Varicose Veins

Question 1

What are varicose veins?

Answer 1

Distended superficial veins more than 3mm in diameter

Question 2

What are reticular veins?

Answer 2

Dilated blood vessels in the skin less than 1-3mm in diameter

Question 3

What is telangiectasia?

Answer 3

Dilated blood vessels in the skin less than 1mm in diameter

Also called spider veins or thread veins

Question 4

How do varicose veins develop?

Answer 4

Deep and superficial veins are connected by perforating veins

Blood flows from superficial to deep veins via perforating veins

When the valves are incompetent in the perforating veins, blood flows from deep veins back to superficial overloading them

Leads to dilatation and engorgement

Question 5

What happens to leaked blood in chronic venous insufficiency?

Answer 5

Blood pools in distal veins

Pressure causes the veins to leak blood into nearby tissues

Leaked haemoglobin breaks down to haemosiderin

Question 6

What colour are the lower legs in haemosiderin staining?

Answer 6

Brown discolouration

Question 7

What causes venous eczema?

Answer 7

Blood pools in distal tissues causing inflammation

Skin becomes dry and inflamed

Question 8

What happens after venous eczema?

Answer 8

Skin and soft tissues become fibrotic and tight

Lower legs become narrow and hard

Lipodermatosclerosis

Question 9

What are the risk factors of varicose veins?

Answer 9

Increased age
Family history
Female
Pregnancy
Obesity
Prolonged standing
Deep vein thrombosis - causes damage to the valves

Question 10

How do varicose veins present?

Answer 10

Present with engorged and dilated superficial leg veins

May be asymptomatic

• Heavy
• Aching
• Tension
• Itching
• Burning
• Oedema
• Muscle cramps
• Restless legs

Signs and symptoms of chronic venous insufficiency

Question 11

What is the tap test for in varicose veins?

Answer 11

Tap test
Pressure to saphenofemoral junction (sfj) and tap distal varicose vein

Thrill will then suggest incompetent valves

Question 12

What is the Cough test for in varicose veins?

Answer 12

Cough test
Pressure to the SFJ, patient coughs, feeling for thrills at the SFJ

Thrill suggests dilated vein at the SFJ (saphena varix)

Question 13

What is the Trendelenburg’s test for in varicose veins?

Answer 13

Trendelenburg’s test
Patient lying down

Lift affected leg to drain the veins completely, apply tourniquet to thigh and stand patient up

Tourniquet should prevent varicose veins reappearing if placed distally to incompetent valve

If proximal to valve the vein will reappear

Question 14

What is Perthe’s test for in varicose veins?

Answer 14

Perthes test
Tourniquet to thigh

Ask patient to pump their calves by doing heel raises

If superficial veins disappear, deep veins are functioning

Increased dilation of superficial veins indicates a problem in deep veins such as DVT

Question 15

What is duplex ultrasound used for?

Answer 15

Assess the flow of blood in vessels

Question 16

How are varicose veins managed?

Answer 16

• Weight loss
• Physically active
• Keeping leg elevated to help drainage
• Compression stockings (exclude arterial disease with ABPI)

Varicose veins in pregnancy often improve after delivery

Question 17

How can varicose veins be managed surgically?

Answer 17

Endothermal ablation
Catheter into vein to apply radiofrequency ablation

Sclerotherapy
Inject vein with irritant foam that causes closure of the vein

Stripping
Veins ligated and pulled out of leg

Question 18

What are the complications of varicose veins?

Answer 18

• Prolonged and heavy bleeding after trauma
• Superficial thrombophlebitis
• Deep vein thrombosis
• Issues of chronic venous insufficiency