Venous.2. Varicose veins Flashcards
(172 cards)
1
Q
Varicose veins of the Lower Limbs
A
- Definition
- Incidence
- Etiology
- MORPHOLOGICAL PICTURE
- CLINICAL PICTURE
- INVESTIGATIONS
- TREATMENT
2
Q
Definition of Varicose veins of the Lower Limbs
A
Dilated, elongated & tortuous veins affecting the superficial venous system of the L.L.
3
Q
Incidence of Varicose veins of the Lower Limbs
A
5 - 10%
4
Q
Etiology of Varicose veins of the Lower Limbs
A
- Primary Varicose Veins
2. Secondary Varicose Veins
5
Q
Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
- Unknown
- Theories
- Aggravating factors
6
Q
Theories in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
- Significance
2. List
7
Q
Significance of Theories in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
neither of which satisfactorily explains all cases
8
Q
List of Theories in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
- The valvular incompetence theory
2. The weak wall theory
9
Q
The valvular incompetence theory in List of Theories in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
Postulates that incompetence of valves either in the main saphenous trunks or in the.communicating veins are responsible for the condition
10
Q
The weak wall theory in List of Theories in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
- Assumes an inherited weakness of the vein wall, producing venous dilatation even with normal pressures.
- Secondary valvular incompetence will occur
11
Q
Aggravating factors in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
- Female sex. The condition is commoner in females.
- High parity.
- Marked obesity.
- estrogens intake e.g. contraceptive pills
- Occupations requiring prolonged standing.
12
Q
Etiology of Secondary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
- Pregnancy : Most common cause
- Deep venous thrombosis
- Pelvic tumours
- Arterio-venous fistula
13
Q
pathogenesis of Pregnancy in Etiology of Secondary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
Oestrogen & progesterone cause smooth muscle vein wall relaxation
14
Q
Deep venous thrombosis in Etiology of Secondary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
- Pathogenesis
2. Timing
15
Q
Pathogenesis of Deep venous thrombosis in Etiology of Secondary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
Recanalization of the thrombosed deep veins leaves the valves of the deep system & perforating veins incompetent leading to reflux of blood.
16
Q
Timing of Deep venous thrombosis in Etiology of Secondary Varicose Veins in Etiology of Varicose veins of the Lower Limbs
A
Occurs 2-5 years after DVT.
17
Q
MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs
A
- Large vein varicosities :
- Reticular varicosities :
- Spider varicosities
18
Q
Large vein varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs
A
- Site
2. Diameter
19
Q
Site of Large vein varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs
A
Affecting the LSV or SSV themselves or one of their main tributaries.
20
Q
Diameter of Large vein varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs
A
Large in diameter : 5-15 mm.
21
Q
Reticular varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs
A
- Site
2. Diameter
22
Q
Site of Reticular varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs
A
Lying immediately beneath the skin.
23
Q
Diameter of Reticular varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs
A
1-5 mm in diameter
24
Q
Alternative name for Spider varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs
A
Telangiectasia
25
CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Symptoms
| 2. Examination
26
Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs
A) Early and mild cases
B) Late and severe cases
C) Determining factors
27
Early and mild cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Complain of
1. Cosmetic disfigurement
2. Swelling of the lower limb
3. Postural discomfort & dull aching pain of the limb
4. Night muscular cramps.
28
Swelling of the lower limb in Early and mild cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Usually at the end of the day
or
2. On prolonged standing.
29
Postural discomfort & dull aching pain of the limb in Early and mild cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Usually at the end of the day
or
2. On prolonged standing.
3. Relieved by leg elevation.
30
Late and severe cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Present with classical picture of chronic venous insufficiency
31
classical picture of chronic venous insufficiency in Late and severe cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1- Pigmentation, itching & eczema.
2. Venous ulcer.
3. Lipodermatosclerosis.
4. Venous claudication
32
Venous claudication in classical picture of chronic venous insufficiency in Late and severe cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Patients with severe CVI may develop claudication or bursting pain during walking
2. due to very high venous pressure
33
Determining factors of Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Severity and duration of venous hypertension
34
Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Status of Examination
2. Exposure
3. Points required to be fulfilled
35
Status of Examination in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
The patient should be examined while STANDING
36
Exposure in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
The patient should be exposed up to the umbilicus.
37
Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Determining
1. Etiology of Varicose veins
2. Which saphenous system is affected
3. The competency of the sapheno-femoral junction
4. The competency of the perforators
5. The condition of the deep system of veins
6. The presence of complications
38
Determining Etiology of Varicose veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Using
1. History
2. inspection
3. palpation
39
Using History in Determining Etiology of Varicose veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
In case of secondary Varicose veins
There will be history Of DVT, previous leg injury, fracture or abdominal surgery
40
Using inspection in Determining Etiology of Varicose veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
In case of secondary Varicose veins
1. Varicose veins may be arranged haphazardly
2. Presence of complications as oedema, eczema, or ulceration
3. Presence of veins crossing the inguinal ligament (with reversed flow)
41
Using palpation in Determining Etiology of Varicose veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Palpation of a thrill over the veins denotes the existence of an A-V fistula.
42
Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Using
1. Inspection
2. Tap lest
43
Using Inspection in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
The site & anatomical distribution of the varicosities
44
The site & anatomical distribution of the varicosities in Using Inspection in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Lateral and then posterior )> Short saphenous system
Medial )> Long saphenous system
Any varicosities above knee )> Long saphenous system even if lateral as no short saphenous above knee
45
Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
a. Chevrier test
| b. Schwartz's Test
46
Chevrier test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Steps
| 2. Results
47
Steps of Chevrier test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. With the patient erect, place the fingers of the left hand at the saphenous opening (or any vein above knee).
2. Percuss the main bunch of varicosities once with the right middle finger.
48
Results of Chevrier test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
If an upward wave of blood is perceived at the saphenous opening, this indicates that these varicosities belong to the LSS
49
Schwartz's Test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Steps
2. Results
3. Disadvantages
50
Steps of Schwartz's Test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
The saphenous vein is percussed by the index of one hand & palpated distally by the fingers of the other hand.
51
Results of Schwartz's Test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Only if the valves are incompetent, the wave is transmitted distally
52
Disadvantages of Schwartz's Test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Other opinion is that the impulse is transmitted along the vessel wall & not the blood column.
53
Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Using
1. Inspection
2. Palpation
3. Special tests
54
Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Saphena-varix may be present
55
Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Definition
2. Examination
3. Differential Diagnosis
56
Definition of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
This is saccular dilatation of upper end of great saphenous vein opposite incompetent sapheno-femoral valve.
57
Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Swelling with the following characters
1. Site
2. Size
3. Shape
4. Edge
5. Surface
6. Consistency
7. Color
8. Special character
58
Site of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
A. Subcutaneous mass in upper part of femoral triangle
B. 4 cm below & lateral to pubic tubercle
59
Size of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Variable
60
Shape of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
rounded or ovoid
61
Edge of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Well defined
62
Surface of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Smooth
63
Consistency of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
soft or cystic
64
Color of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
bluish
65
Special character of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Compressible
| 2. Expansible impulse and thrill on cough
66
Differential Diagnosis of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Femoral hernia ( 99% irreducible ) and other swellings of femoral triangle
67
Using Palpation in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Palpation of a thrill over sapheno-femoral junction on cough
2. denotes an incompetent sapheno-femoral junction
68
Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Trendlenburg test
| 2. Morrisey cough impulse test
69
Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Aim
2. Steps
3. Results
70
Aim of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
a. Detection of sapheno-femoral incompetence
| b. Detection of incompetence of communicating veins
71
Steps of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
a. The patient lies supine and raises his leg to empty the veins.
b. A venous tourniquet is applied just below the SFJ.
c. The patient is then asked stand up.
d. The tourniquet is then released after 10 seconds
72
Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Results when the tourniquet is still in place
| 2. Results when The tourniquet is then released after 10 seconds
73
Results when the tourniquet is still in place in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
a. NO varicosities appear
| b. The veins fill rapidly
74
NO varicosities appear in Results when the tourniquet is still in place in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Means Incompetent SFJ & competent perforators
75
The veins fill rapidly in Results when the tourniquet is still in place in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Means Incompetent perforators
| 2. In this case ONLY the multiple tourniquet test is done to identify the site of the incompetent perforators
76
Results when The tourniquet is then released after 10 seconds in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
a. The veins will fill slowly "minimum 10 seconds" from below upward (normal venous filling)
b. The veins will fill rapidly from below upward Or will fill from above downwards
77
The veins will fill slowly from below upward in Results when The tourniquet is then released after 10 seconds in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Means competent sapheno-femoral valve
78
The veins will fill rapidly from below upward Or will fill from above downwards in Results when The tourniquet is then released after 10 seconds in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Incompetent sapheno-femoral valve
79
Morrisey cough impulse test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Steps
| 2. Results
80
Steps of Morrisey cough impulse test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. The patient lies flat & elevate the limb for 30 degree
2. Ask the patient to cough forcibly.
81
Results of Morrisey cough impulse test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
If there is retrograde filling )> Incompetent SFJ
82
Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
a. Multiple tourniquet test
b. Manual Localization of Blow-Outs
c. Fegan's Method
83
Multiple tourniquet test in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Steps
| 2. Results
84
Steps of Multiple tourniquet test in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Application of three tourniquets
2. The patient is then asked to stand up
3. The tourniquets are released one by one from below upwards
85
Sites of Application of three tourniquets in Steps of Multiple tourniquet test in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. One below the knee.
2. The second at the junction of the lower third of the thigh with the upper two thirds.
3. The third tourniquet is just below the SFJ.
86
Results of Multiple tourniquet test in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Rapid filling beyond any segment indicates the site of incompetent perforator
87
Manual Localization of Blow-Outs in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Alternative name
2. Significance
3. Steps
4. Results
88
Alternative name for Manual Localization of Blow-Outs in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Two Fingers Test
89
Significance of Manual Localization of Blow-Outs in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Simple alternative test to multiple tourniquet test
90
Steps of Manual Localization of Blow-Outs in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Patient stands.
2. The 2 index are pressed at a point on great saphenous vein & then moved in opposing directions to empty a segment.
3. Whole vein is tested segment by segment from above down.
91
Results of Manual Localization of Blow-Outs in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. If this segment remains empty, it has no underlying blowout but
2. if it fills, an underlying blow-out exists.
92
Fegan's Method in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Steps
| 2. Results
93
Steps of Fegan's Method in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Mark the varicosities with a skin pen while the patient stands.
2. Ask him to lie down & raise the affected limb & rest the heel against the examiner's upper chest.
3. Palpate the line of the marked varicosities carefully for gaps in the deep fascia through which the perforating veins pass
94
Results of Fegan's Method in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Gaps in the deep fascia through which the perforating veins pass are felt as circular openings with sharp edges & are marked.
95
Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
a. Modified Perthe's test
b. Perthe's test ( not done as it's subjective)
c. Hoffman's modification of Modified Perthe's test :
96
Modified Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Steps
| 2. Results
97
Steps of Modified Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. While the patient is standing, a tourniquet is applied just below the SFJ
2. The patient is asked to walk quickly in situ for five minutes
98
Results of Modified Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
One of the following
1. Varicose veins disappear
2. Varicose veins become more engorged
99
Varicose veins disappear in Results of Modified Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
A. Deep system is patent & competent
B. 1ry Varicose veins or 2ry Varicose veins with canalized deep veins
100
Varicose veins become more engorged in Results of Modified Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
A. Deep system is occluded or incompetent
B. 2ry Varicose veins with uncanalized deep veins
101
Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Significance
2. Steps
3. Results
102
Significance of Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Not done as it's subjective
103
Steps of Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Patient lies down, his leg is raised & massaged to empty the V.V.
2. Elastic bandage is applied from toes to groin, to occlude superficial veins.
3. The patient then walks in situ for 10 min
104
Results of Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
One of the following
1. No pain
2. Pain occurs
105
No pain in Results of Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Means Deep system is patent.
106
Pain occurs in Results of Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Means Deep system is occluded
107
Hoffman's modification of Modified Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Argument
| 2. Modification
108
Argument in Hoffman's modification of Modified Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
If the patient is having incompetent perforators, modified Perthe's test will show venous engorgement even if the deep system is patent.
109
Modification in Hoffman's modification of Modified Perthe's test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
Application of the tourniquet just below the incompetent perforator & test the veins below.
110
Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Incidence of complications
| 2. List of complications
111
Incidence of complications in Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
more common with secondary Varicose veins
112
List of complications in Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
a. Recurrent superficial thrombophlebitis
b. Haemorrhage
c. CVI with its complications
113
Haemorrhage in List of complications in Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. Pathogenesis
| 2. Management
114
Pathogenesis of Haemorrhage in List of complications in Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
May occur due to rupture of a varicose vein especially when the overlying skin is thin.
115
Management of Haemorrhage in List of complications in Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs
1. It can be initially stopped by elevation and compression bandage.
2. Later treatment is by injection sclerotherapy
116
INVESTIGATIONS of Varicose veins of the Lower Limbs
1. Bedside test for competency of SFJ.
| 2. Gold standard Investigation
117
Bed side test for competency of SFJ in INVESTIGATIONS of Varicose veins of the Lower Limbs
Doppler
118
Gold standard Investigation in INVESTIGATIONS of Varicose veins of the Lower Limbs
Venous Duplex
119
TREATMENT of Varicose veins of the Lower Limbs
1. Aim
2. Management of primary Varicose veins
3. Management of Secondary Varicose veins
120
Aim of TREATMENT of Varicose veins of the Lower Limbs
Overcome venous congestion.
121
Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Conservative Treatment
2. Injection sclerotherapy
3. Surgical Treatment
4. Recent Modalities
122
Conservative Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Indications
| 2. Lines of management
123
Indications of Conservative Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Patients with minor varicosities.
| 2. High risk patients unfit for surgery.
124
Lines of management in Conservative Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
a. Reassurance & avoid prolonged standing.
b. Regular exercise is required
c. Compression elastic stockings are used
d. There is NOTHING called venotonic drugs
125
The reason why Regular exercise is required in Lines of management in Conservative Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Improve the muscle pump
| 2. Overcome mild venous hypertension.
126
Compression elastic stockings are used in Lines of management in Conservative Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Supports the Varicose veins
| 2. Abolishing the effect of venous reflux
127
Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Indications
2. Contraindications
3. Principle & Technique
4. The key point
5. Complications
128
Indications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
a. Cosmetic for reticular veins.
b. Residual varicosities after operation.
c. Small localized bunch of varicosities via a single perforator.
129
Contraindications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
a- Pregnancy.
b. 2ry V.V with uncanalized deep system
130
Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Injection of Sclerosant material in an empty vein
2. Compression by elastic bandage
3. Instructing The patient to walk for a long distance
131
Sclerosant material in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
A. Sodium tetradecyl sulfate "STD
or
B. 5% ethanolarnine oleate.
132
The reason of Injection of Sclerosant material in an empty vein in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. To induce injury of the endothelial layer of intima.
2. If injection is done with the vein full of blood, thrombosis will occur which later recanalizes with recurrence of V.V.
133
Compression by elastic bandage in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Site of application
2. Duration of application
3. The reason of application
134
Site of application of Compression by elastic bandage in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
Applied immediately over the whole leg from the toes to the knee
135
Duration of application of Compression by elastic bandage in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
is left for 4-6 weeks.
136
The reason of application of Compression by elastic bandage in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
to let the two walls of the vein adhere together
137
Instructing The patient to walk for a long distance in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Timing
| 2. The reason
138
Timing of Instructing The patient to walk for a long distance in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
Immediately after application of the bandage
139
The reason of Instructing The patient to walk for a long distance in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
in order to flush any amount of sclerosant that might have reached the deep veins.
140
The key point of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
is that the saphenofemoral junction should be competent To avoid regurge of blood and recanalization of the sclerosed vein
141
Complications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Extravasation of sclerosant material under the skin
| 2. DVT
142
Extravasation of sclerosant material under the skin in Complications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
Leads to
1. Sloughing of the skin
2. Poor cosmetic results
143
DVT in Complications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Pathogenesis
| 2. Guarding against DVT
144
Pathogenesis of DVT in Complications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
May occur if a large amount of the sclerosant material reaches the deep system undiluted
145
Guarding against DVT in Complications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. No more than 1 ml is injected at any point
| 2. No injection is done above the knee.
146
Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
A. Trendelenburg's operation
B. Stripping of the Long saphenous vein
C. Triple ligation of incompetent perforators
147
Steps of Trendelenburg's operation in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. FLUSH disconnection of the LSV from the femoral vein
2. Ligation and dividing of All tributaries of the LSV near the saphenous opening to avoid recurrence
3. Some surgeons routinely do Stripping of the LSV above the knee with Trendelenburg's operation to avoid recurrence even if the LSV was healthy with no varicosities.
148
Meaning of FLUSH disconnection of the LSV from the femoral vein in Steps of Trendelenburg's operation in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. No saphenous stump
| 2. To avoid recurrence from this stump
149
Oral question
How to differentiate between saphenous and femoral intraoperative ?
Saphenous vein has tributaries while femoral vein has no tributaries in this area
150
Steps of Stripping of the Long saphenous vein in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Start with Trendlenburg's operation
2. The long saphenous is stripped
3. Extent of Stripping
151
Extent of Stripping in Steps of Stripping of the Long saphenous vein in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
One of the following
1. Stripping from the medial malleolus to the groin
2. Stripping is usually performed to a hand-breadth just below the knee
152
The reason why Stripping is usually performed to a hand-breadth just below the knee in Extent of Stripping in Steps of Stripping of the Long saphenous vein in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. as below this the saphenous nerve is more closely related to the vein
2. Resulting in an increased risk of injury )> Unaccepted paresthesia & numbness in the medial aspect of the leg & foot
153
Triple ligation of incompetent perforators in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Transverse incision is made over each one.
2. Application of 3 ligatures on the perforator and on the saphenous vein above and below
3. Excision of The intervening T segment
154
Components of The intervening T segment in Triple ligation of incompetent perforators in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
Part of superficial system and part of perforator
155
Recent Modalities in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Hook phlebectomy
2. EVLA: Endovenous laser ablation.
3. RFA : Radiofrequency ablation.
4. Valvuloplasty.
156
Hook phlebectomy in Recent Modalities in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Alternative name
2. Indications
3. Contraindications
157
Alternative name for Hook phlebectomy in Recent Modalities in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
Ambulatory phlebectomy
158
Indications of Hook phlebectomy in Recent Modalities in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Residual varicosities
2. Reticular varicosities
3. Varicosities of Tributaries of long and short saphenous
159
Contraindications of Hook phlebectomy in Recent Modalities in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Varicosities of the main trunk of LSV and SSV
| 2. Reflux in sapheno-femoral junction )> recurrence
160
Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Treatment of post phlebitic Varicose veins
2. Treatment of Varicose veins complicating acquired A-V fistula
3. Treatment of Varicose veins complicating Congenital A-V fistula
4. Treatment of Varicose veins occurring during pregnancy
161
Treatment of post phlebitic Varicose veins in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
Management of :
1. The majority of cases
2. Some rare cases with large varicosities
162
Management of The majority of cases in Treatment of post phlebitic Varicose veins in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
Conservative Treatment by ELASTIC STOCKING.
163
Management of Some rare cases with large varicosities in Treatment of post phlebitic Varicose veins in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Require active treatment
2. Precautions of active treatment
3. Treat as primary varicose veins in cases of recanalized deep system
164
Precautions of active treatment in Management of Some rare cases with large varicosities in Treatment of post phlebitic Varicose veins in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
Verifying recanalization of the deep system Clinically and by duplex
165
The reason of Verifying recanalization of the deep system Clinically and by duplex in Precautions of active treatment in Management of Some rare cases with large varicosities in Treatment of post phlebitic Varicose veins in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
because Surgery will be contraindicated if the deep system is occluded as the superficial system has the main role in venous drainage of the Lower limb
166
Treatment of Varicose veins complicating acquired A-V fistula in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Surgical treatment of the fistula is usually followed by marked regression of varicosities.
2. If residual veins remain, treat as primary varicose veins
167
Treatment of Varicose veins complicating Congenital A-V fistula in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Conservative Treatment
| 2. Precautions
168
Precautions of Treatment of Varicose veins complicating Congenital A-V fistula in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. It is important to know that deep venous system hypoplasia or aplasia are common with congenital fistulae
2. Removal of the superficial Varicose veins may lead to a disaster "venous gangrene" as they may be the only veins draining the L.L
169
Treatment of Varicose veins occurring during pregnancy in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. A complete ELASTIC STOCKING
| 2. After labour any residual veins are treated as 1ry Varicose veins
170
A complete ELASTIC STOCKING in Treatment of Varicose veins occurring during pregnancy in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
1. Site of application
| 2. Duration
171
Site of application of A complete ELASTIC STOCKING in Treatment of Varicose veins occurring during pregnancy in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
from the toes up to the groin
172
Duration of A complete ELASTIC STOCKING in Treatment of Varicose veins occurring during pregnancy in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs
Applied all through the period of pregnancy.
