Varicose veins

Question 1

What is VV?

Answer 1

• dilated superficial veins commonly found on the lower limbs
• associated with valvular incompetence

Question 2

What are the causes of VV?

Answer 2

• idiopathic (98%)
• deep venous thrombosis
• pelvic masses
  
  • pregnancy
  • uterine fibroids
  • ovarian masses
• arteriovenous malformations
  
  • Klippel-Trenaunay Syndrome

Question 3

What is the Px of VV?

Answer 3

1. incompetent valves permit blood flow from the deep venous system to the superficial venous system
2. venous hypertension
3. dilatation of the superficial venous system

Question 4

Which junctions would valves be commonly incompetent?

Answer 4

• saphenofemoral
• saphenopopliteal

Question 5

What are the RF of VV?

Answer 5

• Age
• Pregnancy
• Obesity
• Female gender
• Previous DVT
• Prolonged standing

Question 6

What are the sx of VV?

Answer 6

• asymptomatic
• cosmetic issues
• Pain / tenderness
• Pruritus
• Cramps
• Restless legs
• Bleeding

Question 7

What are the signs of VV?

Answer 7

• Dilated superficial veins
• Bleeding
• Lipodermatosclerosis
• Venous eczema
• Ulcers
• Haemosiderin deposition

Question 8

What is saphena varix?

Answer 8

• dilatation of the saphenous vein at the saphenofemoral junction in the groin
• displays a cough impulse - commonly mistaken for a femoral hernia

Question 9

What classification is used for VV?

Answer 9

• CEAP classification

Question 10

What does the CEAP classification stand for?

Answer 10

• Clinical feature
• aEtiology
• Anatomical
• Pathophysiology

Question 11

What ix woudl you order for VV?

Answer 11

• DUS

Question 12

What are the criterias for vascular surgery referral in VV?

Answer 12

• Symptomatic primary or recurrent varicose veins
• Skin changes (hyperpigmentation, venous eczema) related to chronic venous insufficiency
• Superficial vein thrombosis and suspected venous incompetence.
• Active venous ulcer
• Healed venous leg ulcer.

Question 13

How would you conservatively Mx VV?

Answer 13

• avoiding prolonged standing
• weight loss, and increase exercise
• compression stockings
  
  • if interventional treatment is not appropriate
  • arterial disease excluded
• four-layer bandaging - for venous ulceration

Question 14

What are the surgical options for VV?

Answer 14

• Vein ligation, stripping, and avulsion
• Foam sclerotherapy
• Endothermal ablation
• Phlebectomy

Question 15

What are the postoperative cx of VV surgeries?

Answer 15

• haemorrhage
• thrombophlebitis
• DVT
• disease recurrence
• nerve damage

Question 16

What procedures are contraindicated in inflamed/thrombophlebitic veins?

Answer 16

• Endovenous laser ablation (EVLA)
• Superficial vein sclerotherapy

Question 17

When will you refer VV pt to secondary care?

Answer 17

• significant lower limb symptoms
  
  • pain
  • swelling
  • bleeding
  • significant skin changes,
  • ulcers or thrombophlebitis

Question 18

Which vein is commonly affected in VV?

Answer 18

• Long saphenous vein