226 - Varicose Veins Flashcards
What is a varicose vein?
Enlarged and twisted vein
Which veins are varicose veins most common in?
90% Long saphenous vein (medial side)
Rest usually short saphenous vein
What symptoms can you get with Varicose veins?
Mostly cosmetic
painful, achy, heavy when standing for long periods
Restless leg syndrome
What complications can varicose veins cause? (7 things)
Chronic venous insufficiency -> oedema Thrombophlebitis Hamorsiderin staining Varicose eczema leg ulcers Haemorrhage Lipodermatosclerosis
What is lipodermatosclerosis?
Skin hardness due to s/c fibrosis, inflammation and necrosis of s/c adipose tissue
- pain, brownish-red staining
- inverted champagne bottle leg
What causes varicose veins?
Primary cause unknown
? age (veins loose elasticity)
? imobility / standing (no muscle pump)
? female - progesterone effect on vessel walls
Secondary - impaired flow from deep system
- DVT
- Abdominal mass
Describe the process of varicose vein formation
Valvular incompetance, reflux, hypertension -> stress distally
or, cellular and ECM changes -> vein wall weakens - venous dilatation - valvular incompetance
What are the 5 key treatment options for varicose veins?
Surgery - strip vein Radiofrequency ablation EVLT - Endovenous laser treatment Foam sclerotherapy Compression therapy
What can be done if there are leg ulcers caused by arterial ischaemia?
Bypass surgery of artery
What is chronic oedema?
Oedema lasting more than 3 months
What are the 4 key types of chronic oedema?
Lymphovenous
Dependancy
Lipoedema
Lymphodema
Describe lymphovenous oedema
A lymphatic overload
Venous system pathology causing increased capilary filtration
s/c tissues are soft and pitting
oedema reduces with elevation
What tissue changes can be seen in lymphovenous oedema?
Haemosiderin staining Ulceration varicose eczema Lipodermatosclerosis Telangicetasia
What is dependancy oedema?
A lymphatic overload Gravitational Occurs in dependant, immobile limbs reduced venous return -> increased cap filtration Often people with comorbidities
What tissue changes are seen in dependancy oedema?
Translucent skin
Wet legs - lymph leaks
Shiny
soft + pitting
What is lipodema?
A lymphatic overload Symmetrical fatty deposits occur ? disterbed venous function ? normal lymph system But lymph transport capacity is reduced - > backlog