Varicose veins Flashcards
Define varicose veins
Tortuous, dilated veins of the superficial venous system
How do varicose veins develop?
Valve failure → ↑ pressure in superficial veins → varicosity.
Tends to happen at femoral or popliteal junction
What are the primary causes of varicose veins?
Idiopathic Prolonged standing Obesity Pregnancy OCP FH Congenital valve absence - very rare
What are the secondary causes of varicose veins?
Valve destruction → reflux: DVT, thrombophlebitis
Obstruction eg DVT, foetus, pelvic mass
Constipation
Arteriovenous malformations
What are some of the symptoms of varicose veins?
Cosmetic Pain Cramping Heaviness Tingling Bleeding Swelling
What are some of the signs of varicose veins?
Skin changes eg venous eczema, atrophie blanche, Lipodermatosclerosis
Ulcers - medial malleolus/gaiter region
Oedema
Thrombophlebitis
What investigations can be performed in a patient with varicose veins?
Duplex ultrasonography - show incompetence, any obstructions or reflux
If having surgery, need FBC, U+Es, Clotting, G+S, CXR, ECG
What is the conservative management of varicose veins?
Wt loss Relieve constipation Avoid prolonged standing Regular walks Compression stockings Maintain hydration with emolients, treat ulcers rapidly
What minimally invasive therapies are available for patients with varicose veins?
Injection sclerotherapy using Na tetradecyl sulphate
Endovenous laser/radiofrequency ablation
What is the surgical management of varicose veins?
For if patient has major incompetent valves or severe symptomatic/complications
Ligation of vein
Stripping of vein - high risk of saphenous nerve damage so rarely done
What is the post op care for a patient with varicose veins?
Bandage
Keep leg elevated for 24 hours
Discharge with compression stockings, advise to walk daily
What complications may occur from surgery for varicose veins?
Haematoma Wound sepsis Damage to cutaneous nerve Superficial thrombophlebitis DVT Recurrence
