Peripheral Venous Disease

Question 1

what are Varicose veins?

Answer 1

long, tortuous and dilated veins of the superficial venous system.

Question 2

Blood from the superficial veins of the leg passes into the deep veins via ______ veins and at the _____-femoral and ______-popliteal junctions.

Answer 2

Blood from the superficial veins of the leg passes into the deep veins via perforator veins and at the sapheno-femoral and sapheno-popliteal junctions.

Question 3

what do valves do?

Answer 3

prevent blood from passing from deep to superficial veins.

Question 4

what happens if the valves become incompetent?

Answer 4

there is venous hypertension an dilatation of the superficial veins occurs.

Question 5

what are the risk factors for varicose veins? 5

Answer 5

prolonged standing, obesity, pregnancy, family history and the pill.

Question 6

what are secondary varicose veins?

Answer 6

those developing as collateral pathways, typically after stenosis or occlusion of the deep veins, a common sequel of extensive deep venous thrombosis (DVT)

Question 7

what are the primary causes of varicose veins?

Answer 7

• unknown

- congenital valve absence

Question 8

what are the secondary causes of varicose veins?

Answer 8

• obstruction
• valve destruction: DVT
• arteriovenous malformation (increased pressure )
• constipation
• overactive muscle pumps (eg cyclists)

Question 9

what are some obstructive causes of varicose veins?

Answer 9

DVT, fetus, ovarian tumour

Question 10

why do you get varicose veins following a DVT?

Answer 10

DVT is a condition that can increase the deep veins pressure - eg from occlusion or deep valve incompetence

Question 11

what are the symptoms of VV?

Answer 11

Pain, cramping, tingling, heaviness and restless legs

Question 12

what are the signs of VV?

Answer 12

• dilated and tortuous superficial veins
• Oedema, eczema, ulcers, haemosiderin, haemorrhage, phlebitis
• atrophie blanche

Question 13

what is atrophie blanche?

Answer 13

white scarring at the site of a previous, healed ulcer

Question 14

VV are more prominent standing up, true/false/

Answer 14

true

Question 15

where can VV occur?

Answer 15

in groin or behind the knee

Question 16

what should be inspected for when examining VV?

Answer 16

• ulcers with deposition of haemosiderin

Question 17

what should be palpated for when examining VV?

Answer 17

veins for tenderness and hardness

pulses to rule out arterial disease

Question 18

what would a hard vein indicate?

Answer 18

thrombosis

Question 19

what would a soft vein indicate?

Answer 19

phlebitis

Question 20

what do doppler sound probes do?

Answer 20

listen for flow in incompetent valves

Question 21

under what circumstances should patient’s be referred to specialists?

Answer 21

if patients have : bleeding, pain, ulceration, superficial thrombophlebitis or a ‘severe impact on QoL’.

Question 22

what should management of vv comprise of?

Answer 22

treat the underlying cause

education

intervention

Question 23

what should patients be educated on?

Answer 23

• they should avoid prolonged standing and elevate leg wherever possible
• support stockings
• lose weight
• regular walks

Question 24

what are support stockings used for?

Answer 24

to prevent ulcers / symptoms

Question 25

when are support stockings contraindicated?

Answer 25

with a low ABPI

Question 26

what indicates class I vv?

Question 27

what indicates class II vv?

Answer 27

25-35 mmHg ankle pressure

marked VVs, oedema , CVI

Question 28

what indicates class III vv?

Answer 28

35-45 mmHg ankle pressure

CVI

Question 29

what indicates class IV vv?

Answer 29

45-60mmHg ankle pressure

severe lymphoedema and CVI

Question 30

what is the treatment for class 1

Answer 30

DVT prophylaxis

Question 31

what is the treatment for class III

Answer 31

prevent ulcer recurrence

Question 32

what are the endovenous ways of treating vV?

Answer 32

• foam scleropathy - chemical thrombophlebitis

- endovenous ablation

Question 33

what are the three ways of endovenous ablation?

Answer 33

• mechanical (rotating probe)
• physical trauma -thrombophlebitis
• laser-thermal thrombophlebitis

Question 34

what are the surgical ways to treat VV?

Answer 34

high tie

stripping( getting rid of the vein) or foam (to damage endothelium)

multiple stab avulsions or foam

Question 35

what is saphena varix?

Answer 35

Dilatation in the saphenous vein at its confluence with the femoral vein (the SFJ). It transmits a cough impulse and may be mistaken for an inguinal or femoral hernia, but on closer inspection it may have a bluish tinge.

Answer 36

• bleeding and bruising
• superficial thrombophlebitis
• chronic venous insufficiency

Question 37

how is bleeding and bruising treated?

Answer 37

elevation and pressure

Question 38

what is superficial thrombophlebitis ?

Answer 38

the inflammation of a vein caused by a blood clot

they may causes scarring as it is an inflammatory process

Question 39

what is chronic venous insufficiency?

Answer 39

irreversible skin damage as a result of sustained ambulatory venous hypertension

Question 40

what kind of skin damage occurs with chronic venous insufficiency ?

Answer 40

haemosiderin deposits, lipodermatosclerosis, ulceration

Question 41

what is haemosiderin ?

Answer 41

red cell leakage, red cell breakdown and haemosiderin (iron)

Question 42

what is lipodermatoscerlosis characterised by?

Answer 42

white cells, inflammation and fibrosis