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Y4: Vascular Surgery > Varicose veins > Flashcards

Flashcards in Varicose veins Deck (30)
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What are the different types of varicose veins?

  • Primary
    • Uncomplicated saphenofemoral valvular incompetence
    • Greater saphenous distribution, positive tourniquet test
    • No stasis sequelae or morning ankle oedema
  • Secondary
    • Perforator venous incompetence 
    • Secondary to postphlebitic syndrome 


Clinical features of varicose veins?

  • Cosmetic issues
  • Worsening => pain, swelling, itch 
  • Varicosities in the course of the saphenous veins 
  • Features of venous insufficiency


What are the features of venous insufficiency?

  • Oedema
  • Varicose eczema 
  • Lipodermatosclerosis  
  • Haemosiderin skin staining


Complications of varicose veins?

  • Bleeding 
  • Ulceration
  • Thrombophlebitis


What is a saphena varix?

  • Dilatation of saphenous vein at saphenofemoral junction in the groin
  • Displays a cough impulse
  • Can be mistaken for a femoral hernia 
  • Tx: High saphenous ligation 


What is pictured here??

Varicose eczema 


What is pictured here??

  • Superficial thrombophlebitis 
    • Inflammatory process that causes a blood clot to form 


What is pictured here??

  • Lipodermatosclerosis
    • inverted champagne bottle 


Describe the classification of varicose veins?

  • CEAP classification
    • C => clinical features
    • E => etiology
    • A => anatomical
    • P => pathophysiology 


Describe the investigations into suspected varicose veins?

  • Duplex ultrasound (gold standard)
    • Assesses valve competence


What is pictured here??

  • Haemosiderin skin discolouration
    • Venous insufficiency 


Femoral hernia + varicosities in the rest of the limb = __________ ?

Saphena varix 


When should varicose veins be treated?

  • Refferred to a vascular service if:
    • Symptomatic
    • LL skin changes
    • Superficial vein thrombosis 
    • Venous leg ulcer 


Treatment for varicose veins?

  • Patient education
    • Prolonged standing, weight loss, increase exercise
  • Compression stockings
    • If interventional treatment is inappropriate 
  • Invasive treatments
    • Foam scleropathy 
    • Radiofrequency ablation
    • Ligation
      • High saphenous vein ligation 
      • Ligation of incompetent perforators


What investigation should be performed prior to compression bandaging?

Ankle-brachial pressure index 


What is Virchows triad?

  • Hypercoaguability
  • Stasis of venous blood flow 
  • Disruption of venous intimal lining


Describe Vein ligation?

  • Incision made in groin or popliteal fossa
  • Vein is identified, tyed off then stripped away
  • Surgeon should be aware of saphenous and sural nerves 


Describe Foam scleropathy?

  • Sclerosing agent injected directed into varicosed veins under US guidance
  • Inflammatory response closes off the vein
  • Only requires local anaesthetic 


Describe radiofrquency ablation?

  • Heating of the vein from the inside under US guidance
  • Irreversible damage to the vein which closes it off
  • Performed under local or general anaesthetic 


What is CEAP classification used for?

Assess manifestations of chronic venous disease


Describe the C component of CEAP classification?

  • C - clinical features
    • C0: No signs
    • C1: Telangiectasias, reticular veins
    • C2: Varicose veins
    • C3: Oedema
    • C4: Secondary skin alterations
      • C4a: Pigmentation, eczema or both 
      • C4b: Lipodermatosclerosis
    • C5: Healed venous ulcer
    • C6: Open venous ulcer 
  • A: asymptomatic
  • B: symptomatic 


Describe the E component of CEAP classification?

  • E - etiological
  • Ep: Primary (develops independent of othe diseases)
  • Es: Secondary to another disorder
  • Ec: congeital (present at birth)
  • En: Absence of identifed aetiology 


Describe the A component of CEAP classification?

  • A(s1-s5)
    • Superficial venous system
  • A(d6-16)
    • Deep venous system
  • A(p17-p18)
    • Perforating veins 
  • An
    • Unidentified anatomical location 


Describe the P component of CEAP classification?

  • P - pathophysiology 
    • Pr : Reflux
    • Po: Obstruction
    • Pro: Reflux/obstruction
    • Pn: Unidentified venous pathophysiology 


Describe the difference between a doppler and duplex ultrasound?

  • Duplex ultrasound
    • Valve competence
    • Meausre blood flow through the veins 
  • Doppler ultrasound
    • Pulses?


What is thrombophlebitis?

  • Inflammation of the vein
  • Usually caused by a blood clot 
  • Increased risk in someone with varicose veins 


Describe Postphlebitic syndrome?

  • Also known as post-thrombotic syndrome
  • Symptomatic chronic venous insuffieicny after DVT


Describe the Tourniquet test?

  • (if using fingers = Trendelenburg test)
  • Position patient flat
  • Elevated leg as far as posiible to empty superficial veins
  • Place a tourniquet over saphenofemoral junction
  • Ask patient to stand and observe for filling of the veins
    • If they do not fill -> venous valve incompetence at level of SFJ
    • If they do fill -> repeat 3cm down to find level of incompetence 


Describe stasis sequelae?

  • (stasis dermatitis)
  • Inflammation of the skin due to chronic venous insufficiency
  • Itching, scaling, hyperpigmentation 


Describe the process of haemosiderin deposition

  • Blood pools in the venous due to poor valvular function
  • Haem is broken down and the iron is stored in the tissues
    • Haemosiderin is an iron-storage complex