Condition- Varicose Veins

Question 1

What are varicose veins?

Answer 1

Veins that become prominently elongated, dilated and tortuous, most commonly the superficial veins of the lower limbs.

Dilation of more than 3mm when standing

Question 2

What is the most common cause of Varicose veins?

Answer 2

Chronic Venous Insufficiency

Question 3

Briefly describe the pathological process behind the dvelopment of varicose veins

Answer 3

• Superficial veins drain into deep veins at saphenofemoral and saphenopoplitial junctions via perforator veins.
• Veins prevent backflow at the junctions (from deep to superficial)
• Incompetent valves => backflow => dilation of superficial veins

Question 4

What is thought to cause primary varicose veins?

Answer 4

• Genetic developmental weakness leading to weakened vein walls
• Increased elasticity, dilation and valvular incompetence
• Or congenital valve absence

Question 5

List some causes of secondary varicose veins

Answer 5

• Venous Outflow obstruction
  
  • DVT
  • Ovarian tumour/ cysts
  • Lymphadenopathy
  • Increased IAP
    
    • Pregnancy
    • Ascites
• Due to valve damage- after DVT
• Due to high flow- AV malformations

Question 6

List some of the presenting symptoms of varicose veins

Answer 6

• Visibly distended veins (cosmetic appearance)
• Dull ache in legs- worse at the end of the day
• Swelling
• Tingling
• Itching
• Bleeding

Question 7

What might you see on inspection of a patient with varicose veins?

Answer 7

• Inspect while standing
• Dilated, tortuous superficial veins
• Oedema
• Excoriations
• Lipodermatosclerosis (champagne bottle)
• Atrophie Blanche
• Haemosiderin depositions
• Ulceration

Question 8

What test might you do when palpating the calves of someone with varicose veins?

Answer 8

TAP TEST

• Tapping on saphenofemoral junction will lead to impulse felt distally (this would not happen if valves were competent)

Question 9

What might you conclude if you heard a bruit on ascultation of someone’s varicose veins?

Answer 9

AV malformation

Question 10

State two tests you could conduct on someone with Varicose Veins

Answer 10

• Tap Test
• Trendelenburg Test

Question 11

Which investigation would you conduct on someone with Varicose Veins? What would you look for?

Answer 11

Duplex US of lower limbs

Would look for sites of incompetence or reflux + to exclude DVT

Question 12

List some methods of conservatively managing a patient with Varicose Veins

Answer 12

• Exercise (skeletal pumps)
• Elevation of legs at rest
• Graduated Compression Stockings

Question 13

List 3 endovascular treatments for managing a patient with Varicose Veins

Answer 13

• Radiofrequency ablation
• Endovenous laser ablation
• Injection Sclerotherapy

Question 14

List and describe 3 surgical methods for managing a patient with Varicose Veins

Answer 14

• Saphenofemoral ligation
• Avulsion therapy
• Stripping of the long saphenous vein- remove long saphenous vein from groin to upper calf

Question 15

List some complications of surgical tx of varicose veins

Answer 15

Damage to peroneal nerve => foot drop

Haemorrhage, Infection, recurrence