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Year 3 Breast and Vascular Surgery > Varicose veins > Flashcards

Varicose veins Flashcards

1
Q

Varicose veins

A

Tortuous, dilated veins of the superficial venous

system

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2
Q

Pathophysiology of varicose veins

A

Valve failure → ↑ pressure in sup veins → varicosity

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3
Q

3 main sites where valve incompetence occurs

A

Sapheno- femoral junction

Sapheno-popliteal junction

Perforators: draining the long saphenous vein

  • 3 medial calf perforators
  • 1 medial thigh perforator
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4
Q

Causes of varicose veins

A

Primary- idiopathic (congenitally weak valves)

Secondary
• Valve destruction causing reflux: DVT, thrombophlebitis
• Obstruction: DVT, foetus, pelvic mass
• Constipation
• AVM
• Overactive pumping (e.g. cyclists)
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5
Q

Risk factors for varicose veins

A
  • Prolonged standing
  • Pregnancy
  • Obesity
  • OCP
  • FHx
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6
Q

Symptoms of varicose veins

A
  • Cosmetic defect
  • Pain, cramping, heaviness
  • Tingling
  • Eczema - severe
  • Swelling
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7
Q

Signs of varicose veins

A

• Skin changes:

  • Venous stars
  • Haemosiderin deposition
  • Venous eczema
  • Lipodermatosclerosis - wine glass sign
  • Atrophie blanche
  • Ulcers: medial malleolus
  • Oedema
  • Thrombophlebitis
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8
Q

Investigations for varicose veins

A

• Duplex ultrasonography

  • Anatomy
  • Presence of incompetence
  • Obstruction or reflux
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9
Q

Referral Criteria

A 
• 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

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10
Q

CEAP Classification

A

Clinical signs (1-6 + sympto or asympto)
Etiology
Anatomy
Pathophysiology

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11
Q

Conservative Mx

A
  • Lose weight
  • Relieve constipation
  • Avoid prolonged standing
  • Regular walks
  • Class II Graduated Compression Stockings
  • Skin care
  • Maintain hydration with emollients
  • Treat ulcers rapidly
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12
Q

Minimally invasive mx of varicose veins

A

Injection sclerotherapy
Endovenous laser or radiofrequency ablation
Glue ablation

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13
Q

Varicose veins post op

A
  • Compression bandage for 24hrs

* Compression stockings for 1 month

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14
Q

Indications for surgery

A

(Rare)
• SFJ incompetence
• Major perforator incompetence
• Symptomatic: ulceration, skin changes, pain

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15
Q

Surgical procedures

A
  • Saphenofemoral ligation
  • Short saphenous vein ligation: in the popliteal fossa
  • Multiple avulsions
  • Perforator ligation
  • Subfascial endoscopic perforator surgery (SEPS)
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16
Q

Post op for varicose veins after bigger surgery

A

• Bandage tightly
• Elevate for 24h
• Discharged with compression stockings +
walk daily

17
Q

Venous leg ulcers (75%)

A

Painless, sloping, shallow ulcers
• Usually on medial malleolus
• Associated with haemosiderin deposition and
lipodermatosclerosis
• RFs: venous insufficiency, varicosities, DVT, obesity

18
Q

Arterial leg ulcers (2%)

A
  • Painful, deep, punched out lesions
  • Occur at pressure points
  • Other signs of chronic leg ischaemia
19
Q

Neuropathic ulcers

A
  • Painless with insensate surrounding skin

* Warm foot with good pulses

20
Q

Complications of ulcers

A
  • Osteomyelitis

* Development of SCC in the ulcer (Marjolin’s ulcer)

21
Q

Investigations for leg ulcers

A 
• ABPI if possible
• Duplex ultrasonography
• Biopsy may be necessary
- Look for malignant change in Marjolin’s ulcer
•  Swab and Culture
22
Q

Mx of venous ulcers

A

• 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)
23
Q

Saphena Varix

A

Dilatation of the saphenous vein at the saphenofemoral junction in the groin.

Displays a cough impulse, it is commonly mistaken for a femoral hernia

24
Q

Varicose Veins and Concurrent DVT

A

Cannot treat their superficial incompetence, as the venous blood will have no route back

25
Q

Varicose eczema

A

Dry and scaly
Itchy
Bursting pain and tightness on walking
Resolves with elevation

26
Q

Is for varicose eczema’s

A

Doppler ultrasound scan

27
Q

Thx of varicose eczema

A

Conservative with compression stockings if ABPI above 0.8 and analgesia

28
Q

Does saphena varicose display a cough reflex

A

Yes

Suspect if femoral hernia and varicose veins

Year 3 Breast and Vascular Surgery (8 decks)

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