FN: Varicose Veins Flashcards
Definition
Tortuous, dilated veins of the superficial venous system
Pathophysiology
One-way flow from superior to deep maintained by valves
Valve failure - raised pressure in sup veins - variscosity
3 main sites where valve incompetence occurs
SFJ: 3cm below and 3cm lateral to pubic tubercle SPJ: popliteal fossa Perforatos: draining GSV -3 medial cal perforators (Cocketts) 1 medial thigh perforator (Hunters)
Causes
Primary
Secondary
Primary causes
Idiopathic: (congenitally weak valves)
- prolonged standing
- Pregnancy
- Obesity
- OCP
- FH
Congenital valve absence (v. rare)
Secondary causes
Valve destruction - reflux: DVT, thrombophlebitis Obstruction: DVT, foetus, pelvic mass Constipation AVM Overactive pumps (e.g. cyclists) Klippels-Trenaunay -
Klippels-Trenaunay -
- PWS, varicose veins, limb hypertorphy
Symptoms
Cosmetic defect Pain, cramping, haeviness Tingling Bleedin: may be severe Swelling
Signs
skin changes: 1. Venous stars 2. Haemosiderin deposition 3. Venous eczema 4. Lipodermatosclerosis (paniculitis) Atrophie blanche
Ulcers: medial malleolus/gaiter area
Oedema
Thromnophlebitis
Investigations
Duplex ultrasonography
- Anatomy
- Presence of incompetence
- Caused by obstruction or reflux
Investigations for surgery
FBC U+E Clotting G+S CXR ECG
Referral criteria
Bleeding Pain ulceration Superficial thrombophlebitis Severe impct on QOL
CEAP classification
Chronic venous disease can be classified according to
- Clinical signs (1-6 + sympto or asympto)
- Etiology
- Anatomy
- PAthophysiology
Conservative Mx
- Treat any contributing factors
- Education
- Class II graduated Compression stockings
- Skin care
Contributing factors
Lose weight
Relieve constipation
Education
Avoid prolonged standing
regular walks
Class II graduated compression stockings
18-24 mmHg
Symptomatic relief and slows progression
Skin care
Maintain hydration with emolients
Treat ulcers rapidly
Minimally invasive therapies indications
small below knee varicosirits not involving GSV or SSV
Minimally invasive therapies techniques
Local or GA
Injections sclerotherapy:1% NA tetradecyl sulphate
Endovenous laser or radiofreqeuncy adblation
Post-op
Compression bandage for 24hrs
Compression stockings for 1mo
Surgical management indications
SFJ incompetence
Major perforator incompetence
Sympatomatic: ulceration, skin changes, pain
Sugery procedures
- Trendeleberg:saphenofemoral ligation
- SSV ligation: in the popliteal fossa
- LSV stripping: no longer performed due to potential for saphenous nerve damage
- Multiple avulsions
- Perforator ligationL Cocketts operation
- Subfascial endoscopu perforator surgery (SEPS)
Post-op surgical
Bandage tightly
Elevate for 24hrs
Discharged with compression stockings and isntructed to walk daily
Surgery complications
Haematoma (esp. groim) Wound sepsis Damage to cutaneous nerve (e.g. long saphenous) Superfical thrombophlebitis DVT Recurrence: may approach 50%
