Management of pediatric primary varicose veins

Background: In the past varicose veins managment was practiced with great caution in pediatric patients and there is
limited studies for this topic in literatures that make us enthusiastic for this study.
Aim: To study management and outcome of primary varicose vein in pediatric age group.
Patients and Methods: A This is a prospective clinical single center study including 50 pediatric age group (below 18
years old) having primary varicose veins. Exclusion criteria: Patients older than 18 years old, children with secondary
varicose veins and children with congenital vascular Malformations. All patients were evaluated clinically and by venous
duplex. Sclerotherapy by foam in Double Syringe System, Accuvein AV400, Polidocanol 0.5,1%, and magnification
loop 4×, surgical ablation, conservative, and endovenous laser ablation are the techniques used. Follow-up: patients were
assessed for change in venous clinical severity score.
Results: Mean age 15.48 years, 24(48%) male and 26(52%) female. The complaints were pain, functional before marriage
as cosmetic reason or hindering admission to military faculties, edema, thrombosis and bleeding. Family history was
positive in 74%. Clinical presentation according to CEAP classification. Injection sclerotherapy done in 26(52%) patients,
stab avulsion and perforators ligation done in 13(26%) patient combined in two cases with sclerotherapy in cases with
bleeding VV, stripping done in five (10%) patients, stocking and conservative management in five (10%) patients and one
patient operated with endovenous laser ablation. venous clinical severity score pre intervention was 5.70±2.53 improved
to 0.32±0.55 after 3 months from intervention.
Conclusion: Varicose veins in pediatrics are rare. Pediatrics patients may present by dilated GSV as adult patient so there
is no correlation with size of the vein however ostial reflux is less common than adult patients. Injection sclerotherapy
is safe in pediatrics and it is the most used intervention in the study. Foam sclerotherapy during surgery as a treatment of
acute bleeding reticular varicose veins.