Varicose Veins Flashcards
What are varicose veins and what is their pathophysiology?
Tortuous dilated segments of veins that arise from valvular incompetence
Incompetent valves allow blood flow from deep venous system to superficial venous system (at sapheno-femoral junction and sapheno-popliteal junction)
This leads to venous hypertension and dilatation of superficial venous system
What are some causes of varicose veins?
- 98% are primary idiopathic
- DVT
- Pelvic masses (pregnancy, fibroids, ovarian masses)
- AV malformations
What are some risk factors for developing varicose veins?
- Prolonged standing
- Obesity
- Pregnancy
- Family history
- Age
What are the clinical features of varicose veins?
- Often present with cosmetic issues (unsightly veins or discolouration of skin)
- Can have aching, itching skin changes, ulceration, thrombophlebitis, signs of venous insufficiency as they worsen
- Often along short/great saphenous vein course
What are some signs of venous insufficiency?
- Ulceration
- Varicose eczema
- Haemosiderin deposition
- Lipodermatosclerosis
- Atrophie blanche
What is a saphena varix, how are they investigated an manged?
Ix: duplex US
Mx: high saphenous ligation
How are varicose veins classified?
CEAP classification
Clinical features
Aetiology
Anatomical
Pathophysiology
How are varicose veins investigated?
- Duplex US to look for valve incompetence
- Deep venous incompetence, DVT and stenosis must be looked for
How are varicose veins treated non-surgically?
- Compression stockings for the rest of life
- Any venous ulceration from deep venous incompetence then four layer bandaging unless arterial insufficiency (take ABPI, needs to be >0.8)
- Patient education e.g avoid prolonged standing, weight loss, increased exercise to promote calf muscle action
When are patients with varicose veins referred to a vascular clinic for surgical treatment?
NICE criteria:
- Symptomatic primary or recurrent varicose veins
- Lower limb skin changes e.g pigmentation or eczema
- Superficial vein thrombosis e.g hard painful veins
- Venous leg ulcer that has not healed in 2/52
What are the surgical treatment options for varicose veins?
- Vein ligation, stripping and avulsion: Make incision in groin or popliteal fossa, tye off refluxin vein and strip away. Can damage saphenous or sural nerve
- Foam Scleropathy: Inject sclerosing agent into varicosed vein causing inflammatory response closing off vein. Done under US guidance so foam doesn’t get in deep venous system. Only needs local anaesthetic
- Thermal Ablation: Uses radiofrequency or laser catheters to damage vein and closes it off. Done under US guidance and local anaeshetic
What are some complications of varicose vein treatment?
- Veins will worsen over time withut treatment
- Disease recurrence
- Haemorraghe
- Thrombophlebitis (ablation and sclerotherapy)
- Nerve damage (sural and saphenous)
