Lower limb venous disease

Question 1

How do we classify chronic venous disease

Answer 1

CEAP classification (4-6 = CVI)
 0 No visible or palpable signs of venous disease
 1 - Telangiectasia, reticular veins, malleolar flare
 2 - varicose veins
 3 - oedema without skin changes
 4 - skin changes: pigmentation, venous eczema, lipodermatosclerosis
 5 - skin changes with healed ulceration
 6 - skin changes with active ulceration

Question 2

Risk factors for CVD

Answer 2

Increasing age and pregnancy

[Family history, obesity, prolonged standing, Caucasian race and diet poor in fibre have been proposed as risk factors]

Question 3

Where are venous valves absent

Answer 3

Common iliac veins, the vena cava, the portal system and the cranial sinuses.

Question 4

Causes of venous hypertension

Answer 4

Reflux (90%) Superficial or deep [DVT, 1ry, congenital]

Obstruction (10%)

Question 5

Complications of varicose veins

Answer 5

1. Thrombophebitis (thrombus + inflammation)

2. Bleeding (trauma or spontaneous)

Question 6

Complications of venous HPT

Answer 6

Oedema, skin hyperpigmentation, itching, eczema, lipodermatosclerosis, and finally breakdown of the skin with ulceration.

Question 7

What is the frontline special investigation for varicose veins

Answer 7

Duplex doppler

Question 8

Indications for duplex doppler

Answer 8

· patient with varicose veins prior to any intervention
· patient with C4-C6 disease: haemosiderin staining, lipodermatosclerosis, ulcer
· suspected deep venous pathology (DVT or reflux)
· suspected perforator incompetence
· recurrent varicose veins

Question 9

Indications for intervention in varicose vein

Answer 9

Symptoms
Thrombphlebitis
Bleeding
Hyperpigmentation
Lipodermatosclerosis
Ulceration

Question 10

What class of stocking do we use for symptomatic varicosities

Answer 10

Class ll

Question 11

Treatment modalities for CVD

Answer 11

Compression stockings
Sclerotherapy
Surgery [stripping, endovenous laser and radiofrequency ablation]

Question 12

Complications for CVD surgery

Answer 12

DVT and PE
Saphenous/ sural nerve damage [transient usually]
Pain
Recurrance

Question 13

Gold standard test for venous function in CVI

Answer 13

Ambulatory venous pressure

Question 14

Mainstay of venous ulcer Mx

Answer 14

Graduated compression (40-18mmHg ankle to knee)

Question 15

ABI value that is safe for compression bandaging

Answer 15

> 0.8