Varicose veins

Question 1

What are varicose veins

Answer 1

Distended superficial veins measuring more than 3mm in diameter, usually affecting the legs

Question 2

What are reticular veins

Answer 2

Dilated blood vessels in the skin measuring less than 1-3mm in diameter.

Question 3

What is telangiectasia

Answer 3

Refers to dilated blood vessels in the skin measuring less than 1mm in diameter. They are also known as spider veins or thread veins

Question 4

What causes blood discolouration in the lower legs in chronic venous insufficiency

Answer 4

When blood pools in the distal veins, the pressure causes the veins to leak small amounts of blood into the nearby tissues. The haemoglobin in this leaked blood breaks down to haemosiderin,

Question 5

What causes venous eczema

Answer 5

Pooling of blood in the distal tissues results in inflammation. The skin becomes dry and inflamed, referred to as venous eczema.

Question 6

What is lipodermatosclerosis

Answer 6

The skin and soft tissues become fibrotic and tight, causing the lower legs to become narrow and hard, referred to as lipodermatosclerosis.

Question 7

Risk factors for chronic venous insufficiency

Answer 7

Increasing age
Family history
Female
Pregnancy
Obesity
Prolonged standing (e.g., occupations involving standing for long periods)
Deep vein thrombosis (causing damage to the valves)

Question 8

Presentation of varicose veins

Answer 8

Heavy or dragging sensation in the legs
Aching
Itching
Burning
Oedema
Muscle cramps
Restless legs

Question 9

Simple treatment measures for management of varicose veins

Answer 9

Weight loss if appropriate
Staying physically active
Keeping the leg elevated when possible to help drainage
Compression stockings (exclude arterial disease first with an ankle-brachial pressure index)

Question 10

Surgical options for management of varicose veins

Answer 10

Endothermal ablation – inserting a catheter into the vein to apply radiofrequency ablation

Sclerotherapy – injecting the vein with an irritant foam that causes closure of the vein

Stripping – the veins are ligated and pulled out of the leg

Question 11

Complications of chronic venous insufficiency

Answer 11

Prolonged and heavy bleeding after trauma

Superficial thrombophlebitis (thrombosis and inflammation in the superficial veins)

Deep vein thrombosis

All the issues of chronic venous insufficiency (e.g., skin changes and ulcers)

Question 12

What do arterial ulcers result from

Answer 12

Insufficient blood supply to the skin due to peripheral arterial disease

Question 13

What do venous ulcers result from

Answer 13

Occur due to the pooling of blood and waste products in the skin secondary to venous insufficiency

Question 14

Mx of arterial ulcers

Answer 14

Lifestyle changes - smoking cessation and diet

Wound care

Treat wound infections

Surgical intervention - repair with skin graft

Question 15

Mx of venous leg ulcers

Answer 15

4 layer compression banding after exclusion of arterial disease or surgery

If fail to heal after 12 weeks or >10cm2 skin grafting may be needed