Varicose Veins (3)

Question 1

What is this?

What is its pathophysiology?

Answer 1

➊ Tortuous, elongated, dilated, thickened, superficial veins with non-functional, incompetent valves

➋ Incompetent valve allows blood to flow backwards, causing pooling and high pressures within the superficial veins

Question 2

What are some of the pregnancy-related causes?

What are the secondary causes?

Answer 2

➊ • Gravid uterus → Iliac venous compression
• 70-80% occur in 1st trimester, therefore probably related to oestrogen/progesterone

➋ • Previous DVT – Leaves deep valves incompetent
• Increased pelvic pressure e.g. pregnancy, pelvic tumour
• IVC Obstruction
• Severe tricuspid (R AV valve) valvular incompetence
• Congenital venous malformation e.g. Klippel-Trenunay Syndrome
• AV malformation – Congenital, Acquired (Trauma)

Question 3

Most are asymptomatic. But, what are some of the symptoms that may be present?

When would treatment be required?

What are the different treatment options?

Answer 3

➊ Itch, heaviness, swelling, pain, discolouration, ulceration, eczema

➋ If there’s bleeding, pain, ulceration, thrombophlebitis or significant psychological morbidity

➌ • Radiofrequency ablation - Destruction of endothelium of the vein via high temperature catheter
• Endovascular laser ablation - Destruction of vein using laser
• Injection Sclerotherapy – Injection of sclerosant substance at several points of the vein, leading to occlusion