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We are here concerned with varix as it occurs in the veins of the lower extremity. Etiology. Considerable difference of opinion exists as to the essential cause of varix.
Aneurysmal varix, which was frequently met with in this situation in the days of the barber-surgeons, usually as a result of the artery having been accidentally wounded while performing venesection of the median basilic vein, may be treated, according to the amount of discomfort it causes, by a supporting bandage, or by ligation of the artery above and below the point of communication.
A similar type of elephantiasis may occur after extirpation of the lymph glands in the axilla or groin; in the leg in long-standing standing varix and phlebitis with chronic ulcer; in the arm as a result of extensive cancerous disease of the lymphatics in the axilla secondarily to cancer of the breast; and in extensive tuberculous disease of the lymphatics.
The view that varix is congenital in origin, as was first suggested by Virchow, is supported by the fact that in a large proportion of cases the condition is hereditary; not only may several members of the same family in succeeding generations suffer from varix, but it is often found that the same vein, or segment of a vein, is involved in all of them.
There is reason to believe, moreover, that a sudden strain may, by rupturing the valves and so rendering them incompetent, induce varicosity independently of any congenital defect. Prolonged standing or walking, by allowing gravity to act on the column of blood in the veins of the lower limbs, is also an important determining factor in the production of varix.
Aneurysm of the internal carotid is of special importance on account of the way in which it bulges into the pharynx in the region of the tonsil, in some cases closely simulating a tonsillar abscess. Cases are on record in which such an aneurysm has been mistaken for an abscess and incised, with disastrous results. Aneurysmal varix may occur in the neck as a result of stabs or bullet wounds.
Thrombosis of the deep veins in the leg, for example may induce marked dilatation of the superficial veins, by throwing an increased amount of work upon them. This is to be looked upon rather as a compensatory hypertrophy of the superficial vessels than as a true varix. Morbid Anatomy.
In aneurysmal varix the higher blood pressure in the artery forces arterial blood into the vein, which near the point of communication with the artery tends to become dilated, and to form a thick-walled sac, beyond which the vessel and its tributaries are distended and tortuous.
Phlebitis and thrombosis are common sequelæ of varix, and may prove dangerous, either by spreading into the large venous trunks or by giving rise to emboli. The larger the varix the greater is the tendency for a thrombus to spread upwards and to involve the deep veins.
The frequent occurrence of varix in youth is also an indication of its congenital origin. In the majority of cases it is only when some exciting factor comes into operation that the clinical phenomena associated with varix appear. The most common exciting cause is increased pressure within the veins, and this may be produced in a variety of ways.
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