Varicose vein examination Flashcards

Question

What treatment options are available for varicose veins?

Answer 1

Management of varicose veins consists of both surgical and conservative options. In addition, lifestyle changes are encouraged including exercise and weight loss. Varicose veins are likely to recur after treatment, but for most patients, treatment offers relief from symptoms for a significant period (with the length varying from patient to patient).

Answer 2

Compression therapy -Only if surgical management declined/considered not suitable (e.g. pregnancy) The main non-surgical option for managing varicose veins is compression therapy using bandages or stockings. However, compression therapy is not recommended by NICE unless surgical intervention is declined or considered inappropriate. One such case where it can be deemed not suitable is pregnancy. In this situation, only non-surgical options should be considered unless exceptional circumstances warrant surgical intervention. Before using compression therapy, it is important to exclude arterial insufficiency by performing an ankle-brachial pressure index (ABPI).

Answer 3

Endovenous: 1) endothermal ablation (laser treatment or radiofrequency ablation) 2) US guided foam sclerotherapy Open -Ligation and stripping -Phlebectomy: avulsion via stab incisions Endovenous techniques Endovenous techniques aim to block the faulty veins, which has the same benefit as removing them. It is preferred to open surgery as these techniques are minimally invasive. Options include: Endothermal ablation (first line) involves either radiofrequency ablation or endovenous laser treatment Ultrasound-guided foam sclerotherapy (second line) Rarer techniques, such as the use of glue, steam, and mechanochemical devices Open surgery Open surgery is only considered if endovenous techniques are deemed inappropriate. Options include: Ligation and stripping: incompetent veins are tied off (ligated) and removed (stripped) Phlebectomy (stab avulsions): varicose veins are pulled out through small incisions

Answer 4

Venous ulcers: typically large and shallow ulcers with irregular borders that are only mildly painful. These ulcers most commonly develop over the medial aspect of the ankle. Arterial ulcers: typically small, well-defined, deep ulcers that are very painful. These ulcers most commonly develop in the most peripheral regions of a limb (e.g. the ends of digits).

Answer 5

-Clinical diagnosis -Venous duplex can confirm incompetence -ABPI to determine if arterial component/whether compression therapy would be appropriate -Swab if infection suspected The diagnosis of venous ulcers is clinical, with the underlying venous insufficiency confirmed by Duplex Ultrasound. Most commonly venous incompetence occurs at the sapheno-femoral or sapheno-popliteal junctions, although it may occur in any perforator. An Ankle Brachial Pressure Index (ABPI) is required to assess for any arterial component to the ulcers and to determine whether compression therapy will be suitable. If infection is suspected (i.e. erythematous or with purulent exudate) then consider microbiology swabs and antibiotics. Take swab cultures if suspecting an associated infection. Consider a thrombophilia and vasculitic screening in young patients, especially if there is a suspicion or family history of prothrombotic and autoimmune diseases.

Answer 6

-Lifestyle changes: weight reduction, improved nutrition -Antibiotics if evidence of infection -Compression bandaging (If ABPI >0.6) -Surgical treatment of varicose veins Conservative management for venous ulcers warrants leg elevation and increased exercise (promoting the calf muscle pump action which aids venous return). Encourage lifestyle changes, including weight reduction and improved nutrition, as appropriate. Antibiotics should only be prescribed with clinical evidence of a wound infection (most wounds are colonized, therefore swab results should only be acted upon if evidence of infection). The mainstay of management is via multicomponent compression bandaging, changed once or twice every week; 30-75% of venous leg ulcers will heal after six months of compression therapy. Eight randomised clinical trials demonstrated improved time to healing with compression versus no compression treatment. Importantly, the ABPI must be measured as at least greater than 0.6 before any bandaging is applied. Appropriate dressings and emollients are crucial in maintaining surrounding skin health. If there is concurrent varicose veins, these should be treated with endovenous techniques or open surgery*, as improving venous return will allow for the healing of the venous ulcers. *Recent trial data on the use of surgical treatment of varicose veins in patients with venous ulceration demonstrated that surgery decreases the chance of ulcer recurrence (ESCHAR study), and that early treatment of varicose veins decreases the time for ulcer healing (EVRA trial)

Answer 7

-DVT -Thrombophlebitis -Bleeding -Nerve damage -Disease recurrence Whilst the complications will be specific for each procedure, typical complications seen post-operatively include haemorrhage, thrombophlebitis (important for foam or ablation treatments), DVT (important for any endovenous treatments), disease recurrence, and nerve damage (specifically saphenous or sural nerves).

Answer 8

-Symptomatic varicose veins -Skin changes -Ulcer -Superficial vein thrombosis Symptomatic primary or recurrent varicose veins Lower‑limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency Superficial vein thrombosis (characterised by the appearance of hard, painful veins) with suspected venous incompetence A venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks)

Varicose vein examination Flashcards

(32 cards)