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3: Surgery Y3 - Vascular [20] > [1] Varicose Veins > Flashcards

[1] Varicose Veins Flashcards

1
Q

What are varicose veins?

A

Tortuous dilated segments of vein associated with valvular incompetence

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2
Q

What do varicose veins arise from?

A

Incompetent valves

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3
Q

How do incompetent valves lead to varicose valves?

A

Incompetent valves permit blood flow from the deep venous system to the superficial venous system, resulting in venous hypertension and dilation of the superficial venous system

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4
Q

Where does blood flow from the deep venous system to the superficial venous system?

A

At the saphenous-femoral junction and sapheno-popliteal junction

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5
Q

What % of varicose veins are primary idiopathic varicose veins?

A

98%

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6
Q

What are the secondary causes of varicose veins?

A
  • DVT
  • Pelvic masses
  • Arteriovenous malformations
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7
Q

Give 3 examples of pelvic masses that can lead to varicose veins?

A
  • Pregnancy
  • Uterine fibroids
  • Ovarian masses
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8
Q

What is the age-adjusted prevalence rate for varicose veins?

A

40% in men

32% in women

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9
Q

What % of women with varicose veins are affected during or after pregnancy?

A

40%

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10
Q

By how much does the risk of varicose veins increase per year?

A
  1. 9% in men

2. 6% in women

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11
Q

What are the risk factors for the development of varicose veins?

A
  • Prolonged standing
  • Obesity
  • Pregnancy
  • Family history
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12
Q

How will patients typically present with varicose veins?

A

Cosmetic issues, such as unsightly visible veins or discolouration of the skin

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13
Q

What symptoms may be caused by worsening varicose veins?

A
  • Pain
  • Itching
  • Swelling (often worse on standing or at the end of the day)
  • Aching
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14
Q

What are the subsequent complications of varicose veins?

A
  • Skin changes
  • Ulceration
  • Thrombophlebitis
  • Bleeding
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15
Q

Does cosmetic issues alone qualify for treatment of varicose veins?

A

Not in UK

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16
Q

What will be found on examination in varicose veins?

A

Varicosities in the courses of the great and short saphenous veins

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17
Q

What symptoms of venous insufficiency might varicose veins present with?

A
  • Oedema
  • Varicose eczema or thrombophlebitis
  • Ulcers
  • Haemosiderin skin staining
  • Lipodermatosclerosis
  • Atrophie blanche
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18
Q

Where do ulcers typically appear in varicose veins?

A

Over the medial malleolus

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19
Q

What is lipodermatosclerosis?

A

Tapering of the legs above the ankles, in an ‘inverted champagne bottle’ appearance

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20
Q

What is a saphena varix?

A

A dilation of the saphenous vein at the saphenofemoral junction in the groin

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21
Q

What is saphena varix commonly mistaken for?

A

A femoral hernia

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22
Q

Why is saphena varix commonly mistaken for a femoral hernia?

A

Because it displays a cough impulse

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23
Q

When should suspicion be raised of a saphena varix?

A

In any suspected femoral hernia if the patient has concurrent varicosities present in the rest of the limb

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24
Q

How can saphena varix best be identified?

A

Via duplex ultrasound

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25
Q

What is the management for saphena varix?

A

High saphenous ligation

26
Q

What are the main differentials to consider to any varicose disease?

A
  • Cellulitis
  • DVT
  • Ischaemic ulcers
27
Q

What is the gold standard for varicose vein investigations?

A

Via duplex ultrasound

28
Q

What is the purpose of duplex ultrasound in varicose veins?

A

It assessed valve incompetence at the great/short saphenous veins, and any perforators

29
Q

What must be actively looked for on duplex ultrasound?

A
  • Deep venous incompetence
  • Occlusion (DVT)
  • Stenosis
30
Q

What is the problem with managing varicose veins with a concurrent DVT?

A

You cannot treat their superficial incompetence, as the venous blood will have no route back

31
Q

What is the result of the difficulty of treating varicose veins with concurrent DVT?

A

Any patient with deep vein incompetence is typically offered non-surgical management

32
Q

What patient education can be provided in varicose veins?

A
  • Avoid prolonged standing
  • Loose weight
  • Increase exercise
33
Q

What non-invasive treatments are recommended for varicose veins?

A

Compression stockings

34
Q

When does NICE recommend the use of compression stockings?

A

Only when interventional treatment is not appropriate

35
Q

Why are compression stockings only used in varicose veins if interventional treatment is inappropriate?

A

Because although they are good at preventing complications of varicose veins, they need to be worn for the rest of the patients life

36
Q

What management does venous ulceration generally require?

A

4-layer bandaging

37
Q

What is the purpose of graduated compression in venous ulceration?

A

It aims to move blood from distally to proximally

38
Q

When is graduated compression not used in venous ulceration?

A

When there is arterial insufficiency (based on ABPI measurement of less than 0.7)

39
Q

What is the problem with arterial insufficiency being a contraindication for graduated compression?

A

It often excludes graduated compression as a treatment option

40
Q

How often is graduated compression performed in venous ulceration?

A

Once or twice a week

41
Q

Why is graduated compression treatment expensive?

A

Because of the price of bandages, and the time required to apply them over potentially a lifetime

42
Q

What are the NICE criteria for referral to a vascular service?

A
  • Symptomatic primary or recurrent varicose veins
  • Lower-limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency
  • Superficial vein thrombosis with suspected venous incompetence
  • Venous leg ulcer
43
Q

What is a superficial vein thrombosis characterised by?

A

The appearance of hard, painful veins

44
Q

What are the treatment options for varicose veins?

A
  • Vein ligation, stripping, and avulsion
  • Foam sclerotherapy
  • Thermal ablation
45
Q

What happens in vein ligation, stripping, and avulsion?

A

An incision is made in the groin (or popliteal fossa) and the responsible, refluxing vein is identified, tied off, and stripped away.

46
Q

What must the surgeon be aware of in vein ligation, stripping, and avulsion?

A

The surrounding arterial and nervous structures, such as the saphenous and sural nerves

47
Q

What happens in foam scleropathy?

A

A sclerosing (irritating) agent is injected directly into the varicosed veins, causing an inflammatory response that closes off the vein

48
Q

What imaging guidance is foam scleropathy performed under?

A

Ultrasound

49
Q

Why is foam scleropathy done under ultrasound guidance?

A

To ensure the foam does not enter the venous system

50
Q

What anesthetic does foam scleropathy require?

A

Only local anaesthetic

51
Q

What does thermal ablation involve?

A

Heating the vein from inside (via radiofrequency or laser catheters), causing irreversible damage to the vein which closes it off

52
Q

What imaging guidance is thermal ablation performed under?

A

Ultrasound

53
Q

What anaesthetic is used for thermal ablation?

A

Local or general

54
Q

What is thermal ablation often performed with?

A

Multiple avulsion of visible varicose veins

55
Q

What will happen to untreated varicose veins?

A

They will worsen over time

56
Q

What will happen to many patients who have treated varicose veins?

A

They will require re-intervention surgery

57
Q

What typical complications can be seen post-operatively in varicose veins?

A
  • Haemorrhage
  • Thrombophlebitis
  • DVT
  • Disease recurrence
  • Nerve damage
58
Q

Which procedure is thrombophlebitis an important complication of?

A

Foam or ablation treatments

59
Q

What procedure is DVT an important complication in?

A

Any endovascular treatments

60
Q

Which nerves specifically are at risk after DVT treatment?

A

Saphenous or sural nerves

3: Surgery Y3 - Vascular [20] (10 decks)

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