venous & Lymphatic Disease - Presentation, Investigation & Therapy Flashcards
how many people does varicose veins affect?
at least one third of the population
what is a varicose vein?
varicose vein is a dilated and tortuous, often superficial vein
where are varicose veins most commonly found?
lower limbs
where is the long saphenous vein?
dorsal venous arch drains into the LSV, which passes anterior to the medial malleolus, up the medial aspect of the leg
where is saphenofemoral junction
Found 2.5cm below and lateral to the pubic tubercle
Here the LSV perforates the cribiform fascia and empties into the femoral vein (deep system)
where is the short saphenous?
The plantar venous arch drains into the SSV which travels posterior to the lateral malleolus, up the posterior aspect of the leg and drains into the popliteal vein (deep system)
what mechanisms are there to assist low flow against gravity back to the heart?
valves
calf muscle pump
perforating veins to drain blood into the deep system
what are the causes of valvular failure?
surgical or traumatic disruption of the valve.
DVT: can initially cause obstruction to venous flow, and even as the vein re-canalises through the thrombus, this canal will be a high-pressure avalvular channel.
Hormonal changes in pregnancy can cause weakness of the veins and valves, leading to venous incompetence. The enlarged uterus can cause mechanical obstruction to venous flow within the deep system,
Similarly a large pelvic tumour also could, leading to increased pressure within the distal venous systems.
what happens to the venous pressure when one valve has failed?
there is a dilation of the distal vein and further valvular incompetence
what are the risk factors for varicose
age female pregnancy DVT standing for long periods family history
what is history of varicose veins?
Burning Itching Heaviness Tightness Swelling Discolouration Phlebitis Bleeding Disfiguration Eczema Ulceration
what are the different type of tests?
tap test
trendelenburg/tourniquet test
doppler
what is the tap test?
Place one hand over the saphenofemoral junction and one over the long saphenous vein above the knee.
Tap the saphenofemoral junction – a transmitted impulse at the knee indicates an incompetence of the valves between the two hands.
what is the Trendelenburg/tourniquet test
Lie the patient flat. Drain the superficial veins by raising the leg and stroking the veins towards the trunk.
Apply pressure over the saphenofemoral junction. Keep this pressure on as you ask the patient to stand.
If the varicose veins don’t dilate on standing, you are preventing this by ‘acting’ as a competent valve preventing backflow of blood. If you release your hand you will see the veins refill as the patient’s saphenofemoral junction valve is incompetent.
The Tourniquet test is a similar test, using a tourniquet instead of your hand, and repeating the test at 10cm intervals down the leg (the approximate distance between perforating veins) to find the level of incompetence.
what is the doppler
Hold a doppler probe over the saphenofemoral junction. Squeeze the calf muscles. In a patient with competent superficial veins you will hear a ‘whoosh’ as the blood flows upwards into the deep system.
In a patient with an incompetent saphenofemoral junction you will hear two waves as the blood flows upwards and then refluxes downwards again.
