Varicose veins Flashcards
Varicose veins
Tortuous, dilated veins of the superficial venous
system
Pathophysiology of varicose veins
Valve failure → ↑ pressure in sup veins → varicosity
3 main sites where valve incompetence occurs
Sapheno- femoral junction
Sapheno-popliteal junction
Perforators: draining the long saphenous vein
- 3 medial calf perforators
- 1 medial thigh perforator
Causes of varicose veins
Primary- idiopathic (congenitally weak valves)
Secondary • Valve destruction causing reflux: DVT, thrombophlebitis • Obstruction: DVT, foetus, pelvic mass • Constipation • AVM • Overactive pumping (e.g. cyclists)
Risk factors for varicose veins
- Prolonged standing
- Pregnancy
- Obesity
- OCP
- FHx
Symptoms of varicose veins
- Cosmetic defect
- Pain, cramping, heaviness
- Tingling
- Eczema - severe
- Swelling
Signs of varicose veins
• Skin changes:
- Venous stars
- Haemosiderin deposition
- Venous eczema
- Lipodermatosclerosis - wine glass sign
- Atrophie blanche
- Ulcers: medial malleolus
- Oedema
- Thrombophlebitis
Investigations for varicose veins
• Duplex ultrasonography
- Anatomy
- Presence of incompetence
- Obstruction or reflux
Referral Criteria
• Bleeding • Pain • Ulceration • Superficial thrombophlebitis • Severe impact on QoL - symptomatic - not healed in 2 weeks - skin changes
If have DVT cannot do varicose vein surgery
CEAP Classification
Clinical signs (1-6 + sympto or asympto)
Etiology
Anatomy
Pathophysiology
Conservative Mx
- Lose weight
- Relieve constipation
- Avoid prolonged standing
- Regular walks
- Class II Graduated Compression Stockings
- Skin care
- Maintain hydration with emollients
- Treat ulcers rapidly
Minimally invasive mx of varicose veins
Injection sclerotherapy
Endovenous laser or radiofrequency ablation
Glue ablation
Varicose veins post op
- Compression bandage for 24hrs
* Compression stockings for 1 month
Indications for surgery
(Rare)
• SFJ incompetence
• Major perforator incompetence
• Symptomatic: ulceration, skin changes, pain
Surgical procedures
- Saphenofemoral ligation
- Short saphenous vein ligation: in the popliteal fossa
- Multiple avulsions
- Perforator ligation
- Subfascial endoscopic perforator surgery (SEPS)
Post op for varicose veins after bigger surgery
• Bandage tightly
• Elevate for 24h
• Discharged with compression stockings +
walk daily
Venous leg ulcers (75%)
Painless, sloping, shallow ulcers
• Usually on medial malleolus
• Associated with haemosiderin deposition and
lipodermatosclerosis
• RFs: venous insufficiency, varicosities, DVT, obesity
Arterial leg ulcers (2%)
- Painful, deep, punched out lesions
- Occur at pressure points
- Other signs of chronic leg ischaemia
Neuropathic ulcers
- Painless with insensate surrounding skin
* Warm foot with good pulses
Complications of ulcers
- Osteomyelitis
* Development of SCC in the ulcer (Marjolin’s ulcer)
Investigations for leg ulcers
• ABPI if possible • Duplex ultrasonography • Biopsy may be necessary - Look for malignant change in Marjolin’s ulcer • Swab and Culture
Mx of venous ulcers
• Refer to leg ulcer community clinic
- Graduated compression stockings
- Venous surgery
- Optimise risk factors: nutrition, smoking
- Analgesia
- Bed Rest + Elevate leg
- 4 layer graded compression bandage (if ABPI >0.8)
Saphena Varix
Dilatation of the saphenous vein at the saphenofemoral junction in the groin.
Displays a cough impulse, it is commonly mistaken for a femoral hernia
Varicose Veins and Concurrent DVT
Cannot treat their superficial incompetence, as the venous blood will have no route back
