Varicose Veins

Question 1

Definition

Answer 1

Subcutaneous, perminantly dilated veins >3mm in diameter usually affecting the legs

Question 2

Risk factors

Answer 2

Increasing age
FHx
Female
Obesity
Prolonged standing
Increasing number of births
DVT

Question 3

Pathophysiology

Answer 3

Veins have vavles that allow blood to flow up against gravity.
Deep and superficial veins are connected by perforating veins. Incompetent valves in the perforating veins causes backflow of blood from the deep veins back into superficial veins and overloads. Causing dilation + engorgement of superficial veins

Question 4

Chronic venous insufficiency

Answer 4

When blood pools in distal veins, it causes leakage into nearby tissues, leading to brown discoloration on the lower legs = haemosiderin staining. This also causes inflammation causing skin to become dry and inflamed (Venous eczema). As it advances, skin and soft tissue become fibrotic and tight causing lower legs to become narrow and hard (lipodermatoscelrosis)

Question 5

Signs and symptoms

Answer 5

Can be Asx
Engorged and dilated superficial veins
Leg have:
- Heavy dragging sensation
- Aching
- Itching
- Burning
- Oedema
- Muscle cramps
- Restless legs

Question 6

Signs of venous chronic insufficiency

Answer 6

Haemosiderin staining
Ulcers
Liopdermatosclerosis
Eczema

Question 7

Diagnosis

Answer 7

FIRST LINE = Duplex USS
Tap test = apply pressure to the saphenofemoral junction (SFJ) and tap distal varicose vein feeling for a thrill at SFJ
Cough test = apply pressure to SFJ and ask patient to cough and feel for thrills at the SFJ
Trandelburg test and Perthes test

Question 8

Treatment

Answer 8

Conservative:
- Weight loss
- Exercise
- Keep leg elevated when possible to help drainage
- Compression stockings (exclude arterial disease first with ABPI)

Surgical:
- Endothermal ablation
- Phlebectomy
- Sclerotherapy

Question 9

Complications

Answer 9

Prolonged heavy bleeding after trauma
Superficial thrombophlebitis, DVT,
Chronic venous insufficiency