Varicose Veins Flashcards
Risk factors
Increasing age
FHx
Female
Obesity
Prolonged standing
Increasing number of births
DVT
Definition
Subcutaneous, perminantly dilated veins >3mm in diameter usually affecting the legs
Pathophysiology
Veins have one way vavles that allow blood to flow towards the heart.
In legs, to squeeze bloods up against gravity - muscles contrac.
So when vavles become incompetent, blood is drawn downwards by gravity and pools in veins and feet.
Deep and superficial veins are connected by perforated veins. This incompetance causes backflow of blood from the deep veins back into superficial veins and overloads. Causing dilation + engorgement of superficial veins
Chronic venous insufficiency
When blood pools in distal veins, it causes leakage into nearby tissues, leading to brown discoloration on the lower legs = haemosiderin staining. This also causes inflammation causing skin to become dry and inflamed (Venous eczema). As it advances, skin and soft tissue become fibrotic and tight causing lower legs to become narrow and hard (lipodermatoscelrosis)
Signs and symptoms
- Asx
- Dilated tortuous veins
- Leg fatigue, leg cramps, restless legS
Signs of venous chronic insufficiency
Haemosiderin staining
Ulcers
Liopdermatosclerosis
Eczema
Diagnosis
FIRST LINE + Duplex USS
Tap test = apply pressure to the saphenofemoral junction (SFJ) and tap distal varicose vein feeling for a thrill at SFJ
Cough test = apply pressure to SFJ and ask patient to cough and feel for thrills at the SFJ
Trandelburg test and Perthes test
Treatment
Conservative:
- Weight loss
- Exercise
- Keep leg elevated when possible to help drainage
- Compression stockings (exclude arterial disease first with ABPI)
Surgical:
- Endothermal ablation
- Phlebectomy
- Sclerotherapy
Complications
Prolonged heavy bleeding after trauma
Superficial thrombophlebitis, DVT,
Chronic venous insufficiency
