Varicose Veins

Question 1

What are varicose veins.

Answer 1

Long tortuous and dilated veins of the superficial venous system.

Question 2

What is the pathological process of varicose veins. (3)

Answer 2

Blood from superficial veins of the leg passes into the deep veins via perforator veins (perforate deep fascia) and at the sapheno-femoral and sapheno-popliteal junctions.
Valves prevent blood from passing from deep to superficial veins.
If they become incompetent there is venous hypertension and dilatation of the superficial veins occurs.

Question 3

What are the risk factors for varicose veins. (5)

Answer 3

Prolonged standing. 
Obesity. 
Pregnancy. 
Family history. 
The Pill.

Question 4

What are the primary causes of varicose veins. (2)

Answer 4

Unknown.

Congenital valve absence (very rare).

Question 5

What are the secondary causes of varicose veins. (5)

Answer 5

Obstruction (DVT, fetus, ovarian tumour).
Valve destruction (DVT).
Arteriovenous malformation (increased pressure).
Constipation.
Overactive muscle pumps (eg cyclists).

Question 6

What are the symptoms of varicose veins. (6)

Answer 6

Ugly. 
Pain. 
Cramps. 
Tingling. 
Heaviness. 
Restless legs.

Question 7

What are the physical signs of varicose veins. (8)

Answer 7

Oedema. 
Eczema. 
Ulcers. 
Haemosiderin. 
Haemorrhage. 
Phlebitis. 
Atrophie blanche. 
Lipodermatosclerosis.

Question 8

What are atrophie blanche.

Answer 8

White scarring at the site of a previous, healed ulcer.

Question 9

What is lipodermatosclerosis.

Answer 9

Skin hardness from subcutaneous fibrosis caused by chronic inflammation and fat necrosis.