varcicose veins Flashcards
what are varcicose veins?
superficial veins, most commonly in the legs, that have become dilated and tortuous
indicator of superficial lower extremity venous insufficiency
what is the pathophysiology of developing varicose veins?
Leaky valves cause retrograde blood flow → increased pressure in the distal veins
The superficial veins are thin-walled and are not able to withstand this increase in pressure → dilatation and tortuosity
One leaky valve puts added pressure on other valves, making it more likely that they will also become leaky. In this way, varicosities can spread to affect a large area
what are the risk factors for varicose veins?
- family history
- increasing age
- female sex
- obesity
- pregnancy -> increase blood volume and intraabdominal pressure cause venous distension. oestrogen and progesterone contribute to venous relaxation
- hx of DVT-> can cause damage to valve
- prolonged sitting and standing
what type of symptoms might someone present with?
- dull ache, worse on standing
- itching
- night cramps
- restless legs
- bleeding (rare)
what is perthes test?
used to assess whether the primary problem is in the superficial veins, or whether there is also deep venous obstruction
With the patient standing, a tourniquet is applied to the leg and the patient performs repetitive heel raises
If the varicosities below the tourniquet empty this suggests that the problem is in the superficial veins
If the varicosities remain distended this suggests there is also a problem in the deep venous system
what is the trendelenberg test?
This is used to locate the site of incompetent valves
With the patient lying flat, with legs elevated (so the veins empty), a tourniquet is applied to the thigh over the saphenofemoral junction
If the valve is competent the vein will fill from below
If it is incompetent it will only fill from above on removal of the tourniquet
This is repeated at various levels until the site of the incompetent valve is found
when would you immediately refer someone with varicose veins to surgery?
Bleeding varicose veins need immediate referral to vascular surgery
who will need outpatient referral?
symptomatic varicose veins or signs of chronic venous insufficiency or ulceration
what are primary investigations for varicose veins?
Duplex ultrasound: this uses high-frequency sound waves to show the anatomy of, and the blood flow through, the veins
Helps to confirm the diagnosis and gives more detail on the pattern of disease
These findings help to determine the most appropriate treatment
Ankle-brachial pressure index (ABPI):Used to exclude arterial insufficiency in patients with varicose veins before prescribing compression stockings
This is because compression can further compromise arterial supply leading to complications such as pressure damage, limb ischaemia, and amputation
what is the management of varicose veins if referral is not indicated?
Compression hosiery (after excluding arterial insufficiency): class 2 stockings are more effective than class 1, but may not be as well tolerated
Lifestyle advice: weight loss, regular exercise, avoid prolonged standing, leg elevation when resting
which interventional treatments are available fo varicose veins??
Endothermal ablation: usually offered first-line. This involves using either high-frequency radio waves (radiofrequency ablation) or lasers (endovenous laser treatment) to seal the affected veins
Foam sclerotherapy: offered if ablation is unsuitable. In this procedure, an irritant foam is injected into the vein leading to an inflammatory response, resulting in scarring which closes the vein
Surgery: offered if the above treatments are unsuitable. It involves tying off and stripping the affected veins
what are the complications of varicose veins?
Superficial venous thrombosis: this occurs when a thrombus forms in a superficial vein, along with inflammation of the surrounding tissues . It is characterised by the appearance of hard, painful veins
Deep vein thrombosis: as well as being a risk factor for developing varicose veins, it can also be a complication
Haemorrhage: bleeding from varicose veins can be life-threatening and requires emergency treatment [4]
Venous ulceration: approximately 3-6% of patients develop chronic venous ulceration
what is atrophie blanche?
patches of smooth, porcelain-white scar tissue on the skin, often surrounded by hyperpigmentation.
what is the process by which venous insufficiency can make lower legs look like inverted champagne bottles?
Lipodermatosclerosis is hardening and tightening of the skin and tissue beneath the skin. Chronic inflammation causes the subcutaneous tissue to become fibrotic.
Inflammation of the subcutaneous fat is called panniculitis.
The narrowing of the lower legs causes the typical “inverted champagne bottle”
what is the management of thrombophlebitis?
compression stockings
