Peripheral venous

Question 1

If you see varicose veins, how do you know which vein it is?

Answer 1

short saphenous - posterior lower leg

long saphenous - medial lower leg & thigh

Question 2

How would you examine saphena varix? How is it different from a femoral hernia?

Answer 2

while pt is standing w/ cough impulse

femoral hernia is more lateral, smaller, usually reducible
saphena varix - bluish-discoloration

Question 3

How would you describe inverted champagne bottle legs?

Answer 3

lipodermatosclerosis of the ankles, with edema above the ankles

Question 4

How would you describe a venous ulcer?

Answer 4

Hx - varicose veins; DVTs
site: medial gaiter region of lower leg
sloped edges
lots of exudate
shallow
not a lot of pain
usually associated w/ limb edema
assoc features: venous eczema; hemosiderosis; lipodermatosclerosis; atrophie blanche

Question 5

How would you Rx a venous ulcer?

Answer 5

conservative - graduated compression dressing w/ antibiotics for infection

Question 6

How do you know where are the sites of valvular incompetence in varicose veins?

Answer 6

doing the Tredelenburg test
- if no filling on standing & rapid filling on release of tourniquet –> isolated sapheno-femoral junction incompetence

• slow filling on standing & rapid filling on release on tourniquet –> mixed sapheno-femoral junction & perforating vein incompetence

Question 7

How do you manage varicose veins?

Answer 7

conservative

• elastic support hose
• weight loss
• regular exercise
• avoid prolonged standing

injection sclerotherapy

• suitable for small varices below knee due to incompetence of local perforators
• not satisfactory for varices assoc w/ SFJ incompetence (recurrence inevitable)

surgery

US-guided foam sclerotherapy

Radiofrequency/laser obliteration of LSV/SSV

Question 8

Why is there a scar from medial malleolus to the knee?

Answer 8

Vein harvesting

Question 9

Why is there a scar from the medial malleolus to groin?

Answer 9

femoral-distal bypass

Question 10

What are the causes of chronic venous insufficiency?

Answer 10

valvular incompetence of deep veins (90%)

• primary (etio same as varicose veins)
• secondary (damaged by DVT)

obstruction of deep veins by DVT (10%)

Question 11

What do you call chronic venous insufficiency secondary to DVT?

Answer 11

post-thrombotic syndrome

Question 12

What are the causes of unilateral LL swelling?

Answer 12

DVT
Cellulitis
filiriasis

Question 13

What are the causes of bilateral swelling?

Answer 13

systemic conditions - cardiac failure

Question 14

How much of a calf difference is significant?

Answer 14

> 3 cm