Varicose Veins

Question 1

What are varicose veins?

Answer 1

Dilated, tortuous, superficial veins

Question 2

Cause of varicose veins

Answer 2

Occur 2ary to incompetent venous valves, allowing blood to flow back, away from the heart.

Question 3

Where do varicose veins most commonly occur?

Answer 3

In the legs, due to reflux in the great saphenous vein and small saphenous vein.

Question 4

Risk factors for varicose veins?

Answer 4

1) increasing age

2) female

3) pregnancy

4) obesity

Question 5

Why is pregnancy a risk factor for varicose veins?

Answer 5

the uterus causes compression of the pelvic veins

Question 6

Clinical features of varicose veins?

Answer 6

1) most patients complain of cosmetic appearance

2) aching, throbbing

3) itching

Question 7

What are some complications of varicose veins?

Answer 7

1) Skin changes:
- varicose eczema (also known as venous stasis)
- haemosiderin deposition → hyperpigmentation
- lipodermatosclerosis → hard/tight skin
- atrophie blanche → hypopigmentation

2) Bleeding

3) Superficial thrombophlebitis

4) Venous ulceration

5) Deep vein thrombosis

Question 8

Conservative mx of varicose veins?

Answer 8

• leg elevation
• weight loss
• regular exercise
• graduated compression stockings

Question 9

Possible treatments for varicose veins?

Answer 9

1) endothermal ablation: using either
radiofrequency ablation or endovenous laser treatment

2) foam sclerotherapy: irritant foam → inflammatory response → closure of the vein

3) surgery: either ligation or stripping

Question 10

What is superficial thrombophlebitis?

Answer 10

Inflammation associated with thrombosis of one of the superficial veins (usually the long saphenous vein of the leg).

This process is usually non-infective in nature but secondary bacterial infection may rarely occur resulting in septic thrombophlebitis.

Question 11

What are around 20% of superficial thrombophlebitis cases associated with?

Answer 11

20% will have an underlying DVT at presentation.

3-4% will progress to a DVT if untreated.

Question 12

What is associated with a higher risk of DVT in superficial thrombophlebitis?

Answer 12

The length of vein affected - an inflammed vein > 5 cm is more likely to have an associated DVT.

Question 13

Mx of superficial thrombophlebitis?

Answer 13

1) NSAIDs (topical/oral)

2) Topical heparinoids

3) Compression stockings (measure ABPI first)

4) LMWH