Varicose Veins

Question 1

What are varicose veins?

Answer 1

Dilated, tortuous veins which mainly occur in the superficial venous system of the legs

Question 2

What causes varicose veins?

Answer 2

incompetence of one way valves, leading to leakage, retrograde flow and consequently, pooling of blood in the venous system

Question 3

Why is it that superficial veins are more prone to varicose veins than deep veins?

Answer 3

superficial veins are weaker and thinner, making them more prone to the effects of high pressure build ups of blood, leading to distension of the venous walls

Question 4

How do superficial veins drain into the deep venous system?

Answer 4

Via perforator veins that penetrate muscle facia in the leg (mainly at the saphenofemoral and saphenopopliteal junctions)

Question 5

Give an example of an intravascular cause of varicose veins?

Answer 5

1. DVT

Question 6

Given examples of extravascular causes of varicose veins?

Answer 6

1. Pelvic masses eg tumours fibroids and pregnancy

Question 7

Give 5 risk factors for varicose veins:

Answer 7

1) family history
2) age (40+)
3) female sex
4) history of DVT
5) pregnancy

Question 8

Describe the clinical presentation of varicose veins

Answer 8

dilated, tortuous veins that are often asymptomatic, but if severe…
1) pain (dull ache or burning of the skin)
2) leg fatigue, discomfort or pain after prolonged standing
3) heaviness of the leg

Question 9

Which two veins are most commonly affected by varicose veins?

Answer 9

1. Great saphenous vein
2. short saphenous vein

Question 10

what are 3 less common symptoms of varicose veins?

Answer 10

1. Itching after prolonged standing
2. Ankle oedema
3. lipodermatoschlerosis

Question 11

Give 3 conservative management techniques of varicose veins:

Answer 11

1) compression therapy
2) increased exercise
3) weight loss

Question 12

What is the objective of open varicose vein surgery? (2)

Answer 12

1. Eliminating the saphenofemoral or saphopopliteal junctions
2. joining thigh/calf perforators

Question 13

Give 2 endovascular surgical techniques used to treat varicose veins:

Answer 13

1) endothermal ablation (first line)
2) ultrasound-guided foam sclerotherapy

Question 14

What is endothermal ablation?

Answer 14

Endothermal ablation is a treatment for varicose veins that involves using energy to seal the affected veins. A specialist will use either high-frequency radio waves or lasers to do this. The procedure seals off the main underlying faulty vein that is feeding the varicosities, which will be either the Long saphenous Vein (LSV) in the thigh or the Short Saphenous Vein (SSV) behind the knee and calf.

Question 15

In which ethnicity are varicose veins most common?

Answer 15

caucasian

Question 16

Name 5 differential diagnoses for varicose veins?

Answer 16

1. Telangiectasias: veins <1 mm in diameter
2. Reticular veins: veins 1 – 3 mm in diameter (can also be tortuous)
3. DVT
4. Cellulitis
5. Superficial thrombophebitis

Question 17

How are varicose veins diagnosed?

Answer 17

Usually clinically diagnosed
- duplex ultrasound can confirm

Importantly, an ankle-brachial pressure index (ABPI) can exclude peripheral arterial disease before compression therapy is considered.