FN: Varicose Veins Flashcards Preview

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Flashcards in FN: Varicose Veins Deck (25):
1

Definition

Tortuous, dilated veins of the superficial venous system

2

Pathophysiology

One-way flow from superior to deep maintained by valves
Valve failure - raised pressure in sup veins - variscosity

3

3 main sites where valve incompetence occurs

SFJ: 3cm below and 3cm lateral to pubic tubercle
SPJ: popliteal fossa
Perforatos: draining GSV
-3 medial cal perforators (Cocketts)
1 medial thigh perforator (Hunters)

4

Causes

Primary
Secondary

5

Primary causes

Idiopathic: (congenitally weak valves)
-prolonged standing
- Pregnancy
- Obesity
- OCP
- FH

Congenital valve absence (v. rare)

6

Secondary causes

Valve destruction - reflux: DVT, thrombophlebitis
Obstruction: DVT, foetus, pelvic mass
Constipation
AVM
Overactive pumps (e.g. cyclists)
Klippels-Trenaunay -

7

Klippels-Trenaunay -

- PWS, varicose veins, limb hypertorphy

8

Symptoms

Cosmetic defect
Pain, cramping, haeviness
Tingling
Bleedin: may be severe
Swelling

9

Signs

skin changes:
1. Venous stars
2. Haemosiderin deposition
3. Venous eczema
4. Lipodermatosclerosis (paniculitis)
Atrophie blanche

Ulcers: medial malleolus/gaiter area
Oedema
Thromnophlebitis

10

Investigations

Duplex ultrasonography
-Anatomy
- Presence of incompetence
- Caused by obstruction or reflux

11

Investigations for surgery

FBC
U+E
Clotting
G+S
CXR
ECG

12

Referral criteria

Bleeding
Pain
ulceration
Superficial thrombophlebitis
Severe impct on QOL

13

CEAP classification

Chronic venous disease can be classified according to
-Clinical signs (1-6 + sympto or asympto)
- Etiology
- Anatomy
- PAthophysiology

14

Conservative Mx

1. Treat any contributing factors
2. Education
3. Class II graduated Compression stockings
4. Skin care

15

Contributing factors

Lose weight
Relieve constipation

16

Education

Avoid prolonged standing
regular walks

17

Class II graduated compression stockings

18-24 mmHg
Symptomatic relief and slows progression

18

Skin care

Maintain hydration with emolients
Treat ulcers rapidly

19

Minimally invasive therapies indications

small below knee varicosirits not involving GSV or SSV

20

Minimally invasive therapies techniques

Local or GA
Injections sclerotherapy:1% NA tetradecyl sulphate
Endovenous laser or radiofreqeuncy adblation

21

Post-op

Compression bandage for 24hrs
Compression stockings for 1mo

22

Surgical management indications

SFJ incompetence
Major perforator incompetence
Sympatomatic: ulceration, skin changes, pain

23

Sugery procedures

1.Trendeleberg:saphenofemoral ligation
2. SSV ligation: in the popliteal fossa
3. LSV stripping: no longer performed due to potential for saphenous nerve damage
4. Multiple avulsions
5. Perforator ligationL Cocketts operation
6. Subfascial endoscopu perforator surgery (SEPS)

24

Post-op surgical

Bandage tightly
Elevate for 24hrs
Discharged with compression stockings and isntructed to walk daily

25

Surgery complications

Haematoma (esp. groim)
Wound sepsis
Damage to cutaneous nerve (e.g. long saphenous)
Superfical thrombophlebitis
DVT
Recurrence: may approach 50%

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