Varicose Veins Flashcards
What are various veins?
Long, tortuous, dilated veins of the superficial venous system
What is the pathology in varicose veins?
Blood from superficial veins of the leg assess into the deep veins via perforator veins and at the saphenofemoral and saphenopopliteal junctions.
Valves prevent blood from passing from deep to superficial veins.
If they become incompetent, there is venous HTN and dilatation of the superficial veins occurs.
What are risk factors for VV?
Prolonged standing Obestiy Pregnancy FHx OCP
Causes of VV?
Mechanical factors Secondary to obstruction (EVT, fetus, pelvic tumour) Arteriovenous malformations Overactive muscle pumps (cyclists) Congenital valve abscence
Symptoms of VV?
Dilated veins - aesthetic Pain Cramps Tingling Heaviness Restless legs
What are signs of VV?
Oedema eczema ulcers haemosiderin haemorrhage phlebitis atropine blanche (white scarring at the site of a previous healed ulcer) lipdermatosclerosis (skin hardness from subcutaneous fibrosis caused by chronic inflammation and fat necrosis)
What are atropine blanche and lipodermatosclerosis?
Atropine blanche (white scarring at the site of a previous healed ulcer) Lipdermatosclerosis (skin hardness from subcutaneous fibrosis caused by chronic inflammation and fat necrosis)
When should VV be referred?
Bleeding, pain, ulceration, superficial thrombophlebitis (inflammation of vein related to blood clot)
How are VV treated?
Treat underlying cause
Education - avoid prolonged standing and elevate legs whenever possible., support stockings, lose weight, regular walks
Endovascular treatment - less pain and earlier return to activity than surgery: Radiofrequency ablation - vein closed Endovenous laser ablation Injection sclerotherapy Surgery - ligation, stripping
What is saphena varix?
Dilatation in the saphenous vein at its confluence with the femoral vein (SFJ).
Transmits a cough impulse and may be mistaken for an inguinal or femoral hernia.
what advice to someone with VV?
Avoid prolonged standing and elevate legs when possible
Support stockings
Lose weight
Regular walks (calf muscle action aids venous return)
Investigation?
Duplex ultrasound scan
assessing valve incompetence at the great/short saphenous veins and any perforators. Deep venous incompetence, occlusion (deep venous thrombosis) and stenosis must also be actively looked for.
