Lower limb venous disease

Question 1

What is the CEAP classification of chronic venous disease?

Answer 1

Clinical signs
Aetiology
Anatomy
Pathophysiology

Question 2

What is CEAP class 0?

Answer 2

No visible or palpable signs of venous disease

Question 3

What is CEAP class 1?

Answer 3

Telangectasia, reticular veins, malleolar flare

Question 4

What is CEAP class 2?

Answer 4

Varicose veins

Question 5

What is CEAP class 3?

Answer 5

Oedema without skin changes

Question 6

What is CEAP class 4?

Answer 6

Skin changes:

• Pigmentation
• Venous eczema
• Lipodermatosclerosis

Question 7

What is CEAP class 5?

Answer 7

Skin changes with healed ulceration

Question 8

What is CEAP class 6?

Answer 8

Skin changes with active ulceration

Question 9

Which CEAP classes does the term “chronic venous disease” refer to?

Answer 9

All: C0-C6

Question 10

Which CEAP classes does the term “chronic venous insufficiency” refer to?

Answer 10

C4-C6

Question 11

What are risk factors for chronic venous disease?

Answer 11

Strong: age, pregnancy
Proposed: family history, obesity, prolonged standing, Caucasian, low fibre diet

Question 12

What are the anatomical factors which assist in venous return to the heart?

Answer 12

• One-way venous valves
• Compression of veins/sinusoids by calf muscles
• Negative thoracic pressure on inspiration

Question 13

Causes of venous hypertension?

Answer 13

Reflux (90%):

• Superficial
• Deep: post-DVT with recanalisation; primary valvular incompetence; congenital valvular atresia

Obstruction (10%):

• Iliofemoral vein area
• Superficial femoral vein area
• Varied locations

Question 14

Causes of venous insufficiency?

Answer 14

• Venous pump overwhelmed by incompetent superficial vein valves
• DVT with: damage to pumping units; obstruction to deep veins; damage to valves; reflux from over-expanded veins acting as collaterals
• Deep veins obstructed by external pressure
• Inborn deficiency of valves or inherent weakness in vein walls
• Prolonged inactivity of muscles in dependant position
• Muscle dysfunction/paralysis
• Skeletal problems, arthritis, injury

Question 15

What is primary venous insufficiency?

Answer 15

When no aetiologic mechanism can be identified: current theory is: inherently weak wall –> dilatation –> separation of valve cusps –> valvular incompetence

Question 16

What is secondary venous insufficiency?

Answer 16

When there is an identifiable cause for the insufficiency e.g. DVT

Question 17

Symptoms of venous insufficiency?

Answer 17

Aching, throbbing, itching, leg fatigue, heaviness, swelling
Usually worse at end of the day
Alleviated by elevation

Question 18

Complications of varicosities?

Answer 18

• Thrombophlebitis: thrombosis in superficial varicosity followed by inflammation
• Pulmonary embolism if thrombophlebitis extends to sapheno-femoral junction
• Rupture/bleeding of varicosity - may be spontaneous or due to trauma

Question 19

Complications of venous hypertension?

Answer 19

• Oedema
• Skin hyperpigmentation
• Itching
• Eczema
• Lipodermatosclerosis
• Breakdown of skin with ulceration

Question 20

Definition of telangiectasia?

Answer 20

Dilated intradermal venules

Question 21

Definition of reticular veins?

Answer 21

Dilated, non-palpable, subdermal veins

Question 22

Definition of varicose veins?

Answer 22

Dilated, palpable subcutaneous veins >3mm

Question 23

What is the anatomical distribution of the great saphenous vein?

Answer 23

Medial calf and thigh

Question 24

What is the anatomical distribution of the short saphenous vein?

Answer 24

Posterolateral calf