Varicose veins

Question 1

What are varicose veins?

Answer 1

distended superficial veins measuring more than 3mm in diameter, usually affecting the legs.

Question 2

How do they develop?

Answer 2

When muscles contract they squeeze blood
Valves prevent blood going back to feet
When valves are incompetent the blood flows down and pools in veins and feet
Deep and superficial veins are connected by perforating veins, when valves are incompetent here blood flows from deep veins back to superficial and overloads them-> dilation

Question 3

What is chronic venous sufficiency?

Answer 3

pressure from pooling blood can leak into near by tissues
Hemoglobin -> hemosiderin which causes brown discolouration to lower legs
you can also get venous eczema and lipodermatosclerosis

Question 4

What are the risk factors?

Answer 4

Increasing age
Family history
Female
Pregnancy
Obesity
Prolonged standing (e.g., occupations involving standing for long periods)
Deep vein thrombosis (causing damage to the valves)

Question 5

How do varicose veins present?

Answer 5

asymptomatic or
Heavy or dragging sensation in the legs
Aching
Itching
Burning
Oedema

Question 6

How to test for varicose veins ?

Answer 6

Tap test- on distal vein and feel for thrill at saphenofemoral junction
cough test- pressure to SFJ and ask patient to cough, feel for thrills at SFJ
Trendelenburg’s test- lift affected leg to drain veins, apply tourniquet which should prevent the varicose vein from reappearing if it is distal to incompetent valve
Perthes test- apply tourniquet and ask patient to pump calf muscle while performing heel raises, if superficial veins disappear, deep veins are functioning
Duplex ultrasound- shows speed and volume of blood flow

Question 7

How do we manage varicose veins?

Answer 7

weight loss, stay physically active, keep leg elevated
Surgery- Endothermal ablation- insert catheter to apply radio frequency ablation, sclerotherapy- inject vein with an irritant foam that closes vein. Stripping- veins are ligated and pulled out of the leg

Question 8

Complications of varicose veins?

Answer 8

Prolonged and heavy bleeding after trauma
Superficial thrombophlebitis (thrombosis and inflammation in the superficial veins)
Deep vein thrombosis
All the issues of chronic venous insufficiency (e.g., skin changes and ulcers)