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Vascular > Varicose Veins > Flashcards

Varicose Veins Flashcards

1
Q

What is the definition of varicose veins

A

Superficial veins in the lower limb that are dilated and tortuous. Due to valve incompetence.

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2
Q

What are some risk factors for varicose veins

A

Family history
Pregnancy
Past history of DVT or long bone fracture

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3
Q

What is the pathophysiology of varicose veins

A

Fibrous tissue invades the tunica intima and media of the vein and breaks up the smooth muscle. This prevents maintenance of adequate vascular tone

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4
Q

What might a patient with varicose veins complain of

A 
Aching and heaviness in the lower limb on prolonged standing
Leg cramps
Restless legs
Itching
Eczema
Ulcers
Swelling
Bleeding if vein bursts (raise leg to stop)
Thrombophlebitis
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5
Q

What would you expect to find on examination of a patient with varicose veins (complications of varicose veins)

A 
Dilated tortuous veins
Lipodermatosclerosis
Venous Eczema
Ulceration
Pedal oedema
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6
Q

In which group of people would you expect to find veins that are dilated ONLY

A

Athletes

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7
Q

Which vein is most likely responsible for varicose veins seen in the thigh or medial calf

A

Long saphenous vein

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8
Q

Which vein is most likely responsible for varicose veins seen in the popliteal fossa or posterior calf

A

Short saphenous vein

*Distinction may be difficult below the knee

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9
Q

Where would you expect to find the signs of chronic venous insufficiency

A

‘Gaiter area’ - around the medial malleolus

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10
Q

What is a healed venous ulcer called

A

Atrophie blanche - causes a white patch

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11
Q

Where is the saphenofemoral junction

A

3.5cm (2 finger breadths) below and lateral to the pubic tubercle

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12
Q

What is the tap test

A

Patient stands
Tap the long saphenous vein at the medial knee
Palpate over the saphenofemoral junction
Feel for transmitted impulse (positive test)

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13
Q

How do you interpret the tap test

A

Palpable impulse indicates valve incompetence along the long saphenous vein

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14
Q

What may cause secondary varicose veins

A

Pregnancy

Pelvic or abdominal tumours (rarely)

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15
Q

What are the indications for preoperative Duplex ultrasound scanning

A

Some surgeons say all patients should undergo Duplex scanning before surgery

Indications:-
Previous history of DVT
Any signs of chronic venous insufficiency
Recurrent varicose veins
Difficulty in deciding which vein is incompetent

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16
Q

What would you need to inform that patient about the surgery for varicose veins

A

Day case
Compression stockings for 7 days post-op (NICE guidelines)
No driving for 1 week
Surgery doesn’t fix skin changes
Surgery may not improve symptoms such as aching
Risk of recurrent veins (20% at 5 years)

17
Q

What are the indications for referral of varicose veins to a vascular surgeon

A 
Symptomatic
Skin changes
Venous ulcer
Superficial vein thrombosis
Bleeding varicose veins (refer immediately)
18
Q

What non-surgical management is available for varicose veins

A

Weight loss
Light to moderate physical activity (to improve calf muscle pump)
Class II compression stockings
Elevation of the legs

19
Q

What minimally invasive therapy is available for varicose veins

A

Sclerotherapy

Endovenous laser or radio frequency ablation

20
Q

What is sclerotherapy

A

Involves injection of 1% sodium tetradecyl sulphate. It irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot.

High recurrence rate

21
Q

In which cases is sclerotherapy indicated

A

Postoperative recurrence of veins

Below knee varicosities if the long and short saphenous veins are not involved

22
Q

What surgical options are available for varicose veins

A

Ligation of the incompetent saphenofemoral or saphenopopliteal junction
Ligation of incompetent perforating vessels
Subcutaneous endoscopic perforator surgery (SEPS)

23
Q

What syndromes are associated with varicose veins

A

Klippel-Trenaunay syndrome

Parkes-Weber syndrome

24
Q

What is Klippel-Trenaunay syndrome

A

Triad of:-
Varicose veins
Port wine stains
Bony and soft tissue hypertrophy of the limbs

May present with varicose veins in unusual positions (lateral aspect of thigh)
Peripheral oedema is often significant (deep venous system may be abnormal)

25
Q

What is Parkes-Weber syndrome

A

Multiple AV fistulae
Limb hypertrophy

AV fistulae may be so severe as to cause high-output cardiac failure

26
Q

What must the ABPI be before compression stockings can be used in varicose veins

A

Greater than 0.8

27
Q

What is the course of the long saphenous vein

A

It originates from the medial side of the dorsal venous arch, ascending anterior to the medial malleolus, up the medial aspect of the leg, draining into the femoral vein at the saphenofemoral junction, which is 3.5cm inferior and lateral to the pubic tubercle

28
Q

What is the course of the short saphenous vein

A

It originates from the lateral side of the dorsal venous arch, ascending posterior to the lateral malleolus, up the posterior aspect of the calf, draining into the popliteal vein at the saphenopopliteal junction, posterior to the knee

29
Q

What is the CEAP classification?

A

Classification system for chronic venous disease. Based on:
C- clinical signs (0-6, where 0 = asymptomatic and 6 = active ulceration)
E- Aetiology
A- Anatomy
P- Pathophysiology

30
Q

What are the post-op complications of varicose vein surgery?

A

Early:
Haematoma, especially groin. (infection).
Wound sepsis
Nerve damage e.g. long saphenous damage saphenous nerve, short saphenous damage sural nerve

Late:
Superficial thrombophlebitis
DVT
Recurrence (20% at 5 years)

31
Q

What is thrombophlebitis?

A

Clot in the vein with inflammation around the clot
Pain for 2-3 weeks before settling
Treat with anti-inflammatories (gel or PO), rest, elevation

32
Q

Why isn’t long saphenous vein stripping performed as surgical management for varicose veins anymore?

A

Due to potential for saphenous vein nerve damage

Vascular (18 decks)

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