Varicose Veins

Question 1

Varicose veins are veins that have lost their valvular efficiency and, as a result of continuous dilatation under pressure, in the course of time becomes elongated, twisted and enlarged. What % of the population have varicose veins?

1 - 5-10%
2 - 20-25%
3 - 20-40%
4 - 50-60%

Answer 1

3 - 20-40%
- more common in females and increase with age

Question 2

Which of the following is NOT a typical risk factor for varicose veins?

1 - Increasing age
2 - DVT
3 - Obesity
4 - Alcohol
5 - Smoking
6 - Pregnancy
7 - Inactivity

Answer 2

4 - Alcohol

Question 3

Typically blood from superficial veins of the legs pass into the deep veins and back up towards the inferior vena cava. Valves in the veins prevent blood from moving from the deep to superficial veins. What can cause blood to move from the deep to superficial veins resulting in varicose veins?

1 - valves become incompetent
2 - increased pressure in veins
3 - dilation and hypertension
4 - all of the above

Answer 3

4 - all of the above
- this leads to more blood collecting in the veins and they become elongated and twisted called varicose veins

Question 4

Which of the following is NOT a symptom patients with varicose veins present with?

1 - pain
2 - cramps
3 - tingling
4 - heaviness
5 - restless legs
6 - claudication

Answer 4

6 - claudication

Question 5

Haemosiderin can be caused by varicose veins. What is Haemosiderin?

1 - chronic inflammatory condition characterised by subcutaneous fibrosis and hardening of the skin on the lower legs
2 - iron deposits near the skin appearing brown
3 - atrophy of skeletal muscle
4 - lymphadenopathy

Answer 5

2 - iron deposits near the skin appearing brown

Question 6

Lipodermatosclerosis can be caused by varicose veins. What is Lipodermatosclerosis?

1 - chronic inflammatory condition characterised by subcutaneous fibrosis and hardening of the skin on the lower legs
2 - iron deposits near the skin appearing brown
3 - atrophy of skeletal muscle
4 - lymphadenopathy

Answer 6

1 - chronic inflammatory condition characterised by subcutaneous fibrosis and hardening of the skin on the lower legs

Question 7

Stasis dermatitis refers to the skin changes that occur in the leg as a result of “stasis” or blood pooling from insufficient venous return. What is the more common name for this?

1 - Lipodermatosclerosis
2 - Allergic dermatitis
3 - Haemosiderin
4 - Venous eczema

Answer 7

4 - Venous eczema

Red, scaly, flakey and itchy skin

Question 8

A percussion tapping test can be performed by tapping on the lower varicose veins and the tap being felt in which vein and indicates incompetence of superficial vein valves?

1 - sapheno-femoral junction
2 - posterior tibial vein
3 - perforating veins
4 - femoral vein

Answer 8

1 - sapheno-femoral junction

• bruits may also be heard over the varicose veins
• handheld doppler can also be useful for identifying varicose veins

Question 9

What is the 1st line imaging in patients with suspected varicose veins?

1 - CT contrast
2 - duplex ultrasound
3 - MRI
4 - X-ray

Answer 9

2 - duplex ultrasound
- confirms or establishes source of reflux.
- provides a roadmap.
- assesses the Deep Veins.
- allows planning of treatment.
- guides treatment.

Question 10

The following are all complications of varicose veins, but which is most common?

1 - Phlebitis
2 - Bleeding
3 - Skin changes
4 - Ulceration

Answer 10

3 - Skin changes
- phlebitis (inflammation of the veins) is also very common

Thrombophlebitis is inflammation that results in a blood clot

Question 11

Which of the following is NOT a conservative management of choice for varicose veins?

1 - leg elevation
2 - exercise
3 - radio frequency ablation
4 - weight loss

Answer 11

3 - radio frequency ablation

Question 12

Before prescribing compression stockings in venous insufficiency, it is important to check that patients ankle brachial pressure index (ABPI). What must the ABPI be between in order to use compression stockings?

1 - 0.9-1.3
2 - 0.7-0.9
3 - 0.4-0.69
4 - <0.4
5 - >1.3

Answer 12

1 - 0.9-1.3

If PVD is bad, the compression stockings can cause acute limb ischaemia

Question 13

Which of the following is NOT an invasive management of choice for varicose veins?

1 - high tie and stripping surgery
2 - catheter (heat based) therapy
3 - radio frequency ablation
4 - exercise
5 - sclerotherapy

Answer 13

4 - exercise

• high tie and stripping surgery = tieing off or removing varicose veins
• radio frequency ablation = heating veins forcing them to close
• sclerotherapy = injecting medicine into veins to make them shrink

Question 14

High tie and stripping surgery, which is where the veins are either tied off or varicose veins are removed is typically performed at the groin and recovery is around 1-2 weeks. Which of the following is NOT typically a complication of this procedure?

1 - Bleeding / Bruising
2 - Infection / Swelling
3 - Nerve Injury
4 - Urethral damage
5 - DVT

Answer 14

4 - Urethral damage

Question 15

Endovascular radio frequency recovery is faster than High tie and stripping surgery and is around 1-3 days. Which of the following is NOT typically a complication of this procedure?

1 - Bleeding / Bruising
2 - Infection / Swelling
3 - Burns
4 - DVT
5 - Gonadal varicose veins

Answer 15

5 - Gonadal varicose veins

Question 16

A varicose infarction is rare, but can occur following what?

1 - cellulitis
2 - necrotising fasciitis
3 - massive DVT
4 - coagulation disorder

Answer 16

3 - massive DVT

• pulses palpable initially
• swelling (often severe)
• tenderness (compartment syndrome)
• discolouration/ cyanosis

Question 17

A varicose infarction is rare, but can be caused by a massive DVT. Are these dangerous?

Answer 17

• yes
• medical emergency

Question 18

A varicose infarction is rare, but can be caused by a massive DVT. These are dangerous and are medical emergencies with a mortality of 20%. How do these need to be treated?

1 - Elevation
2 - Fluid resuscitation
3 - Thrombolysis
4 - Consider emergency amputation
5 - all of the above

Answer 18

5 - all of the above

Question 19

In addition to complications of varicose veins, there are also rare conditions that can affect both the deep and superficial veins causing reflux. Which of the following syndromes causes the following:

• Port wine stain
• Soft tissue or bone overgrowth
• Venous abnormalities (VVs)

1 - Addisons syndrome
2 - Klippel-Trenaunay syndrome
3 - Parkes-Weber syndrome
4 - Serrotonin syndrome

Answer 19

2 - Klippel-Trenaunay syndrome
- KTS

• Parkes-Weber syndrome (very rare) is the same as KTS but also has arterio-venous malformations that lead to heart failure