Varicose Veins

Question 1

What are varicose veins?

Answer 1

Distended superficial tortuous veins that measure more than 3mm in diameter usually affecting the legs.

Question 2

Common Site of varicose veins.

Answer 2

Legs due to reflux in the great saphenous vein or small saphenous vein.

Question 3

Why is pregnancy a risk factor of varicose veins?

Answer 3

Uterus compression of pelvic veins.

Question 4

Why is DVT a risk factor of varicose veins?

Answer 4

Damage to valves.

Question 5

What are reticular veins?

Answer 5

Dilated blood vessels in the skin that measure less than 1-3mm in diameter.

Question 6

What is telangiectasis?

Answer 6

Dilated blood vessels in the skin that measure less than 1mm in diameter. Also known as spider/thread veins.

Question 7

Why does chronic venous insufficiency cause hyperpigmentation / brown discolouration?

Answer 7

1. Blood pools in distal veins.
2. Pressure causes leakage of small amounts of blood into nearby tissues.
3. Haemoglobin in leaked blood breaks to Haemosiderin.
4. Deposited around shins in legs.

Question 8

What is Lipodermatosclerosis?

Answer 8

Chronic venous insufficiency causes skin and soft tissues to become fibrotic and tight, causing the lower legs to become narrower and harder - ‘champagne bottle legs’.

Question 9

What is Atrophie Blanche?

Answer 9

Hypopigmentation, also as a result of chronic venous insufficiency.

Question 10

What connects the deep and superficial veins?

Answer 10

Perforating veins/Perforators - allow blood to flow from superficial veins to deep veins.

Question 11

What happens when valves are incompetent?

Answer 11

Blood is drawn downwards by gravity and pools in the veins of the legs. Blood flows from the deep veins back into the superficial veins - overloaded.

Question 12

Anatomy of Long Saphenous Vein.

Answer 12

1. Originates at 1st Digit where Dorsal Vein merges with Dorsal Venous Arch of Foot.
2. Passes anterior to Medial Malleolus and runs up Medial Leg.
3. Runs over posterior border of medial epicondyle of femur.
4. Passes laterally to lie anterior surface of the thigh.
5. Enters saphenous opening (opening in the fascia Lata) and joins femoral vein at saphenofemoral junction.

Question 13

Anatomy of Short Saphenous Vein (5).

Answer 13

1. Originates at 5th digit where dorsal vein merges with dorsal venous arch of foot.
2. Passes around lateral aspect of foot (inferio-posterior to lateral malleolus).
3. Runs along posterior aspect of leg with sural nerve.
4. Between heads of gastrocnemius.
5. Drains into popliteal veins.

Question 14

Investigations of Varicose Veins (5).

Answer 14

1. Tap Test.
2. Cough Test.
3. Trendelenburg Test.
4. Perthes Test.
5. Duplex Ultrasound.

Question 15

What is the Tap Test?

Answer 15

1. Apply pressure at the SFJ and tap at the distal varicose vein.
2. Feel for a thrill - thrill suggests incompetent valves between varicose vein and SFJ.

Question 16

What is the Cough Test?

Answer 16

1. Apply pressure to SFJ and ask patient to cough.

2. Feel for a thrill - thrill suggests dilated vein at the SFJ (saphenous varix).

Question 17

What is the Trendelenburg Test?

Answer 17

1. Patient lies down.
2. Lift affected leg to drain veins completely.
3. Apply tourniquet and ask patient to stand up.
4. If varicose veins reappear, incompetent valve is below level of tourniquet.

Question 18

What is Perthes Test?

Answer 18

1. Apply a tourniquet to thigh and ask patient to pump calf muscles by heel raises.
2. If superficial veins disappear, deep veins function.
3. If superficial veins are more dilated, a problem in deep veins e.g. DVT.

Question 19

Management of Varicose Veins (4).

Answer 19

1. Weight Loss.
2. Stay physically active.
3. Keep leg elevated when possible to help drainage.
4. Graduated compression stockings (after arterial disease is excluded).

Question 20

Indications for Secondary Care Referral (5).

Answer 20

1. Significant/Troublesome Lower Limb Symptoms.
2. Previous Bleeding from Varicose Veins.
3. Skin Changes (Chronic Venous Insufficiency)
4. Superficial Thrombophlebitis.
5. Active/Healed Venous Leg Ulcer.

Question 21

Surgical Management of Varicose Veins (3).

Answer 21

1. Endothermic ablation (catheter into vein - radio frequency ablation).
2. Sclerotherapy - inject irritant foam to cause closure.
3. Stripping - ligate and pull out of leg.

Question 22

Complications of Varicose Veins (4).

Answer 22

1. Prolonged and Heavy Bleeding after Trauma.
2. Superficial Thrombophlebitis (Thrombosis + Inflammation).
3. Deep Vein Thrombosis.
4. Chronic Venous Insufficiency.