41. Venous and Lymphatic Disease Flashcards
What are varicose veins?
- Swollen and enlarged veins on legs and feet usually
- Often bulging, twisty and lumpy on appearance
- Purple or dark blue in colour
- tortuous dilated superficial veins
What veins are affected by varicose veins?
Superficial veins only (superficial limb disease)
What happens to valves in varicose veins?
- valves become floppy and bend backwards which makes them leaky
- this means blood is not held up and blood no longer can flow upwards normally
- if valves don’t work ,leakage of blood backwards occurs (backflow) which causes swollen veins
What are main sites of varicose veins? (2)
- long saphenous (80-87%)
- short saphenous (21-30%)
alone= 13%
combined= 21%
What is the primary aetiolgoy of varicose veins?
- multifactorial
- mainly due to valvular dysfunction
What is the prevalence of varicose veins in males and females?
males= 10-15% females= 20-25%
What parts of patient history are most important when diagnosing varicose veins?
- age when veins first appeared
- occupation (esp. if standing for long periods)
- pregnancies (twins, big babies)
- previous DVT/ major trauma (good reason for DVT which affects DEEP veins in contrast)
- family history
- signs and symptoms
- complications
What are common signs and symptoms for varicose veins? (9)
- cosmesis (surgical correction)
- localised or generalised discomfort in the leg
- nocturnal cramps
- swelling
- acute haemorrhage
- superficial thrombophlebitis (inflammation because of blood clot or vein wall damage)
- pruritus (itching)
- skin changes (eg. eczema, lipodermatosclerosis and ulcers)
- oedema
What are indications for intervention for varicose veins? (6)
- when symptoms severe
- superficial thrombophlebitis
- signs of chronic venous insufficiency
- bleeding
- cosmetic wishes
- anxiety that disease may progress
What is the treatment for varicose veins?
- surgery; superficial venous surgery (vein junction is tied; high tie, stripping, multiple stab avulsions)
- injection (sclerotherapy)
- minimally invasive procedures
- compression
- conservative
What do new NICE guidelines say about specialist referral for varicose veins? (5)
Only referred when:
- bleeding
- pain
- ulceration
- superficial thrombophlebitis
- severe impact on quality of life
What are contra-indications for surgical approach for varicose veins? (4)
- previous DVT (collaterals)
- arterial insufficiency
- patient comorbidity
- morbid obesity
What happens during a surgery to treat varicose veins?
- conventional surgery under general anaesthesia
- ligation of the sapheno-femoral or sapheno-popliteal junctions (joining)
- vein stripping and multiple stab avulsions ( PIN; perforate invaginate stripping)
What are common complications for varicose vein surgery? (7)
- minor haemorrhage
- thrombophlebitis
- haematoma
- wound problems
- severe pain
less common: - sural/ saphenous nerves can be damaged (sural supplies inner foot and saphenous supplies outer foot) which can affect function
- damage to deep veins, arteries, nerves, DVT
What are 4 minimally invasive treatments of main trunk varicosities?
- foam sclerotherapy (chemical reaction with endothelium)
- endovenous laser ablation (EVLA; thermal ablation)
- Radiofrequency ablation (VNUS; thermal ablation/)
- Compression
What is ablation?
- surgical removal of body tissue
What anaesthetic is used for minimally invasive treatments?
local anaesthetic
What are potential advantages of minimally invasive treatments with local anaesthetic? (5)
- reduce surgical trauma (bruising, scarring, no incisions, less pain)
- reduce time off work
- do not require operating theatre
- potential to increase patient throughput
- more clinical and cost effective compared to conventional surgery
What is a laser (EVLA) technique to treat varicose veins?
- less invasive treatment than surgery
- micro puncture needle inserted into incompetent long or short saphenous vein using ultrasound
- guidewire introduce and manoeuvred to saphenous junction with deep vein using ultrasound
- catheter and laser fibre introduced over guidewire to 1cm below junction
In EVLA treatment, is the vein removed?
No, instead veins are heated by laser. Heat kills walls of the veins and the body naturally absorbs the dead tissue and abnormal veins are destroyed. as they collapse and are sealed shut. Once vein is no longer functioning and damaged completely, body will restore blood flow to healthy veins and damaged vein will turn into scar tissue and become reabsorbed into the body
What is the difference between EVLA and VNUS procedures?
- have the same goal and outcomes and do the same thing except they have different technology involved.
- EVLA uses laser as heat and VNUS uses radiofrequency to heat
What is foam sclerotherapy?
- needle inserted into the incompetent vains under ultrasound control
- foam injected and prevented from entering deep venous system which makes varicose veins shrink
- common for smaller varicose veins or spider veins
What are symptoms of chronic venous insufficiency?
- ankle oedema
- telangectasia
- venous eczema
- haemosiderin pigmentation
- hypopigmentation “atrophie blanche”
- lipodermatosclerosis
- venous ulceration
What is chronic venous insufficiency?
- Veins cannot pump enough blood back to the heart
- typically affects legs
- includes varicose veins
