Varicose veins Flashcards
Define varicose veins
Long, tortuous, & dilated veins of the superficial venous system (>3mm in diameter)
(They are often visible and palpable, and are an indication of superficial lower extremity venous insufficiency.)
What is the aetiology of varicouse veins?
Normally insufficient venous valves –> reflux of blood into veins –> venous hypertension –> dilation
What are risk factors for varicouse veins?
- female
- age
- obesity
- prolonged standing
- pregnancy
- History of DVT
- sedentary lifestyle
- genetic predisposition
What are the presenting symptms of varicose veins?
‘My legs are ugly.’ –> mostly cosmetic
But might cause
- Pain, cramps,
- tingling,
- heaviness, and
- restless legs.
(symptoms unspecific and only slightly more common in vvs)
What are prsenting signs of varicose veins on examination?
Might lead to
- bleeding
- changes in pigmentation (brown-red discolouration caused by haemosiderin)
- superficial vein thrombosis + DVT (only as complication from thrombophlebitis)
- venos ulceration
- eczema
- atrophie blache (white scarring at the site of a previous, healed ulcer)
- lipodermatosclerosis (skin hardness from subcutaneous fibrosis caused by chronic inflammation and fat necrosis)
What is atrophie blache?
white scarring at the site of a previous, healed ulcer)
What is lipodermatosclerosis
lipodermatosclerosis
(skin hardness from subcutaneous fibrosis caused by chronic inflammation and fat necrosis)
What are reticular veins?
permanently dilated intradermal veins that range between 1–3 mm in diameter. They may be tortuous but are usually asymptomatic.
What are Telangiectasias?
spider or thread veins –> are intradermal veins that are less than 1 mm in diameter.
Identify appropriate investigations for varicose veins and interpret the results
Examine
Visually and on palpation (standing + lying)
- Note the extent, size, and location of the dilated veins
- VV have to be >3mm in diameter
- Aseess for complications
- Skin changes — look for hyperpigmentation (brown-red discolouration caused by haemosiderin deposition)
- venous eczema (itchy, red, scaly, and/or flaky skin which may have blisters and crusts on the surface)
- lipodermatosclerosis (painful, hardened, tight skin)
- atrophie blanche (star-shaped, ivory-white, depressed, atrophic scars with surrounding pigmentation)
- leg ulceration (active or healed)
- Superficial vein thromposis (hard, painful veins)
- Duplex ultrasound to assess extend (if referred)
When should a patient with varicose veins be referred to specialist care?
Refere to specialist treatment if
- if LL symptoms: typically pain, aching, discomfort, swelling, heaviness, and itching.
- Skin changes, such as pigmentation or eczema
- Superficial vein thrombosis + suspected venous incompetence
- An active or healed venous leg ulcer (break in the skin below the knee that has not healed within 2 weeks
*
What is the management plan for patients with Varicose veins?
- Inform Patient (verbally and written)
- avoid long standing
- elevate legs when sitting and lying down
- reassure that complications are uncommon
- ggf. loose weight and increase physical activity
- Referr to specialist if necessary
- if not: offer compression stocking
- (Possible treatements iclude surgery, endothermal ablation and foam sclerotherapy)
What is the prevalence of varicose veins in the population?
- Varies in different populations but thought to be around 1/3
- increase with age
- often develop with pregnancy
- higher in industrialised countries
What is the prognosis for someone with varicose veins?
Without appropriate management, varicose veins may progress in severity and extent and complications, such as skin changes and ulceration, may occur
(But otherwise complications are uncommon)
