Varicose Veins Flashcards
What is the definition of varicose veins
Superficial veins in the lower limb that are dilated and tortuous. Due to valve incompetence.
What are some risk factors for varicose veins
Family history
Pregnancy
Past history of DVT or long bone fracture
What is the pathophysiology of varicose veins
Fibrous tissue invades the tunica intima and media of the vein and breaks up the smooth muscle. This prevents maintenance of adequate vascular tone
What might a patient with varicose veins complain of
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
What would you expect to find on examination of a patient with varicose veins (complications of varicose veins)
Dilated tortuous veins Lipodermatosclerosis Venous Eczema Ulceration Pedal oedema
In which group of people would you expect to find veins that are dilated ONLY
Athletes
Which vein is most likely responsible for varicose veins seen in the thigh or medial calf
Long saphenous vein
Which vein is most likely responsible for varicose veins seen in the popliteal fossa or posterior calf
Short saphenous vein
*Distinction may be difficult below the knee
Where would you expect to find the signs of chronic venous insufficiency
‘Gaiter area’ - around the medial malleolus
What is a healed venous ulcer called
Atrophie blanche - causes a white patch
Where is the saphenofemoral junction
3.5cm (2 finger breadths) below and lateral to the pubic tubercle
What is the tap test
Patient stands
Tap the long saphenous vein at the medial knee
Palpate over the saphenofemoral junction
Feel for transmitted impulse (positive test)
How do you interpret the tap test
Palpable impulse indicates valve incompetence along the long saphenous vein
What may cause secondary varicose veins
Pregnancy
Pelvic or abdominal tumours (rarely)
What are the indications for preoperative Duplex ultrasound scanning
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
What would you need to inform that patient about the surgery for varicose veins
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)
What are the indications for referral of varicose veins to a vascular surgeon
Symptomatic Skin changes Venous ulcer Superficial vein thrombosis Bleeding varicose veins (refer immediately)
What non-surgical management is available for varicose veins
Weight loss
Light to moderate physical activity (to improve calf muscle pump)
Class II compression stockings
Elevation of the legs
What minimally invasive therapy is available for varicose veins
Sclerotherapy
Endovenous laser or radio frequency ablation
What is sclerotherapy
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
In which cases is sclerotherapy indicated
Postoperative recurrence of veins
Below knee varicosities if the long and short saphenous veins are not involved
What surgical options are available for varicose veins
Ligation of the incompetent saphenofemoral or saphenopopliteal junction
Ligation of incompetent perforating vessels
Subcutaneous endoscopic perforator surgery (SEPS)
What syndromes are associated with varicose veins
Klippel-Trenaunay syndrome
Parkes-Weber syndrome
What is Klippel-Trenaunay syndrome
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)
