Varicose Veins Flashcards
What is the pathology?
Deep veins drain the muscles and superficial veins drain the skin and superficial tissues
During inspiration there is a decrease in intra thoracic pressure and contraction of calf muscles which forces blood back up to the heart
During calf relaxation blood flows from superficial veins into deep veins ready to be returned
Valves prevent the backflow of blood
In VV there is incompetence of these valves causing backflow of blood leading to dilated and engorged superficial veins
What are primary causes?
AKA idiopathic
More common in women and pregnancy
Deep veins function normally so due to superficial valve problems
What are secondary causes?
Superficial varicosities occur due to deep venous incompetence
Previous DVT causing damage to valves
Raised systemic venous pressure due to pregnancy/pelvic tumour or ateriovenous fistula
What are the risk factors?
Age FH Obesity Female Pregnancy Prolonged standing DVT
What are the symptoms?
Engorged and dilated veins Can be asymptomatic Heavy/dragging sensation Aching pain Oedema Itching Muscle cramps Restless legs
Can also get signs of venous insufficiency
- eczema
- hyper/hypopigmentation
- lipodermatosclerosis
What investigations are needed?
Tap test
-place hand on sapheno-femoral junction and feel for thrill over distal varisocities
Hand held doppler- to look for venous reflux
Doppler USS
-to assess flow and valves
Perthes Test
- tourniquet over upper thigh and then ask patient to go up and down on tip does
- if normal deep venous functioning then superficial varicosities should disappear
What is the management?
Conservative
- weight loss
- compression stockings
- elevate legs when resting
- increase exercise
Surgery
- endothermal ablation
- sclerotherapy- for cosmetic veins
- surgical ligation
When should referral to secondary care be completed?
Troublesome symptoms Previous or current ulcer Skin changes due to chronic venous insufficiency Previous bleeding on VV Superficial thrombophlebitis
