SIRAJA GRANDHI(VARICOSE VEINS)

1. By
Dr. S.Kamalakar Puripanda
1st
year PG Scholar,
DEPT.OF SAMHITA
SIDDHANTA

2. Grandhi literally means grandhana or knot, the mechanism being clotting
or accumilation of dushita dathu or dosha locally
Vata associated with kapha ,getting aggravated,vitiate the muscles,blood
and fat tissues and produce a round bulged swelling.
Types: Vataja ,pittaja ,kaphaja, medhoja ,siraja
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3. In person who are weak ,indulging in more of physical excersice ,vata
gets aggravated, invades the network of veins,effect on walls gives rise to
roughness in veins, elevated,quick devoloping and round swelling of
veins .
Charaka defines grandhi has a pulsatile swelling ,mainly siraja gandhi
can be pulsatile
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4. When a veins become dilated,elongated and tortuous,the vein is said to be
varicose
SITES:THE COMMON SITES OF VARICOSITY ARE:
1.Superficial venous system of the lower limbs- affecting either the long
saphenous or the short saphenous vein or the both.
2.Oesophageal varix: Affecting veins of the gastro-oesophageal junction
3.Varicosity of the haemorrhoidal veins-piles
4.Varicosity of the spermatic veins- varicoceole
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5. The veins are the blood vessels that return blood at low pressure to the heart
The walls of the veins are thinner than those of arteries but have the same
three layers of tissue.they are thinner because there is less muscle and elastic
tissue in the tunica media
Veins possess valves,which prevent backflow of blood,ensuring that it flows
towards the heart
The smallest veins are called venules
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6. The venous valves are abundant in
the distal lower extremity and
number of valves decreases
proximally, with no valves in
superior and inferior vena cava
Delicate structures
Prevent reverse flow in the veins
Ensure that the blood is pumped
from the superficial to the deep
system and back towards the heart
when the patient is walking
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7. Connect superficial to deep veins at various
levels.
Travel from superficial fascia through an
opening in the deep fascia before entering the
deep veins.
The direction of blood flow - from superficial
to deep veins.
Guarded by valves so that the flow is
unidirectional, i.e. Towards deep veins.
Reversal of flow occurs due to incompetence of
perforators which will lead to varicose veins
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8. Superficial venous system
Deep venous system
Venous valves
Perforator veins
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LCIV
RFV
RPV
LLSV
LSSVRATV
RPTV

9. Under normal conditions the blood from the superficial venous system is
passed to the deep veins through the competent valves and negative
intrathoracic pressure
But if this mechanism breaks down, either due to destruction of the valves of
the deep veins or of the perforaters or of the superficial venous system,the
blood becomes stagnated in the superficial veins,thus becomes distended and
tortuous to become varicose veins
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10. Athipravruthy (excessive flow..)
Sanga (Stasis)
Siranam gradhnanam (dilatation, elongation, tortuosity &
‘cord like feel’)
Vimargatho vaa gamanam (retrograde flow)
Athipravruthy, sanga, siranam grandhanam, vimarga
gamanam – in Varicose Veins
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11. Morphplogical factors:
Varicose veins of the lower limbs are the penality the man has to pay for its
erect posture.The veins have to drain against gravity.The superficial veins
have loose fatty tissue to support them and thus suffer from
varicosity.There are 3 types of varicocity
Primary
Secondary
congenital
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12. This condition is mainly due to defect in the valves
Defect in the SephanoFemoral V alve leads to varicosity of the
Defect in the SephanoPopliteal Valve leads to varicosity of the
Defect in the valves of the perforators lead to varicosity of either LSV
or SSV
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LSVLSV
SSVSSV

13. PROLONGED STANDING:
During prolonged standing long column of blood along with gravity
puts pressure on the weakend valves of the veins.This causes failure of
the valves quickly giving rise to varicosity
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14. OBESITY:
Excessive fatty tissue in the subcutaneous tissue offer poor support to the
veins.this leads to the formation of varicosity
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OLD AGE:
this causes atrophy and weakness of the vein wall.at the same time with ageing the
valves in the veins become gradually incompetent

15. ATHLETS:
Forcible contraction of the calf muscles may force blood through the
perforating veins in reverse direction.this will cause destruction of the
valves of the perforating veins and ultimately lead to formation of
varicose veins.
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16. The commenest symptom is tired and aching sensation in the affected
lowerlimb ,particularly in calf ,at the end of the day
Dragging pain in the leg
Night cramps occurs due to change in the diameter of veins
Sharp pains may be complained of in grossly dilated veins
Pain is relieved at night on taking rest or elevation of limbs
Sudden pain in calf region with fever and odema of the thigh and
ankle region suggests deep vein thrombosis
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17. 17

18. 18
GRADE 1 GRADE 2 GRADE 3
GRADE 4 GRADE5 GRADE 6
RETICULAR VEINS VARICOSE VEINS
ODEMA WITHOUT
SKIN CHANGES
SKIN CHANGES
(PIGMENTATION,VENOUS
ECZEMA)
ULCERATION

19. MORRISSEY’S TEST(COUGH IMPULSE):
This test should be done in the standing position
The examiner keeps the finger at SF junction and asks the patient to
cough
Fluid thrill ,an impulse felt by the fingers,is indicative of SFI
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FluidFluid
thrillthrill

20. TRENDELENBURG TEST:
This test is done in 2 parts
The patient is asked to lie on the bed in the supine position
The leg is elevated above the level of heart and the vein emptied
SF junction is occluded with the help of the thumb and the patient asked to stand
T1:Release the thumb immediately ,rapid gush of blood from above downwards indicates
SFI
T2:Without releasing the thumb, slow filling of the LS is the seen,it is due to PI
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21. Poor prognosis- If the siraja grandhi is freely movable,painful
Incurable- Severe painful,arises from a marma sthana
Easily curable- Swelling is stable, Painless
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22. Dopler ultrasound
Duplex ultrasound imaging
Venography
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23. Apatarpana
Alepa
Parisekha
 Abyanga
 Sweda
Vimlapana
Upanaha
 Pachana
Visravana
 Snehana
Vamana
 Virechana 23
Ocassionally ,a Grandhi may subside with some
or all of the poorva karmas only.The surgeon has
to use yukti in selecting the above mentioned 12
purvakarmas and thus needed not do all the
poorva karmas for each and every grandhi.The
scientific basis of adopting medicinal treatment
for a surgical case is that,A disease which looks
like a local abnormality,will certainly have it’s
general source of pathogenisis either through out
the body or in an unconcerned remote base

24. Shalya vignyanam .Dr.Ramasundar rao
Shalya vignyanam..Dr.Rajneesh
Susrutha samhita(ancient indian surgery Prof.G.D.Singhal)
Manipal manual of surgery 3rd
editon
A consice text book of surgery.7TH
edition.S.Das
Ross and wilson Anatomy and physiology
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