Varicose veins exam

Question 1

What are you looking for on general inspection in a varicose veins exam?

Answer 1

• Comfort
• Scars
• Ulcers (venous/arterial)
• Dressings/compression stockings
• Mobility aids

Question 2

What are looking for on closer inspection of the legs in a varicose veins exam?

Answer 2

• Venous eczema (itchy, red, blistered, plaques)
• Lipodermatosclerosis (skin hardening, hyperpigmentation, swelling, erythema)
• Venous ulcers (large, irregular borders, shallow, mild pain)
• Arterial disease (pallor, cyanosis, gangrene, reduced temperature)
• Varicose veins: great saphenous vein (medial thigh and leg), small saphenous vein (back of legs)
• Saphena varix: dilation of the saphenofemoral junction (4cm lateral and inferior to the pubic tubercle)

Question 3

How do you assess varicosities in a varicose veins exam?

Answer 3

• Temperature: increased suggests inflammation (phlebitis)
• Palpate for pain (phlebitis) or hardness (thrombosis)
• Auscultate: bruit suggests turbulent blood flow

Question 4

What special tests are performed in a varicose veins exam?

Answer 4

Cough test:
- place finger on SFJ, ask the patient to cough, palpate for thrill (saphena varix)
Tap test:
- place one finger on SFJ and tap the varicose vein, a thrill (transmitted percussion) at the SFJ suggests valve incompetence
Tourniquet/Trendelenburg’s tests:
- lie patient flat, lift their leg, and empty the superficial veins towards the groin
- apply the tourniquet over the SFJ
- ask the patient to stand and observe for filling of the veins (no filling = SFJ incompetence, filling = incompetence lower than SFJ)
- repeat the test lower than the previous position to find the level of incompetence
Perthe’s test:
- apply a tourniquet around the thigh and ask the patient to rock on tip toes 10 times
- if the superficial veins empty this suggests that the deep veins are intact
- if the superficial veins become more distended this suggests there is also a problem with the deep venous system

Question 5

How do you use a handheld Doppler to asses for valve incompetence?

Answer 5

• With the doppler probe over the SFJ, squeeze the calf
• A single ‘woosh’ indicates the blood being squeezed from the saphenous to the femoral vein
• A second ‘woosh’ would indicate valve incompetence as the blood flows back down