Varicose Veins Flashcards
Define varicose veins
Subcutaneous, permanently dilated veins 3mm or more in diameter when measure in a standing position
Aetiology of varicose veins
Venous valve incompetence is the most common
Primary (95%)
- Primary cause is unknown
- Associated with prolonged standing, pregnancy, obesity
Secondary (5%)
- DVT valve destruction
- AV malformation
- Pelvic mass obstruction
- Syndromes e.g. Parkes-Weber
Where is venous valve incompetence most common
Most commonly at:
1. Saphenofemoral junction
2. Saphenopopliteal junction
3. Perforators (draining great saphenous vein)
What is the risk of developing varicose veins if both parents are affected
90%
Classification of varicose veins
Classification is via CEAP - clinical, etiological, anatomical and pathophysiological
E.g. Clinical
C0 - no visible or palpable signs of venous disease
C1 - telangiectasis or reticular vein; veins less than 3 mm
C2 - varicose veins; veins greater than 3 mm
C3 - oedema
C4a - pigmentation or eczema
C4b - lipodermatosclerosis or atrophie blanche
C5 - healed venous ulcer
C6 - active venous ulcer
Symptoms of varicose veins
Dilated tortuous veins
Leg fatigue or aching with prolonged standing, relieved by elevation
Leg cramps, usually nocturnal
Restless legs
Itching
Ankle swelling
Ulceration
Bleeding from varices
Signs of varicose veins on examination
Dilated tortuous veins
Corona phlebectatica (multiple fine vein branches)
Lipdermatosclerosis
Ankle swelling
Tap test/Chevrier’s test (tap proximally, feel for impulse distally)
Tournique/Trendelenburg test (elevate legs and milk veins → apply tourniquet high to compress SFJ → stand pt → repeat distally until controlled filling)
- Distal veins do not fill = controlled (incompetent valve above tourniquet)
- Distal veins do fill = uncontrolled (incompetent valve lies below)
NEGATIVE cough impulse (exclude saphena varix)
Investigations for varicose veins
Clinical diagnosis
Duplex US
Valve closure time > 0.5s- indicative of reflux
Valve closure time > 1s- Indicative of reflux in the deep system
Management for varicose veins
Conservative (superficial disease, post-op period)
- Compression with compression stockings
- Frequent elevation of legs
- Physical therapy, manual lymphatic drainage
- Avoid long periods of standing and sitting and heat
Medical: Vein ablation - if there is pain and swelling
1. Endovenous thermal ablation (laser and radiofrequency)
2. Chemical ablation (sclerotherapy)
Surgical: Open surgery with partial or complete removal of a vein (only for those that are not accessible by other interventions)
What are the surgical options for varicose veins
Trendelenburg ligation (saphenofemoral junction)
Cockett’s ligation (perforator vein)
Short saphenous vein ligation (short saphenous vein (in popliteal fossa))
SEPS (subfascial endoscopic perforator surgery) (perforator vein)
Complications of varicose veins
Chronic venous insufficiency/PVD
Haemorrhage
Venous ulceration
Lipodermatosclerosis
Haemosiderin deposition
Prognosis for varicose veins
Generally resolution of symptoms occur in >95% of patients
Patients need to be counselled that new varicosities will very likely occur with time, as it is a progressive disease - new varicosities do not necessarily represent treatment failure
