Flashcards in Venous and Lymphatic Disease Deck (40)
What is the main function of the venous system?
To carry oxygen depleted blood which is rich in metabolism waste products back to the heart
Where do superficial veins drain from?
Drain from superficial tissues into deeper veins which then drain back to the heart
What do veins contain that prevent the back flow of blood?
When do varicose veins occur?
When blood which should drain superficial to deep backflows and takes the route of least resistance, due to leaky valves within the veins
Why do primary varicose veins occur?
Due to valvular dysfunction
What vessels become varicose veins?
Greater saphenous veins 80-87%
Lesser saphenous veins 21-30%
What is the prevalence of varicose veins?
20-25% in females
10-15% in males
How many procedures are done in the UK per year for varicose veins?
What percentage of people who have operations for their varicose veins will have recurrent varicose veins?
What features of the history are important in a patient with varicose veins?
Age when veins appeared
Pregnancies - especially twins and big babies
Previous DVT, major trauma or suspected DVT
Signs and symptoms
What are the signs and symptoms of varicose veins?
Largely a cosmetic problem - unhappy with the appearance
Localised or general discomfort in the leg
Acute haemorrhage - itching, sports, trauma
Skin changes e.g. venous eczema, lipodermatosclerosis
What is the standard investigation for varicose veins?
Doppler ultrasound scan of the leg/vein
What are the indications for intervention in varicose veins?
Signs of chronic venous insufficiency
Cosmetic issues (more likely to be treated privately)
Anxiety that disease might progress
What are the treatment options for varicose veins?
Surgery - high tie, stripping, multiple stab avulsions
Minimally invasive procedures
What are minimally invasive procedures for the treatment of varicose veins dependent on?
Shape of the vein - requires a long straight vein
What are the relative contraindications for superficial venous surgery?
What are the conventional venous surgical methods, done under general anaesthetic?
Ligation of the sapheno-femoral or sapheno-popliteal junctions
Vein stripping and multiple stab avulsions
Perforate invaginate stripping
What are the possible complications of superficial venous surgery?
Wound problems, severe pain
Sural/saphenous nerve damage
Damage to deep veins/arteries/nerves
What are the minimally invasive treatment options for main trunk varicosities?
Foam sclerotherapy - chemical reaction with endothelium
Endovenous laser ablation (EVLA) - thermal ablation
Radiofrequency ablation (VNUS) - thermal ablation
What are the benefits of local anaesthetic minimally invasive treatment options?
Reduce superficial trauma - no incisions, less pain, bruising and scarring reduced
Reduce time off work
Don't require operating theatre
Potential to increase patient throughput
Short to medium-term results just as effective clinically as surgery
Cost effectiveness and long-term results not yet known
What is involved in the laser EVLA technique?
Micro-puncture needle inserted into the incompetent long or short saphenous vein using ultrasound
Guidewire introduced and manoeuvred to the saphenous junction within the deep vein using ultrasound
Catheter and laser fibre introduced over the guidewire to 1cm below the junction
How does closure VNUS work?
Heats vein to 85 degrees celsius
What is involved in the foam sclerotherapy technique?
Needle inserted into the incompetent veins under ultrasound control
Foam injected, prevented from entering deep venous system
Give examples of chronic venous insufficiency
Hypopigmentation - atrophie blanche
What is the pathophysiology of chronic venous insufficiency?
Venous engorgement and stasis
Imbalance of Starling forces and fluid exudate
What is the ambulatory venous pressure (AVP)?
Pressure in the foot is 90mmHg when standing motionless, this falls to 30mmHg with active movements - this is known as AVP
How does high AVP result in venous hypertension?
High ambulatory venous pressure results in failure of muscle pump or valves, or outflow obstruction leading to venous hypertension
What are the possible aetiologies of chronic venous insufficiency?
Failure of calf muscle pump
Superficial venous reflux
Deep venous reflux
What is a leg ulcer?
Breach in the skin between the knee and ankle joint which is present for over 4 weeks