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Vascular Surgery > Venous Diseases > Flashcards

Venous Diseases Flashcards

1
Q

What are varicose veins?

A

Tortuous dilated segments of vein associated with valvular incompetence

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2
Q

What is the most common cause for varicose veins?

A

Primary idiopathic

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3
Q

Name some secondary cause of varicose veins?

A

DVT
Pelvic masses (pregnancy, fibroids, ovarian masses)
Ateriovenous malformations

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4
Q

What are the risk factors for varicose veins?

A

Prolonged standing
Obesity
Pregnancy
Family history

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5
Q

What are the some presentations of varicose veins?

A

Cosmetic issues

Aching/itching

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6
Q

Some complications of untreated varicose veins?

A 
Skin changes
Ulceration 
Thrombophlebitis 
Bleeding 
Venous insufficiency
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7
Q

What is saphena varix?

A

Dilation of the saphenous vein at the sphenofemoral junction in the groin - cough impulse

May be mistaken for femoral hernia

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8
Q

How do you distinguish saphena varix and femoral hernia?

A

Saphena varix :
Concurrent varicosities
Duplex ultrasound can be used and treatment is high saphenous ligation

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9
Q

What is used to classify varicose veins?

A

CEAP classification

Clinical features, aEtiology, Anatomical, Pathophysiology

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10
Q

Which two veins are commonly affecting in varicose veins?

A

Great/short saphenous veins

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11
Q

What is the gold standard investigation for varicose veins?

A

Duplex ultrasound

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12
Q

What are the non-invasive management options for varicose veins?

A

Patient education - avoid prolonged standing, weight loss, increase exercise
Compression stockings - check ABPI first, lifelong
For venous ulcerations - 4-layer bandaging unless evidence or arterial insufficiency.

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13
Q

What are the criteria for referral to vascular team for varicose veins?

A

Symptomatic primary or recurrent varicose veins
Lower-limb skin changes - chronic venous insufficiency
Superficial vein thrombosis - hard painful veins
Venous leg ulcer - below knee not healed after 2 week s

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14
Q

What surgical treatment is available for varicose veins?

A

Vein litigation and avulsion
Foam sclerotherapy
Thermal ablation

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15
Q

Name some complications of surgery for varicose veins

A 
Haemorrhage 
Thrombophlebitis 
DVT 
Disease recurrence 
Nerve damage - saphenous or sural nerves)
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16
Q

What is deep venous insufficiency?

A

Chronic disease commonly caused by DVT/valvular insufficiency together with varicose veins

It is part of chronic venous insufficiency

17
Q

What causes deep venous insufficiency?

A

Failure of the venous system
Causes:
Primary - underlying defect to the vein or valvular e.g. congenital and connective tissue disorder
Secondary - due to damage e.g. post-thrombotic, trauma and post-phlebitic disease

18
Q

What are the risk factors for DVI?

A 
Increasing age
Female gender 
Pregnancy 
FH
Long periods of standing 
Obesity 
Smoking 
Previous history
19
Q

What are the clinical feature of DVI?

A

Chronically swollen lower limbs - aching, pruritic and painful
Venous claudication - pain worse on walking but doesn’t stop working, progressive through day and relived by rest.

20
Q

What signs may be present on examination on someone with DVI?

A 
Thrombophlebitis 
Haemosiderin staining 
Lipodermatosclerosis 
Atrophie Blanche 
Pedal oedema 
Venous ulcers
21
Q

What are patients who have had a previous DVT at risk of?

A

Post-thrombotic syndrome

Use villalta scale to assess progression with treatment

22
Q

What are the differential diagnosis with leg swelling for DVI?

A

Renal, hepatic and cardiac disease

23
Q

What is the primary investigations for DVI?

A

Doppler ultrasound
Routine bloods
Documentation of foot pulses and ABPI

24
Q

What is the conservative management for DVI?

A

Compression stockings and suitable analgesia control

Elevate feet above level of heart to reduce symptoms

25
Q

What are the surgical options available for DVI?

A

Valvuloplasty only in deteriorating symptoms

Venous stenting — most severe symptoms when iliac vein becomes occluded

26
Q

What are the complications of DVI?

A

Swelling, recurrent cellulitis, chronic pain, ulceration , DVT

27
Q

What is venous gangrene?

A

It is when there is a significant occlusion of the venous system that the blood flow backs up into the arterial system and leads to gangrene.

28
Q

What is the CEAP classification of varicose veins?

A 
C1 - cosmetic concern only 
C2 - ache/pan +/- other symptoms e.g. heaviness/tiredness, restless legs, pruritus 
C3 - swelling 
C4a - Phlebitis 
C4b - eczema 
C5 - healed ulcers 
C6 - active ulcers
29
Q

What are some venous related issues for varicose veins?

A 
Reduced mobility -OA 
Thrombophilia - malignancy 
Venous obstruction - intra-abdominal mass, previous IVDA -intravenous drug addict 
Fluid retention 
Medications
30
Q

What is superficial thrombophlebitis?

A

Inflamed varicose veins. Leading to pain and aching. Very tender to touch and doesn’t change when moving around or walking.

Vascular Surgery (3 decks)

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