226 Varicose veins Flashcards
Which 2 veins join to become the common femoral vein?
Profunda vein Superficial femoral vein
Where in the leg does the profunda vein and superficial femoral vein join to form the common femoral vein?
Just distal to the inguinal ligament
Which vein joins the common femoral vein at the inguinal ligament?
Long saphenous vein
What prevents the blood draining back into the superficial veins from the deeper veins?
Valves in the perforating veins
What is the result of incompetence of the valves in the communicating veins of the lower limbs?
Deep to superficial incompetence - reflux of blood into the superficial system with excercise
What can deep-to-superficial incompetence in the lower limbs lead to?
Lipodermatosclerosis
Was is the prevalence of varicose veins?
2%
What can a chronic venous hypertension lead to in the skin?
Marjolins ulcer - aggressive ulcerating SCC arising from an area of chronic ulceration
Which 2 sites in the lower limb do deep-to-superficial incompetence occur?
Sapheno-feoral junction Sapheno-popliteal junction
Name 2 things which can cause secondary varicosities
Obstruction Thromboinflammatory destruction of valves
Why is multiple pregnancy a R/F of varicosities?
Hormonal effects of progesterone and oestrogen causing relaxation of smooth muscle
What is the normal plasma oncotic pressure in venular ends of capillary loops?
25mmHg
What causes skin ulceration in chronic venous hypertension?
Accumulation of interstiitial oedema + impaired oxygen delivery to cells -> breaks down under minor trauma + egress of plasma and RBCs into surrounding tissues
What causes sterile inflammation in lipodermatosclerosis?
Macrophages attacking plasma proteins which have leaked from the circulation causing an immune response
How should sterile inflammation in lipodermatosclerosis be treated?
Anti-inflammatory agents
What causes pigmentation in lipodermatosclerosis?
Destruction of leaked RBCs by macrophages causing breakdown of Hb into haemosiderin which is brown.
What is ‘atrophie blanche’?
Atrophy of the skin in chronic venous insufficiency with depletion of normal pigment cells causing white patches
Name 2 microscopic changes of lipodermatosclerosis which stem from the venous hypertension (4 listed)
- Decrease in number of capillaries (+ dilation and tortuosity) - Trapping of white cells in capillary loops - Peri-capillary deposition of a cuff of fibrin - Increased no.s of extravasated leucocytes
What is the trap hypothesis?
Physical presence of fibrinogen and alpha-2-macroglobulin binds GFs both causing tissue repair in chronic venous hypertension
What is Perthe’s test?
Torniquet placed around the patients thigh at pressure higher than superficial venous system but lower than arterial - more discomfort felt.
What can cause a thrombophlebitis in varicose veins?
Clot
Which venous system is affected here?
Long saphenous system
What is the trendelenberg test?
Patient supine and leg angled at 45 degrees, milk down vein and apply torniquet distal to sapheno-femoral junction.
What is continuous wave ultrasound used to detect in varicosities?
Reflux after accelerated flow is suspended (squeezing calf and then letting go)
