Varicose Veins Flashcards
What are varicose veins?
Subcutaneous permanently dilated veins > 3mm in diameter when measured in a standing position ( most often the superficial veins of the lower limb)
What is the patho of varicose veins?
- Incompetent valves
2. Turbulent flow
What is the epid of varicose veins?
- 10-15% men
2. 20-25% women
What are RF for varicose veins?
- Old age
- Women
- Obesity
- FHx
- Caucasian
What is the primary cause of varicose veins?
idiopathic valvular incompetence (98%)
What are secondary causes of varicose veins?
- Venous outflow obstruction: pregnancy, ascites, ovarian cysts, pelvic malignancy
- DVT
- AV malformations
What are symptoms of varicose veins?
- Visible dilation of veins
- Leg aching: worse with prolonged standing
- Swelling and itching
- Bleeding
What are signs of varicose veins?
- Veins feel tender or hard
- Tap test
- Auscultation for bruits – abnormal blood flow
- Trendelenburg test
What is the tap test?
Tap VV proximally can see movement in vein also tap distally feel thrill over saphenous-femoral junction and shows where damage is
What does the trendelenburg test allow?
localise sight of valvular incompetence
What is the Trendelenburg test?
- patient lies supine and leg lifted up to empty veins
- then place torneque above knee
- patient then stands up and vein should refill within 30-35 seconds and if super quickly shows valvular incompetence somewhere
What do the results show?
- remove torneque and vein fills quickly superficial valvular problem
- if fills with torneque on suggests deeper valvular problem
- can be both
- has to just be when torque off for superficial varicose veins as that is defintion of VV
What is a positive result?
vein fills quickly when tonrneque off and not when torneque on
What is a double positive result?
vein fill quickly when torneque on and when taken off
What is the negative test?
when vein fills when tornque on and doesnt change when tornnque taken off
What is gold standard Ix for varicose veins?
duplex US
What does duplex US allow?
- localise the site of valve incompetence
- can also exclude DVT
What is the conservative management of varciose veins?
- Compression stockings
2. Lifestyle changes: weight loss, exercise, leg elevation
What is the endovascular treatment for varicose veins?
- Radiofrequency ablation
- Endovenous laser ablation
- Microinjection scleropathy: liquid or foam
What is the surgical treatment for varicose veins?
- Stripping of long saphenous vein
- Saphenofemoral ligation
- Avulsion of varicosities
Only for LSV not short saphenous vein
What are possible complications of varciose veins?
- Venous ulcer
- Stasis eczema
- Lipodermatoscelrosis
- Hemosiderin deposition
- Sclerotherapy: skin staining and local scarring
- Surgery: haemorrhage, infection, recurrence, paraesthesia, peroneal nerve injury
