. Patient did not give history of antecedent trauma, weight lifting, or prolonged standing. On examination there were multiple soft, cystic, compressible swellings on the right and left arm and forearm with bilateral lower limbs, chest, back, and abdomen along with penis vein distribution [Figure 1] and [Figure 2]. These swellings disappeared on compression and reappeared on relieving the compression or applying the pressure in direction of blood flow at distal end of swellings. Surrounding skin was normal with no hemangiomas. On examination of upper extremities bilateral pulses were normal, no bruit was audible and arms were of equal size. Swellings disappeared on raising the arms above the head. There was no history suggestive of neck varicosities or family history of varicose veins. On color Doppler examination, there was evidence of multiple venous engorgement and dilation with incompetence of valves. Deep venous system on cooler Doppler was normal, including inferior and superior vena cavae. The patient underwent successful treatment of upper and lower extremities varicose veins by ligation and excision of varicose veins under general anesthesia. Postoperative recovery was uneventful. A follow-up at 6 months showed no residual or recurrent varicosities on extremities. Histopathological appearance was consistent with varicose veins.
Figure 1: B/L lower limb varicose veins

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Figure 2: B/L upper limb varicose veins on upper limb with genital

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  Discussion Top


A varicose vein may be defined as a vein that becomes elongated, dilated, tortuous, pouched, and thickened due to continuous dilatation under pressure. [1] Varicose veins are swollen and twisted veins which usually develop in the lower legs that are caused by a weakening in the vein's walls or valves. Primary varicose veins are the ones which develop due to intrinsic valvular incompetence and have no apparent underlying cause. Secondary varicose veins form due to outflow obstruction, valve destruction secondary to deep vein thrombosis, or because of arterio-venous fistulae.

O'Donoghue and Leahy have quoted the prevalence of visible tortuous veins as 10-15% in males and 20-25% in females. When non-saphenous varices are included, approximately 45% of men and 50% women have varicose veins. Presumably the cause primary varicose veins of whole body with genitals is the same as upper and lower extremity varicosities that is collagen defects in the vein wall resulting in weakness and dilatation. [2] Among the other factors, primary valvular incompetence caused by floppy value cusps is well-recognized as a cause of deep venous reflux. This condition exists in the superficial system as well with the resulting reflux leading to venous dilatation. When the valves no longer operate correctly the blood is allowed to flow backward, causing further enlargement. When the vein becomes enlarged it can become twisted and will actually stand out from the rest of the skin. It is hard to determine at the time what actually caused the vein to stop working properly, but it can usually be attributed to one of the risk factors. Many individuals will have just one varicose vein while others will be plagued with them all over their body like in our case.

The diagnosis of varicose veins can be made with a good history and physical examination besides investigations like non invasive color Doppler. The color flow Doppler ultrasound or noninvasive duplex allows visualization and quantification of incompetence or obstruction. With the availability of this modality, more invasive investigations are generally unnecessary but may be required in unusual situations like congenital and anatomical variants, to further define the pathology.

In rare cases, some individuals may develop small varicose veins on the penis. This is more obvious on the erect penis. In some cases, the varicose vein may be seen when the penis is flaccid. The vein may feel lumpy but is usually not tender. The vein is generally engorged with blood and thickens with time. A corresponding condition seen in the female is called Mondor's disease, which is a thick varicose vein seen on the breast. The condition has no adverse health effects. The varicose vein on the penis does not require any treatment. It may bruise during sexual intercourse and thus wearing of a condom is highly recommended. In either case, use of lubricants is recommended during masturbation or during sexual intercourse to avoid bruising the vein. No other treatment is required There are no creams, ointments, or herbs to treat the varicose veins on the penis.

There are two basic types of treatment for varicose veins and those are non-surgical treatments and surgical treatments. Most doctors recommend that patients attempt to solve the problem with non-surgical treatments before doing surgery, and this is because many of the non-surgical treatments are affordable, effective, worth trying prior to an invasive treatment.

One great way to provide relief is to wear compression stockings. This type of stocking has been very effective in reducing swelling and pressure in the legs. They can also help provide pain relief that is often associated with a site that is affected by varicose veins.

Another great treatment is anti-inflammatory medications. These medications can be purchased over-the-counter and can be effective when used in conjunction with compression stockings. Many doctors consider open surgery to be the best way to deal with varicose veins that just will not go away with less invasive treatments. There are also newer methods of treating this disease that is known as endovenous laser treatment, which other doctors favor. The fact of the matter is that there is now more information and treatment options for those that are suffering from this unsightly and painful disease. Other treatments are vein stripping, ambulatory phlebotomy, and vein ligation. Every patient has to work with his or her doctor to determine the best course of action for their specific case.

Treatment of whole body varicosities is similar to that of varicose veins on upper and lower extremities. The stab-avulsion technique combined with stripping of longer segments provides excellent cosmetic and functional outcomes. Welch and Villavicencio (1994) have described three cases with symptomatic upper limb varicose veins. Surgical treatment was similar in upper and lower limb varicose veins which entailed ligation and stripping of the varicose veins. Ligation and stripping successfully eliminated the varicosities with prevention of recurrence during a mean follow up of 17 months. [3]

Sclerotherapy with agents like sodium tetradecyl sulphate and polidocanal remain a useful alternative to surgery. [4]

In conclusion, although primary varicose veins of whole body are extremely rare, they can be readily diagnosed and successfully treated surgically like upper lower extremities but varicose veins of chest, back, abdomen, and penis are difficult to treat.

 
  References Top

1.
Donogue GO, Leahy A. Varicose veins. Surgery 2002;1:8-11.  Back to cited text no. 1
    
2.
Rose SS, Ahmed A. Some thoughts on the aetiology of varicose veins. J Cardiovasc Surg (Torino) 1986;27:534-43.  Back to cited text no. 2
[PUBMED]    
3.
Welch HJ, Villavicenocio MD. Primary varicose veins of upper extremity: A report of 3 cases. J Vas Surg 1994;5:839-43.  Back to cited text no. 3
    
4.
Duffy DM, Garcia C, Clark RE. The role of sclerotherapy in abnormal hand varicose veins. Plast Reconstr Surg 1999;104:1474-9.  Back to cited text no. 4
    


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