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JG Year 2 > 226 Varicose veins > Flashcards

226 Varicose veins Flashcards

1
Q

Which 2 veins join to become the common femoral vein?

A

Profunda vein Superficial femoral vein

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2
Q

Where in the leg does the profunda vein and superficial femoral vein join to form the common femoral vein?

A

Just distal to the inguinal ligament

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3
Q

Which vein joins the common femoral vein at the inguinal ligament?

A

Long saphenous vein

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4
Q

What prevents the blood draining back into the superficial veins from the deeper veins?

A

Valves in the perforating veins

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5
Q

What is the result of incompetence of the valves in the communicating veins of the lower limbs?

A

Deep to superficial incompetence - reflux of blood into the superficial system with excercise

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6
Q

What can deep-to-superficial incompetence in the lower limbs lead to?

A

Lipodermatosclerosis

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7
Q

Was is the prevalence of varicose veins?

A

2%

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8
Q

What can a chronic venous hypertension lead to in the skin?

A

Marjolins ulcer - aggressive ulcerating SCC arising from an area of chronic ulceration

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9
Q

Which 2 sites in the lower limb do deep-to-superficial incompetence occur?

A

Sapheno-feoral junction Sapheno-popliteal junction

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10
Q

Name 2 things which can cause secondary varicosities

A

Obstruction Thromboinflammatory destruction of valves

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11
Q

Why is multiple pregnancy a R/F of varicosities?

A

Hormonal effects of progesterone and oestrogen causing relaxation of smooth muscle

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12
Q

What is the normal plasma oncotic pressure in venular ends of capillary loops?

A

25mmHg

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13
Q

What causes skin ulceration in chronic venous hypertension?

A

Accumulation of interstiitial oedema + impaired oxygen delivery to cells -> breaks down under minor trauma + egress of plasma and RBCs into surrounding tissues

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14
Q

What causes sterile inflammation in lipodermatosclerosis?

A

Macrophages attacking plasma proteins which have leaked from the circulation causing an immune response

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15
Q

How should sterile inflammation in lipodermatosclerosis be treated?

A

Anti-inflammatory agents

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16
Q

What causes pigmentation in lipodermatosclerosis?

A

Destruction of leaked RBCs by macrophages causing breakdown of Hb into haemosiderin which is brown.

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17
Q

What is ‘atrophie blanche’?

A

Atrophy of the skin in chronic venous insufficiency with depletion of normal pigment cells causing white patches

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18
Q

Name 2 microscopic changes of lipodermatosclerosis which stem from the venous hypertension (4 listed)

A
  • 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
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19
Q

What is the trap hypothesis?

A

Physical presence of fibrinogen and alpha-2-macroglobulin binds GFs both causing tissue repair in chronic venous hypertension

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20
Q

What is Perthe’s test?

A

Torniquet placed around the patients thigh at pressure higher than superficial venous system but lower than arterial - more discomfort felt.

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21
Q

What can cause a thrombophlebitis in varicose veins?

A

Clot

22
Q

Which venous system is affected here?

A

Long saphenous system

23
Q

What is the trendelenberg test?

A

Patient supine and leg angled at 45 degrees, milk down vein and apply torniquet distal to sapheno-femoral junction.

24
Q

What is continuous wave ultrasound used to detect in varicosities?

A

Reflux after accelerated flow is suspended (squeezing calf and then letting go)

25
Q

What uses Doppler and USS techniqes in varicose vein investigations?

A

Duplex scanning

26
Q

Which imaging technique is no longer routinely performed now that duplex scanning is available?

A

Ascending venography

27
Q

What is the initial treatment for primary varices?

A

Compression hose

28
Q

Why may varices persist with sclerotherapy?

A

If there is deep-to-superficial incompetency i.e. only the superficial system has been treated here

29
Q

What are sodium tetradecyl sulphate and polidocanol used for?

A

Sclerosing agents in sclerotherapy

30
Q

What is the purpose of compression sclerotherapy?

A

Produce chemical inflammation in the vein with sclerosing agent then keep it empty for a few weeks with compression to obliterate the lumen

31
Q

What is the recurrence rate of varicosities following sclerotherapy?

A

15%

32
Q

What is the risk of foam sclerotherapy?

A

Embolisation to brain through patent foramen ovale

33
Q

What can sclerotherapy be used for post partum?

A

Vulval varices which persist after pregnancy

34
Q

Name 3 complications of varicose vein surgery

(7 listed)

A
  • Bruising
  • Bleeding/haematoma
  • Wound infection
  • Neuropraxia
  • DVT
  • Recurrence
  • Arterial/major nerve injury
35
Q

What is edoluminal venous obliteration?

A

Obliteration of varices using thermal coagulation of vein using radiofrequency/LASER energy from catheter placed in the lumen

36
Q

What can happen following endoluminal venous obliteration which can persist for weeks after surgery? Tx?

A

Thrombophlebitis

NSAIDs

37
Q

What is the cause of lymphoedema?

A

Increased protein concentration

38
Q

What is the cause of lyphovenous oedema?

A

Venous system pathology causing increased capillary filtration

39
Q

What is the cause of dependency oedema?

A
  • Immobile limbs
  • Decreased venous return
  • Increased capillary filtration
40
Q

What is lipoedema?

A

Symmetrical fatty deposits bilaterally

41
Q

Define chronic oedema

A

Swelling that persists for more than 3 months which does not resolve overnight or with elevation of the affected limb

42
Q

Name 3 R/F for lymphoedema

(4 listed)

A
  • Chronic venous problems
  • Chonic skin problems
  • Immobility
  • Obesity
43
Q

Name 2 types of primary congenital lymphoedema

(4 listed)

A
  • Aplasia
  • Hypoplasia
  • Hyperplasia
  • Valvular incompetence
44
Q

What is Milroy’s disease and what is it associated with?

A

Congenital, hereditary abnormalities in the lymphatic system causing lymphoedema primarily in the lower limbs

45
Q

Name 3 causes of secondary lymphoedema

(6 listed)

A
  • Parasitic infection
  • Obstruction due to surgery/tumour/RTx
  • Trauma
  • Infection/inflammation
  • Venous disease
  • Immobility
46
Q

What is Stemmer’s sign?

A

Ability to pick up a fold of skin at the base of the 2nd toe - positive sign of chronic lymphoedema

47
Q

Name 5 complications of lymphoedema

(13 listed)

A
  • dry/flaky skin
  • eczema
  • contact dermatitis
  • fungal infections
  • hyperkeratosis
  • papillomatosis
  • lymphangioma
  • lymphorrhoea
  • ulceration
  • folliculitis
  • fibrosis
  • thickened scar tissue
  • cellulitis
48
Q

What is this?

A

Lipodermatosclerosis

49
Q

What is the fist line treatment of cellulitis?

A

Amoxicillin 500mg (TDS)

+/- fluclox 500mg (QDS)

For 14 days

50
Q

What is the second line treatment for cellulitis?

A

Clindamycin 300mg QDS

JG Year 2 (28 decks)

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