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

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 7

1 - sapheno-femoral junction

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

Question 8

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

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

Answer 8

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

Question 9

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

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

Answer 9

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

Question 10

In addition to complications of varicose veins, there are also rare conditions

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

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

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

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

Answer 12

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 13

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 13

4 - Urethral damage

Question 14

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 14

5 - Gonadal varicose veins

Question 15

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

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

Answer 15

3 - massive DVT

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

Question 16

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

Answer 16

• yes
• medical emergency

Question 17

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 17

5 - all of the above

Question 18

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 18

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