1. Anatomi struktur pembuluh darah vena inferior ?

http://repository.usu.ac.id/bitstream/123456789/21444/4/Chapter%20II.pdf

2. Apa hubungan varises dg obese dan ibu hamil serta tekanan darah yang tinggi ?

Peregangan pembuluh darah ini terjadi karena besarnya tekanan di dalamnya yang
mengakibatkan dinding pembuluh darah menjadi lemah dan dengan demikian mudah teregang.
Misalnya, tekanan yang bertambah pada pinggul dan perut seperti halnya kehamilan dan terlalu
gemuk.

Kehamilan dapat memperberat keadaan, karena pembuluh darah balik panggul yang
menampung darah dari tungkai tertekan oleh janin.
 Biasanya katup yang terdapat di bagian dalam pembuluh juga sudah melemah, sehingga tidak
lagi mampu mengatur aliran darah yang masuk ke dalam pembuluh darah tersebut.

Kerentanan seseorang terhadap terjadinya kelainan ini biasanya diturunkan. Kelainan ini sering
ditemukan pada tungkai bawah, tungkai atas, dan dinding perut bawah, walaupun pada
dasarnya dapat terjadi di bagian tubuh manapun.

Gejala yang sering dirasakan penderitanya adalah pembengkakan di sepanjang pembuluh balik,
diikuti dengan kekejangan pada otot serta perasaan lelah di tungkai belakang lutut.

Dalam hal lain, kulit pada tungkai bagian bawah mungkin pecah dan menyebabkan borok-borok
besar. Selain itu terasa nyeri bila peradangan dan penggumpalan darah pada pembuluh balik
terjadi di tungkai.

Komplikasi yang lebih berbahaya bila terjadi infeksi pada dinding pembuluh varikose. Infeksi ini
mempermudah terbentuknya gumpalan darah yang mungkin mengalir dan tersangkut,
kemudian menyumbat pembuluh darah di tempat lain.

Tekanan dalam perut yang meninggi, atau tekanan langsung pada pembuluh balik dalam panggul
akan menyebabkan aliran vena dari ekstremitas terganggu . Tekanan akan meninggi dan volume
darah akan bertambah maka pembuluh balik akan melebar yang sebagian besar akan mengecil
lagi sesudah kehamilan. Pengaruh hormonal yaitu estrogen melonggarkan hambatan pembuluh
darah pada jaringan sekitarnya dan menyebabkan dinding pembuluh semakin besar.
Progesteron mengurangi tonus otot polos vaskuler.Apalagi tidak diabaikan pertambahan volum
darah dalam panggul karena pengaruh dari kebutuhan yang meningkat pada uterus dan
membesarnya volume plasma pada bulan terakhir kehamilan. Komplikasi selama kehamilan
relative sering terjadi adalah thrombosis. Suntikan sklerotik tidak dianjurkan pada varises selama
kehamilan ,namun bila diberikan suntikan sklerotik 6 minggu setelah melahirkan akan
memberikan hasil yang memuaskan.

ILMU BEDAH VASKULER

3. Mengapa terjadi pembengakakan kemerahan serta nyeri pada kaki kanan?

4. Kenapa pada saat di palpasi teraba keras ?
5. Kelainan pembuluh darah vena (DD) ?

What Are Varicose Veins?

Varicose (VAR-i-kos) veins are swollen, twisted veins that you can see just under the surface of the
skin. These veins usually occur in the legs, but they also can form in other parts of the body.

Varicose veins are a common condition. They usually cause few signs and symptoms. Sometimes
varicose veins cause mild to moderate pain, blood clots, skin ulcers (sores), or other problems.

Overview

Veins are blood vessels that carry blood from your body's tissues to your heart. Your heart pumps
the blood to your lungs to pick up oxygen. The oxygen-rich blood then is pumped to your body
through blood vessels called arteries.
From your arteries, the blood flows through tiny blood vessels called capillaries, where it gives up its
oxygen to the body's tissues. Your blood then returns to your heart through your veins to pick up
more oxygen.

Veins have one-way valves that help keep blood flowing toward your heart. If the valves are weak or
damaged, blood can back up and pool in your veins. This causes the veins to swell, which can lead to
varicose veins.

Many factors can raise your risk for varicose veins. Examples of these factors include family history,
older age, gender, pregnancy, overweight or obesity, and lack of movement.

Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are
to relieve symptoms, prevent complications, and improve appearance.

What Causes Varicose Veins?

Weak or damaged valves in the veins can cause varicose veins. After your arteries and capillaries
deliver oxygen-rich blood to your body, your veins return the blood to your heart. The veins in your
legs must work against gravity to do this.

One-way valves inside the veins open to let blood flow through, and then they shut to keep blood
from flowing backward. If the valves are weak or damaged, blood can back up and pool in your
veins. This causes the veins to swell.

Weak vein walls may cause weak valves. Normally, the walls of the veins are elastic (stretchy). If
these walls become weak, they lose their normal elasticity. They become like an overstretched
rubber band. This makes the walls of the veins longer and wider, and it causes the flaps of the valves
to separate.

When the valve flaps separate, blood can flow backward through the valves. The backflow of blood
fills the veins and stretches the walls even more. As a result, the veins get bigger, swell, and often
twist as they try to squeeze into their normal space. These are varicose veins.

Normal Vein and Varicose Vein

Figure A shows a normal vein with a working valve and normal blood flow. Figure B shows a varicose
vein with a deformed valve, abnormal blood flow, and thin, stretched walls. The middle image shows
where varicose veins might appear in a leg.

Older age or a family history of varicose veins may raise your risk for weak vein walls. You also may
be at higher risk if you have increased pressure in your veins due to overweight or obesity or
pregnancy.

Who Is at Risk for Varicose Veins?

Many factors may raise your risk for varicose veins, including family history, older age, gender,
pregnancy, overweight or obesity, and lack of movement.

Family History

Having family members who have varicose veins may raise your risk for the condition. About half of
all people who have varicose veins have a family history of them.

Older Age

Getting older may raise your risk for varicose veins. The normal wear and tear of aging may cause
the valves in your veins to weaken and not work well.
Gender

Women tend to get varicose veins more often than men. Hormonal changes that occur during
puberty, pregnancy, and menopause (or with the use of birth control pills) may raise a woman's risk
for varicose veins.

Pregnancy

During pregnancy, the growing fetus puts pressure on the veins in the mother's legs. Varicose veins
that occur during pregnancy usually get better within 3 to
12 months of delivery.

Overweight or Obesity

Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins.

Lack of Movement

Standing or sitting for a long time, especially with your legs bent or crossed, may raise your risk for
varicose veins. This is because staying in one position for a long time may force your veins to work
harder to pump blood to your heart.

What Are the Signs and Symptoms of Varicose Veins?

The signs and symptoms of varicose veins include:

 Large veins that you can see just under the surface of your skin.
 Mild swelling of your ankles and feet.
 Painful, achy, or "heavy" legs.
 Throbbing or cramping in your legs.
 Itchy legs, especially on the lower leg and ankle. Sometimes this symptom is incorrectly
diagnosed as dry skin.
 Discolored skin in the area around the varicose vein.

Signs of telangiectasias are clusters of red veins that you can see just under the surface of your skin.
These clusters usually are found on the upper body, including the face. Signs of spider veins are red
or blue veins in a web or tree branch pattern. Often, these veins appear on the legs and face.

See your doctor if you have these signs and symptoms. They also may be signs of other, more
serious conditions.

Complications of Varicose Veins

Varicose veins can lead to dermatitis (der-ma-TI-tis), an itchy rash. If you have varicose veins in your
legs, dermatitis may affect your lower leg or ankle. Dermatitis can cause bleeding or skin ulcers
(sores) if the skin is scratched or irritated.

Varicose veins also can lead to a condition called superficial thrombophlebitis (THROM-bo-fleh-BI-
tis). Thrombophlebitis is a blood clot in a vein. Superficial thrombophlebitis means that the blood
clot occurs in a vein close to the surface of the skin. This type of blood clot may cause pain and other
problems in the affected area.

http://www.nhlbi.nih.gov/health/health-topics/topics/vv/livingwith.html

6. Faktor yang mempengaruhi terjadinya varises ?

Ada sejumlah factor predisposisi perkembangan varises primer. Kecenderungan familial

sudah diketahui; agaknya kelemahan dinding pembuluh darah bersifat diturunkan. Selain itu,
ada faktor-faktor yang meningkatkan tekanan hidrostatik dan volume darah pada tungkai,
misalnya berdiri terlalu lama, atau kehamilan, ikut berperan dalam timbulnya dilatasi vena.

Patofisiologi, Sylvia

A number of things can increase your likelihood of developing varicose veins, including:

 gender
 genetics
 age
 being overweight
 occupation
 being pregnant
 other conditions

Gender

Women are more likely to be affected by varicose veins than men. Research suggests this
may be because female hormones tend to relax the walls of veins, making the valves more
prone to leaking. Hormones are chemicals produced by the body.

Genetics

Your risk of developing varicose veins is increased if a close family member has the
condition. This suggests varicose veins may be partly caused by your genes (the units of
genetic material you inherit from your parents).

Age

As you get older, your veins start to lose their elasticity and the valves inside them stop
working as well.

Being overweight

Being overweight puts extra pressure on your veins, which means they have to work harder
to send the blood back to your heart. This can put increased pressure on the valves, making
them more prone to leaking. The impact of body weight on the development of varicose
veins appears to be more significant in women.
 Occupation

Some research suggests jobs that require long periods of standing may increase your risk of
getting varicose veins. This is because your blood does not flow as easily when you are
standing for long periods of time.

Pregnancy

During pregnancy, the amount of blood increases to help support the developing baby. This
puts extra strain on your veins. Increased hormone levels during pregnancy also cause the
muscular walls of the blood vessels to relax, which also increases your risk.

Varicose veins may also develop as the womb (uterus) begins to grow. As the womb expands
it puts pressure on veins in your pelvic area, which can sometimes cause them to become
varicose.

Although being pregnant can increase your risk of developing varicose veins, most women
find their veins significant improve after the baby is born.

http://www.nhs.uk/Conditions/Varicose-veins/Pages/Causes.aspx

7. Etiologi varises ?

Varicose veins are usually caused by weak vein walls and valves.

Weakened valves

Inside your veins are tiny one-way valves that open to let the blood through and then close
to prevent it flowing backwards.

Sometimes, the walls of the veins can become stretched and lose their elasticity, causing the
valves to weaken. If the valves do not function properly, this can cause the blood to leak and
flow backwards. If this happens, the blood will collect in your veins, which will become
swollen and enlarged.

The reasons why the walls of the veins stretch and valves in your veins weaken are not fully
understood. Some people develop the condition for no obvious or apparent reason.

http://www.nhs.uk/Conditions/Varicose-veins/Pages/Causes.aspx

8. Klasifikasi varises ?
Berdasarkan penyebabnya :
- Varises Primer
Varises yang disebabkan karena adanya kelemahan struktur herediter dari dinding
pembuluh darah. Dilatasi dapat disertai gangguan katup vena karena daun katup tidak
mampu menutup dan menahan aliran refluks. Varises primer cenderung terjadi pada
vena-vena superfisialis karena kurangnya dukungan dari luar atau kurangnya tahanan
dalam jaringan subkutan.
 - Varises Sekunder
Disebabkan oleh gangguan patologi system vena profunda yang timbul congenital atau
didapat, menyebabkan dilatasi vena-vena superfisialis, saluran penghubung, atau
kolateral. Misalnya, kerusakan katup vena pada system vena profunda akan
mengganggu aliran darah menuju jantung; stasis yang timbul dan penimbunan darah
menyebabkan hipertensi vena profunda. Jika katup penghubung tidak berfungsi dengan
baik, maka peningkatan tekanan sirkuit vena profunda akan menyebabkan aliran balik
darah ke dalam vena penghubung. Darah vena akan dipirau ke vena superfisialis dari
vena profunda, hal ini merupakan factor predisposisi timbulnya varises sekunder pada
vena-vena superfisialis.

Patofisiologi, Sylvia

Secara klinis, varises tungkai dikelompokkan atas :

- Varises Trunkal
Varises pada vena saphena magna dan vena saphena parva.

- Varises Retikular
Varises yang menyerang cabang vena saphena magna atau vena saphena parva yang
umumnya kecil dan berkelok hebat.

- Varises Kapilar
Varises kapiler vena subkutan yang tampak sebagai kelompok serabut halus dari
pembuluh darah.

Buku Ajar Ilmu Bedah, Edisi 3

9. Patofisiologi varises ?

Varicose veins develop when the small valves inside the veins stop working properly. In a
healthy vein, blood flows smoothly to the heart. The blood is prevented from flowing
backwards by a series of tiny valves that open and close to let blood through. If the valves
weaken or are damaged, the blood can flow backwards and can collect in the vein,
eventually causing it to be swollen and enlarged (varicose).

http://www.nhs.uk/Conditions/Varicose-veins/Pages/Whatarevaricoseveins.aspx

Katup katup pada system vena seringkali menjadi “tidak mampu” berfungsi atau kadang-
kadang malah rusak. Hal ini terutama terjadi bila vena teregang berlebihan akibat tekanan
vena yang tinggi selama berminggu-minggu atau berbulan-bulan seperti yang terjadi pada
kehamilan atau bila seseorang berdiri terlalu lama. Peregangan vena akan menngkatkan luas
penampang, tidak meningkatkan ukuran daun katup. Oleh karena itu, daun katup tdak dapat
lagi menutup rapat. Bila hal ini terjadi, tekanan di vena tungkai akan meningkat tajam akibat
kegagalan pompa vena; hal ini selanjutnya akan meningkatkan ukuran vena dan akhirnya
 merusak seluruh fungsi katup. Jadi, orang tersebut akan mengalami “Varises” yang ditandai
dengan adanya penonjolan berkelok-kelok dibawah kulit seluruh tungkai.

Fisiologi Kedokteran Guyton, Hall

Yang memengaruhi terjadinya kelainan dan gangguan aliran vena ialah keutuhan katup di
ketiga system vena. Jika katup di system vena superficial tida memadai, tekanan hidrostatik
akan meninggi sehingga terjadi pelebaran di vena tersebut. Pelebaran akan menambahkan
lagi kebocoran katup, demikian seterusnya.
Bila katup di vena perforantes tidak memadai, darah akan diperas keluar dari system vena
profunda ke system vena superficial setiap kali otot betis atau paha berkontraksi. Akibatnya,
makin banyak katup yang mengalami insufisiensi dan mengganggu tekanan hidrostatik di
vena saphena magna dan/atau di vena saphena parva. Bila katup penghubung dengan
system dalam tidak memadai, aliran darah akan berbalik dari proksimal ke distal sehingga
vena makin melebar, memanjang, dan berkelok-kelok.

Buku Ajar Ilmu Bedah, Edisi 3

10. Manifestasi klinis?

11. Komplikasi varises ?
12. Penatalaksanaan ?

Memakai stoking kompressi. Stoking kompressi memiliki berbagai macam ukuran dan kekuatan
penekanan. Stoking kompressi bermanfaat untuk memperbaiki pembengkakan, pertukaran
nutrisi, dan meningkatkan mikrosirkulasi pada kaki yang terdapat varises. Selain itu bermanfaat
untuk mengurangi rasa ketidaknyamanan akibat penyakit ini. Memakai stoking kompresi harus
kuat tapi tidak selalu harus ketat. Jika dengan memakai stoking kompresi, varises tidak
mengalami penyembuhan maka harus dipertimbangkan pengobatan yang lain.

Sclerotherapy . Dalam prosedur ini, dokter menyuntikkan obat kedalam varises yang akan
membuat varises menyusut. Obat yang sering digunakan adalah golongan sklerosan seperti
polidocanol (POL) and sodium tetradecyl sulphate (STS). Sclerotherapy telah digunakan untuk
mengobati varises selama 150 tahun.

Bedah laser. Dokter menggunakan teknologi baru yaitu bedah laser untuk menutup pembuluh
darah varises yang kecil dan varises yang menyerupai sarang laba-laba.

Endovenous thermal ablation. Endovenous thermal ablation adalah metode pengobatan varises
yang tergolong efektif untuk jangka pendek maupun untuk jangka panjang namun tidak semua
dokter dapat melakukan teknik ini karena harus kursus dan memiliki peralatannya yang lumayan
mahal.
Vein stripping. Vein stripping adalah membuang sebagian atau keseluruhan vena varises. Ini
merupakan prosedur rawat jalan bagi kebanyakan orang.

Ambulatori phlebectomy. Dokter akan menghilangkan varises yang lebih kecil melalui
serangkaian tusukan kecil pada kulit. Hanya bagian kaki Anda yang ditusuk yang mati rasa dalam
prosedur ini dan umumnya parut yang terjadi minimal.

 Elevate your legs. Raising your legs higher than the level of your heart can help promote
circulation. When there's a chance to rest with your feet up, take it. You might even
place a firm pillow between the mattress and box spring at the foot of your bed to raise
your legs while you sleep.

 Change position. If you tend to stand for long periods of time, take frequent breaks to
sit. If you tend to sit a lot, take frequent breaks to walk around.

 Monitor your weight. Gaining a large amount of weight in a short period of time is
especially hard on your veins.

http://www.mayoclinic.com/health/varicose-veins-and-pregnancy/MY02363