varicose veins Flashcards
what are varicose veins?
Varicose veins are tortuous dilated segments of vein associated with valvular incompetence.
what is the pathophysiology for varicose veins?
from incompetent valves which permit blood flow from the deep venous system to the superficial venous system e.g at sapheno-femoral and sapheno-popliteal junction
this results in venous hypertension and dilation of the superficisal venous system
what are the causes of varicose veins?
most are primary idiopathic varicose veins
secondary causes include
- DVT
- pelvic masses e.g pregnancy, uterine fibroids and ovarian masses
- arteriovenous malformations
what are the risk factors for developing varicose veins?
- prolonged standing
- obesity
- pregnancy
- family history
what are the clinical features of varicose veins?
usually present with cosmetic issues
worsening veins may cause
- pain
- aching
- swelling (worse on standing or at the end of the day)
- itching
subsequent complications may include
- skin changes
- ulceration
- thrombophlebitis
- bleeding
may also cause signs and symptoms of venous insufficiency
on examination, where will varicosities present?
in the course of the great and / or short saphenous veins
what are the clinical features of venous insufficiency?
- oedema
- varicose eczema
- thrombophlebitis
- ulcers (usually over medial malleolus)
- haemosiderin staining
- lipdormatosclerosis
- atrophie blanche
what is a saphena varix and how is it identified?
dilation of the saphenous vein at the saphenofemoral junction in the groin
displays on cough impulse. however is commonly mistaken for a femoral hernia
can identify with a duplex US, and manage with high saphenous ligation
what investigations are done into varicose veins?
- duplex US is gold standard
- it asses valve incompetence and great/short saphenous veins and any perforators
- also will look for deep venous incompetence, occlusion and stenosis
how do varicose veins form ulcers?
A venous ulcer, sometimes called a varicose ulcer, is a leg wound that happens when the leg veins don’t circulate blood back toward the heart. Blood can back up in the veins, building up pressure on the skin, which can cause an open sore to form.
what non invasive management can be done for varicose veins?
- patient education e.g avoid prolonged standing, weight loss, increased exercise to promote calf muscle action
- compression stocking only if interventional treatment is not appropriate as need to be worn forever
- venous ulceration from deep venous incompetence will need for layer bandaging to compress
what are the criteria for surgical treatment of varicose veins?
- symptomatic
- lower limb skin changes e.g eczema or pigmentation
- superficial vein thrombosis (get hard, painful veins) with suspected venous incompetence
- venous leg ulcer (a break in the skin below the knee that hasn’t healed within 2 weeks)
what are the surgical treatment options for varicose veins?
- vein ligation, stripping and avulsion
- foam sclerotherapy. Inject irritating agent into varicosed vein, causing an inflammatory response that closes of the vein. Do under US guidance.
- thermal ablation. The vein is heated from the inside via radio frequency or laser catheter. damages the vein and closes it off. Done under US guidance.
Which term describes the tapering of the legs above the ankles (“inverted champagne bottle”)?
lipodermatosclerosis
Which investigation should be performed prior to compression bandaging?
ABPI
