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Proc Derm 2020 > Sclerotherapy of varicose veins > Flashcards

Sclerotherapy of varicose veins Flashcards

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1
Q

The aim of sclerotherapy is the transformation of a treated vein into a fibrous cord

A

T

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2
Q

Foam sclerotherapy is the method of choice for telangiectasia and reticular veins.

A

F Liquid sclerotherapy.

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3
Q

Liquid sclerotherapy is effective for the treatment of saphenous veins and tributaries. y.

A

F Foam sclerotherap

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4
Q

Larger diameter veins respond well to sclerotherapy.

A

F

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5
Q

Sclerotherapy is the treatment of choice for small-calibre varicose veins (reticular varicose veins, spider veins).

A

T

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6
Q

Severe systemic disease is an absolute contraindication to sclerotherapy.

A

T

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7
Q

Uncompensated leg oedema is an absolute contraindication to sclerotherapy.

A

F Relative CI.

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8
Q

Acute DVT is an absolute contraindication to sclerotherapy.

A

T As is Pulmonary embolism

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9
Q

Arterial occlusive disease of any stage is an absolute contraindication to sclerotherapy.

A

F Advanced disease only (stage III or IV). Stage II is relative CI.

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10
Q

Bronchial asthma is an absolute contraindication to sclerotherapy.

A

F Relative CI.

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11
Q

Late complications of diabetes are an absolute contraindication to sclerotherapy.

A

F Relative CI. Eg. polyneuropathy.

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12
Q

Marked allergic diathesis is a relative contraindication to sclerotherapy.

A

T

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13
Q

Pregnancy is a relative contraindication to sclerotherapy.

A

F Absolute CI.

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14
Q

Known asymptomatic patent foramen ovale is a relative contraindication to foam sclerotherapy.

A

T

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15
Q

Visual disturbances or neurological disturbances following previous foam sclerotherapy is a relative contraindication to foam sclerotherapy.

A

T

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16
Q

Sclerotherapy is generally performed in sequential order of leakage points, proceeding from the smaller to the larger varicose veins.

A

F Larger to smaller.

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17
Q

Aethoxysklerol, containing the active ingredient polidocanol, can be used for foam sclerotherapy.

A

T Liquid and foam sclerotherapy.

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18
Q

Severe pain during injection of liquid sclerosant may be indicative of perivascular injection.

A

T

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19
Q

Asclera injection contains the active ingredient polidocanol

A

T In concentrations 0.25/.5/1/2/3/4%

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20
Q

Immediately after injection of liquid sclerosant and removal of the cannula, local compression should be avoided.

A

F Should be performed along the course of the sclerosed vein.

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21
Q

Following liquid sclerotherapy, local compression can be removed the same evening or the next day.

A

T

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22
Q

After liquid sclerotherapy, the patient should remain immobile.

A

F Walking good (physical thrombophylaxis).

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23
Q

Medium sized varicose veins use 2-3% POL

A

T Large varicose veins should use 3% POL

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24
Q

Intensive sports activity, hot baths, saunas and strong UV radiation are not prohibited in the initial days after sclerotherapy.

A

F Should be avoided.

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25
Q

The use of duplex ultrasound in performing liquid sclerotherapy allows greater control with fewer complications and increased efficacy.

A

T Performed with the patient lying down.

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26
Q

Foam sclerotherapy involves the use of detergent-type sclerosants such as polidocanol

A

T

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27
Q

Hypopigmentation occurs more commonly after foam sclerotherapyr

A

F Hyperpigmentation and induration occu

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28
Q

Neurological disturbances are more frequent after foam sclerotherapy

A

T Eg migraine-like symptoms

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29
Q

Maximum foam volume per session should be 20mls in routine cases

A

F 10mls

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30
Q

After injection of foam the patient should rest supine for at least 5 mins

A

T

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31
Q

History of symptomatic patent foramen ovale is a contraindication for foam sclerotherapy

A

T

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32
Q

Intra-arterial injection of foam causes erythma

A

F Causes extensive necrosis

33
Q

Matting; fine telangiectasia in the area of a sclerosed vein occurs in most patients

A

F Unpredictable individual reaction. Can occur after surgical removal of a varicose vein

34
Q

Transitory phenomena after sclerotherapy includes phlebitis

A

T

35
Q

Sclerotherapy is considered to be the standard treatment for intracutaneous varicose veins, allowing improvement of up to 90% to be achieved

A

T

36
Q

The Monfreux technique of foam sclerosant production involves the use of negative pressure generated by drawing back the plunger of a glass syringe.

A

T

37
Q

The Tessari technique of foam sclerosant production, involves the turbulent mixing of polidocanol with air in a sclerosant plus air ratio of 1 + 4 in two syringes linked via a connector.

A

F This is true for the double-syringe system technique.

38
Q

The Puzzi technique of foam sclerosant production involves the mixing of liquid and air in two syringes connected via a three-way stopcock.

A

F True for the Tessari technique. There is no Puzzi technique.

39
Q

When treating the long saphenous vein with foam sclerosant, it is recommended that the venous puncture be performed in the proximal thigh area when utilising a direct puncture method.

A

T Below the knee if long catheters are used.

40
Q

When treating the short saphenous vein by direct puncture with foam sclerosant the venous puncture should be performed in the distal part of the lower leg.

A

F Proximal or middle part.

41
Q

When treating perforating veins with foam sclerosant, the injection should ideally be made directly into the affected vein.

A

F This should be avoided.

42
Q

The Tessari and Tessari/double syringe system methods are recommended for the generation of foam sclerosant for all indications.

A

T

43
Q

Air should not be used as the gas component for the generation of foam sclerosant.

A

F Recommended for all indications.

44
Q

The preferred ratio of liquid sclerosant and gas for the generation of a foam sclerosant is 1 + 2 (1 part liquid + 2 parts gas).

A

F 1 + 4.

45
Q

The recommended maximum foam volume per leg and session (given in a single injection or in several injections) is 10mL.

A

T

46
Q

Duplex ultrasound for foam sclerotherapy should be performed with the patient lying down.

A

F Standing up.

47
Q

After foam sclerotherapy, the length of the occluded venous segment must be compared with the length of the incompetent venous segment that was to be occluded by sclerotherapy injection.

A

T Thus the segment to be treated is defined prior to the injection. This is important for checking whether the ‘whole vein’ is occluded after Rx.

48
Q

Venous reflux can be assessed after sclerotherapy during a Valsalva maneuver or during distal compression/decompression

A

T

49
Q

After foam sclerotherapy, the injected areas should be immediately compressed.

A

F This should be avoided.

50
Q

After foam sclerotherapy, the use of ultrasound to monitor foam distribution improves the safety of the procedure

A

T

51
Q

For foam sclerotherapy, highly viscous foam should be avoided.

A

F This improves safety.

52
Q

After foam sclerotherapy, there should be no patient or leg movement for 2-5 minutes, no Valsalva maneuver, or other muscle movement.

A

T

53
Q

After foam sclerotherapy, active muscle movement should be encouraged if a larger volume of foam is detected in the deep venous system.

A

T

54
Q

Allergic reactions are a common complication in foam and liquid sclerotherapy.

A

F Rare.

55
Q

Hyperpigmentation and induration occur more commonly after liquid sclerotherapy compared with foam sclerotherapy.

A

F More commonly after foam.

56
Q

Neurological disturbances, including migraine-like symptoms, are more frequent after liquid sclerotherapy compared with foam sclerotherapy.

A

F More common after foam.

57
Q

After injection with sclerotherapy, the patient should rest supine for at least 5 minutes.

A

T

58
Q

A history of symptomatic patent foramen ovale is an absolute contraindication for foam sclerotherapy.

A

T

59
Q

After successful foam sclerotherapy, there should be partial occlusion of the treated venous segment detectable by duplex ultrasound.

A

F Complete occlusion (non-compressibility), complete vein disappearance, or ‘fibrous cord’.

60
Q

Allergic reactions following foam sclerotherapy occur in the form of allergic dermatitis, contact urticaria or erythema.

A

T

61
Q

Anaphylactic shock is not an adverse reaction of sclerotherapy

A

.F Occurs very rarely.

62
Q

Patent foramen ovale is proposed to be a contributing factor to the development of transient migraine-like symptoms following sclerotherapy.

A

T

63
Q

Thromboembolic events may occur after sclerotherapy.

A

T

64
Q

The risk of thromboembolic events is higher when large amounts of sclerosant are used, particularly in the form of liquid.

A

F Foam.

65
Q

Previous history of thromboembolism or known thrombophilia is an absolute contraindication to sclerotherapy.

A

F Must weight risk vs. benefit and perform with caution.

66
Q

Skin necrosis can occur following perivascular or intra-arterial injection of sclerotherapy.

A

T Described as ‘embolia cutis’.

67
Q

Hyperpigmentation occurs following sclerotherapy in 0.3-10% of patients.

A

T

68
Q

Matting, fine telangiectasia occurs universally following sclerotherapy.

A

F Unpredictable individual reaction.

69
Q

Nerve damage can occur after perivascular sclerosant injection.

A

T

70
Q

Transient phenomena that can occur after sclerotherapy include: intravascular clots, phlebitis, haematomas, disturbed sense of taste, feeling of chest tightness, pain at injection site, swelling, induration, mild cardiovascular reactions and nausea.

A

T

71
Q

Patients with patent foramen ovale who undergo sclerotherapy should remain lying down for 1hr following the procedure.

A

F 8-30 minutes.

72
Q

Patients with patent foramen ovale who undergo sclerotherapy should only have small volumes of foam (2mL) or liquid injected.

A

T

73
Q

Patients with patent foramen ovale who undergo sclerotherapy should avoid Valsalva maneuvers.

A

T

74
Q

Patients with patent foramen ovale who undergo sclerotherapy should have their leg elevated by 30cm.

A

T

75
Q

Prior to foam sclerotherapy, it is necessary to perform specific investigations for patent foramen ovale.

A

F

76
Q

Prior to foam sclerotherapy, it is necessary to perform specific investigations for thrombophilia.

A

F

77
Q

Foam sclerotherapy is more effective than liquid sclerotherapy.

A

T

78
Q

Sclerotherapy is considered to be the standard treatment for intracutaneous varicose veins (spider veins and reticular veins).

A

T Allows for improvement of up to 90%.

79
Q

Compression treatment with medical compression stockings does not improve the result of sclerotherapy for spider veins.

A

F

Proc Derm 2020 (50 decks)

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