Varicose Veins

Question 1

what are varicose veins?

Answer 1

dilated, elongated and torturous superficial veins due to increased intra-luminal pressure

Question 2

what three things are required to get blood from the legs to the heart?

Answer 2

open veins
competent valves
calf muscle pump

Question 3

two systems of lower limb veins

Answer 3

1. superficial veins

2. deep veins

Question 4

examples of superficial veins in the leg

Answer 4

long and short saphenous veins

Question 5

examples of deep veins in the leg

Answer 5

tibial
popliteal
femoral
iliac

Question 6

direction of blood flow in veins

Answer 6

superficial to deep via perforator veins

Question 7

classification of varicose veins

Answer 7

1. primary= incompetent valves in superficial veins

2. secondary= occurred due to another issue e.g. DVT, pregnancy, neoplasms, etc.

Question 8

what should patients have before surgery?

Answer 8

duplex USS to show the anatomy

Question 9

varicose veins presentation

Answer 9

pain
thrombophlebitis
bleeding
chronic venous insufficiency
venous hypertension
venous ulcers

Question 10

pain in varicose veins

Answer 10

dull ache
worse at the end of the day
prolonged standing

Question 11

aspects of chronic venous insufficiency

Answer 11

irreversible skin damage including venous eczema, haemosiderin deposits and lipodematosclerosis

Question 12

causes of venous hypertension

Answer 12

vein reflux
vein occlusion
abnormal calf pump

Question 13

idea of management in varicose veins

Answer 13

disconnecting deep and superficial venous systems

Question 14

non-interventional management for varicose veins

Answer 14

fitted support hosiery
graduated compression
ulcer prevention

Question 15

when is compression contraindicated?

Answer 15

low ABPI

Question 16

examples of minimally invasive surgery techniques for varicose veins

Answer 16

• foam sclerotherapy
• EVLT
• radiofrequency ablation
• clarivein

Question 17

examples of sclerosants

Answer 17

sodium tetradecyl sulphate (fibrovein)

liquid fibrovein

Question 18

how does foam sclerotherapy close varicose veins?

Answer 18

induces chemical thrombophlebitis

Question 19

what is EVLT?

Answer 19

endovenous laser therapy - laser probe is passed up the affected vein and it is withdrawn slowing inducing a thermal thrombophlebitis

Question 20

how does radiofrequency ablation cause occlusion of affected veins?

Answer 20

induces a thermal thrombophlebitis

Question 21

what is clarivein?

Answer 21

prolonged probe is deployed which rotates within in the vein while injecting a sclerosant inducing a mechanical and chemical thrombophlebitis

Question 22

which nerves are likely to be damaged in open varicose vein surgery?

Answer 22

saphenous nerve

sural nerve

Question 23

classification of varicose veins

Answer 23

CEAP