2-varicose veins Flashcards
what is the chronic venous disease?
The most common chronic venous diseases are varicose veins (affecting approx. 23% of the US population) and chronic venous insufficiency (CVI), which affects 2–5% of the population. The condition is most often caused by increased venous pressure due to malfunctioning valves in the veins. Elevated venous pressure results in fluid accumulation in the lower extremities, leading to alterations in the skin and veins. Depending on the severity of hemodynamic changes, clinical manifestations may include superficial tortuous veins, edema, skin changes (e.g., stasis dermatitis), and ulcer formation. Diagnosis is established based on duplex ultrasonography. In complicated cases, magnetic resonance venography (MRV) may be performed as well. Treatment may be conservative (e.g., compression stockings) or involve ablation therapies (e.g., sclerotherapy, surgical excision).
what is the spectrum of diseases of varicose veins?
• Very common, 30% women, 20% men
• Spectrum of disease
– Asymptomatic, symptomatic, complicated
– Minimal superficial dilation
– Varicose veins (dilated, tortuous, elongated superficial veins)
– Severe chronic skin changes with ulceration
what s the epidemiology of CVD
Prevalence:
–CVI affects 2–5% of individuals in the US.
Varicose veins affect approx. 23% of individuals in the US.
–Peak incidence: CVI
♀: 5th decade
♂: 8th decade
–Sex: ♀ > ♂ (∼ 2:1)
what are the primary causes o varicose veins?
– Primary valve failure/reflux
– Incompetent perforating veins
– Venous thrombosis
what are the secondary causes o varicose veins?
– Chronic deep venous insufficiency
– Deep venous or IVC obstruction (cirrhosis)
– Trauma
– Pelvic tumors
what are the risk factors of varicose veins?
- -Increasing age and female sex
- -Family history of venous disease
- -Ligamentous laxity
- -Sedentary lifestyle and prolonged standing
- -Obesity
- -Pregnancy
- -Smoking
- -Prior thrombosis (postthrombotic syndrome)
- -Prior extremity trauma
- -Congenital abnormalities
what are the varieties of venous insufficiency?
1)Varicose veins
2)Chronic Venous Insufficiency
3)Telangiectasia
• Oedema
• Hyperpigmentation
• Lipodermatosclerosis
• Venous Ulcer
what are the clinical features of varicose veins?
- Asymptomatic/Cosmetic concerns only
- Discomfort/Leg heaviness/Pruritis
- Ankle swelling
- Skin changes including inflammation, eczema, ulceration
what is the pathophysiology of varicose veins?
Elevated venous pressure → incompetence of venous valves (superficial or deep veins)→ reflux of blood into superficial veins and back into the extremity → further elevation of venous pressure → formation of varicose veins
what are the skin findings of varicose veins
1) Edema formation (may be unilateral) that starts in the ankle and may involve the calf later in the disease course (in about half of affected individuals)
2) Telangiectasias (esp. in women)
3) Yellow-brown or red-brown skin pigmentation of the medial ankle; later of the foot and possibly lower leg
- -RBC breakdown leads to hemosiderin release → accumulation in the dermis → skin pigmentation
- -May lead to stasis dermatitis; a scaly, pruritic rash
4) Paraplantar varicose veins
5) Lipodermatosclerosis: Localized chronic inflammation and fibrosis of skin and subcutaneous tissues of lower leg
- -Painful, indurated, and hardened skin
- -Atrophie blanche: White, coin- to palm-sized atrophic plaques due to absent capillaries in the fibrotic tissue.
what is the stasis dermatitis?
An inflammatory skin condition characterized by a scaly, pruritic rash on the lower extremities. Most commonly occurs as a consequence of chronic venous insufficiency and edema.
what is the lipodermatosclerosis?
Localized chronic inflammation and fibrosis of the skin and subcutaneous tissues of lower leg. Characterized by painful, indurated, and hardened skin. Can result in atrophie blanche.
how varicose veins are clinically assessed?
Assessment • Distribution – GSV/SSV • Skin changes/Hyperpigmentation/Lipodermatosclerosis • Cough Impulse • Trendelenburg test
what is the Trendelenburg test?
Used to diagnose valve incompetency in the superficial and deep veins of the legs. While supine, a tourniquet is applied to compress the superficial great saphenous vein. Rapid filling of the superficial veins as soon as the patient stands indicates valve incompetence in the deep veins. If there is no rapid refilling, the tourniquet is released, at which point rapid refilling indicates incompetence in the superficial vein
how varicose veins are diagnosed?
- -The diagnosis of varicose veins is based on history and clinical findings. Imaging is only used in the diagnosis of CVI.
- -Test of choice: duplex ultrasonography
- -Presence of venous reflux confirms diagnosis of CVI
- -Examine patency of deep vein
- -Examine sufficiency of superficial and perforating veins
