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Flashcards in Lower Limb Vasculature Deck (19):
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What are varicose veins?

How do they present clinically?

Enlarged torturous veins associated with reflux of blood due to incompetent valves
They develop gradually over time
Unilateral or bilateral
Pain, aching, heaviness, itching, bleeding
May present with skin complications: varicose eczema, ulceration, thrombophlebitis, lipodermatosclerosis, skin pigmentation

Risk factors include obesity, pregnancy, family history

1

What is the course of the great saphenous vein?

Formed by the dorsal venous arch of the foot and dorsal veinof the great toe
Ascends up the medial side of the leg
Anterior to the medial malleolus at the ankle
Passes posteriorly to the medial condyle of the femur
Anastomoses with the s.s.v.
Drains into the femoral vein by passing through the saphenous opening in the fascia lata

2

What is the course of the small saphenous vein?

Formed by the dorsal venous arch of the foot and the dorsal vein of the little toe
Ascends up the posterior side of the leg
Passes posterior to the lateral malleolus
Moves between the two heads of the gastrocnemius
Drains in to the popliteal vein

3

What is meant by thrombophlebitis?

Complications of varicose veins whereby the affected veins become hard and tender with tenderness of the overlying skin
Treat with NSAIDs
Not Abx

4

What are the available treatments for varicose veins?

Conservative: exercise, weight loss, limb elevation
Compression stockings
Thermal ablation
Foam sclerotherapy
Surgery (Valve construction,Tying off the affected veins

5

Describe the deep venous drainage of the leg

Fibular vein, and anterior and posterior tibial veins drain in to popliteal
Popliteal becomes femoral when it passes posterior to the knee
Femoral drains in to external iliac at the point of the inguinal ligament
Superior and inferior gluteal veins drain in to the internal Iliac vein

6

Where can the femoral artery be palpated?

Directly inferior to the inguinal ligament, midway between ASIS and the pubic symphysis

7

Describe the arterial supply of the leg

External iliac branching in to femoral at the inguinal ligament
Becomes popliteal artery behind the knee
At the inferior border of popliteus, gives rise to the anterior tibial artery, then fibular, then continues in to the posterior compartment of the leg as the posterior tibial artery
Terminal branch of the anterior tibial artery is the dorsalis pedis artery

8

What happens in saphenous cutdown?
When does it happen?
What is a risk, and how would this present?

In emergency situations when it is difficult to find a a vein for venepuncture or cannula insertion
The Gsv can be located anterior to the medial malleolus by making a skin incision at this location.
There is a risk of saphenous nerve injury, which would present as pain along the medial border of the foot

9

What is meant by lipodermatosclerosis?

A sign of venous insufficiency
Panniculitis - inflammation of subcutaneous fat
Skin induration (hardening), erythema, swelling
Inverted champagne bottle appearance

10

What leads to pigmentation of the skin in venous insufficiency?

Deposition of haemosiderin and melanin

11

What is meant by atrophie blanche?

'White atrophy'
Looks like a white patch on the skin - typically around the malleoli
Capillary hypoxia, poor blood flow and poor hound healing

12

What are the risk factors for varicose veins?

Obesity
Pregnancy
Family history
Prolonged standing

13

What is a saphena varix?

A large varicosity of the great saphenous vein at the saphenofemoral junction
It displays cough impulse so is commonly confused with a femoral hernia

14

What is the anatomical landmark for the saphenofemoral junction?

4cm inferior and medial to the pubic tubercle

15

What is the treatment of venous ulcers?

4 layer graded compression bandaging

16

What are the NICE criteria for varicose vein surgery?

Symptomatic
Skin changes
Thrombophlebitis
Venous ulceration

17

What are the complications of varicose vein surgery?

Recurrence
DVT
Thrombophlebitis (important inform sclerotherapy and ablation techniques)
Nerve damage (sural and saphenous nerves)

18

Why should patients have a Duplex scan before undergoing surgery for varicose veins?

If varicose veins are recurrent
Those who have had a previous DVT
In those patients where the distribution affected is uncertain