Venous and Lymphatic Disease

Question 1

Are deep varicose veins more serious than superficial varicose veins?

Answer 1

yes

Question 2

Can varicose veins be familiar ?

Answer 2

yes

Question 3

where are the two main sites where varicose veins form?

Answer 3

saphenofemoral junction

saphenopopliteal junction

Question 4

is the short or long saphenous vein more commonly affected? (and give percentages)

Answer 4

= long (80-87%)

short (21-30%)

Question 5

Are varicose veins more prevalence in women or males?

Answer 5

females

Question 6

What percentage of patients have combined varicose veins affecting the two junctions?

Answer 6

21%

Question 7

What occupations are more likely to have varicose veins?

Answer 7

people who stand up for long periods of time

• hair dressers
• teachers

Question 8

whats the reason thought to cause varicose veins on pregnant women?

Answer 8

• hormonal changes

- as well as weight changes

Question 9

state 7 symptoms of varicose veins

Answer 9

localised/ generalised discomfort 
nocturnal cramps 
swelling 
acute haemorrhage 
superficial thrombophlebitis 
pruritus 
skin changes (dry, red, ulcerated)

Question 10

state the one investigation done for varicose veins

Answer 10

duplex scan

Question 11

what are the chances varicose veins will occur again after being treated?

Answer 11

100%

Question 12

what are the two methods of superficial venous surgery

Answer 12

ligation of the sapheno-femoral or sapheno-popliteal junctions
vein stripping

Question 13

state some indications for intervention

Answer 13

patient has bad symptoms
superficial thrombophlebitis
signs of chronic venous insufficiency
bleeding

Question 14

State four contraindications for venous intervention

Answer 14

• arterial insufficiency
• previous DVT
• morbid obesity
• co-morbitity

Question 15

state 4 complications of venous intervention

Answer 15

• minor haemorrhage
• thrombophlebitis
• wound pain/infection
• damage to deep veins or nerves

Question 16

state three minimal invasive procedures done to treat varicose veins

Answer 16

Foam sclerotherapy
Endovenous laser ablation (EVLA)
Radio frequency ablation (VNUS)

Question 17

state 4 advantages of minimal invasive procedures compared to surgery

Answer 17

• less side effects
• reduced time off work
• doesn’t require an operating room
• local anaesthetic so reduces surgical trauma

Question 18

As well as surgery and minimal invasive procedures, what else can be done to treat varicose veins?

Answer 18

compression hosiery

Question 19

What is the definition of a leg ulcer ?

Answer 19

• breach in the skin between knee and ankle joint, present for over 4 weeks

Question 20

State two investigations done for chronic venous insufficiency ?

Answer 20

Duplex

ABPI

Question 21

state the pathophysiology of chronic venous insufficiency

Answer 21

• Venous hypertension
• High AVP -failure of muscle pump, valves, or outflow obstruction
• Venous engorgement and stasis
• Imbalance of Starling forces and fluid exudate
• Standing motionless - pressure at foot ~90mmHg
• Active movements: pressure falls to 30mmHg – pressure falls due to the muscle pump pushing the blood back up to the heart
• Known as ambulatory venous pressure (AVP)

Question 22

State 6 ways that chronic venous insufficiency can occur?

Answer 22

Ð	Superficial venous reflux
Ð	Deep venous reflux
Ð	Venous obstruction
Ð	Neuromuscular
Ð	Obesity
Ð	Inactivity

Question 23

What four ways can chronic venous insufficiency be treated?

Answer 23

compression hosiery (for oedema)
dressings (for ulcers)
systematic and topical steroids
exercise (calf muscle pump to increase venous return)

Question 24

what is Klippel-Trenaunay Syndrome

Answer 24

when the leg and foot is swollen due to lymphatic system

Question 25

What are the three primary phases of lymphoedema ?

Answer 25

Ð Congenital – from birth
Ð Praecox – occurs during puberty
Ð Tarda – rare and occurs after 35 years

Question 26

state four causes of secondary lymphoedema

Answer 26

Ð Malignancy
Ð Surgery (Radical mastectomy; groin/axillary dissection)
Ð Radiotherapy
Ð Infection (Filariasis/tuberculosis/pyogenic)

Question 27

State three treatments for lymphoedema

Answer 27

compression hosiery
elevation
manual compression

Question 28

what does lymphoedema look like?

Answer 28

swollen leg not foot

and usually only occurs in one leg