6. Venous Disease: Varicose Veins Flashcards
What are the primary causes of varicose veins?
Valve failure
Incompetent perforating veins (connecting deep and superficial)
Venous thrombosis
What are the secondary causes of varicose veins?
Chronic deep venous insufficiency
Deep venous or IVC obstruction
Trauma
Pelvic tumours
Which veins in the leg are deep and which are superficial?
Deep: femoral, popliteal
Superficial: Greater and lesser saphenous
What are the risk factors for varicose veins?
Female Older age Family history Obesity Prolonged standing Pregnancy
What is the name given to spider veins?
Telangiectasia
What are the symptoms of chronic venous insufficiency?
Oedema
Hyperpigmentation
Lipodermatosclerosis
Venous ulcer
What causes hyperpigmentation in chronic venous insufficiency?
RBCs seep out from veins and haemosiderin is deposited
What is lipodermatosclerosis?
Inflammation of fat under the skin
Skin becomes thickened, scarred and turn a red/purple colour
Inverted champagne bottle shape
What should be asked as part of the history in varicose veins?
How much is their life affected?
Any discomfort, heaviness or pruritis
Ankle swelling (oedema)
Skin changes: inflammation, eczema and ulceration
How is a varicose femoral vein differentiated from a femoral hernia?
Cough test
What test is used to show which vein the insufficiency is in?
Trendelenburg test
Describe the Trendelenburg test
Raise leg as high as possible
Milk blood back to groin
Apply tourniquet around mid-thigh
Get patient to stand up slowly and watch for blood refill
What investigations should be done into varicose veins?
Check pulses in leg and foot: use ankle-brachial index
Duplex ultrasoundography
What is the ankle-brachial index?
BP is checked in the brachial artery and ankle: should be the same
What is the conservative treatment of varicose veins?
Compression socks
emollients to treat eczema
Wound dressings
