Varicose Veins

Question 1

def

Answer 1

veins that have become elongated, dilated + tortuous

commonly superficial veins in the legs

Question 2

aetiology

Answer 2

1 primary
-genetic/developmental weakness of vein wall resulting in decreased elasticity + dilation over time
2 secondary - venous outflow obstruction:
-pregnancy
-pelvic malignancy
-ovarian cysts
3 valve damage
-DVT
-arteriovenous fistula

Question 3

epi

Answer 3

common
increases with age
females>males

Question 4

history

Answer 4

1 aching in the legs
-worse towards end of day
-worse with prolonged standing
2 swelling
3 itching

Question 5

examination

Answer 5

1 inspection (patient standing)
-vein distribution
-oedema (DVT)
2 palpation
-tap test - impulse felt distally along the vein after tapping on the saphenofemoral vein (not normally present due to competent valves)
3 trendelenburg test
4 doppler for sites of valvular incompetence

Question 6

what is the trendelenburg test

Answer 6

can localise sites of valvular incompetence
1 patient supine, leg raised, veins are emptied
2 compression of the saphenofemoral junction
3 leg is hung off the bed and filling of veins is observed
4 compression is released + filling of veins is observed

Question 7

pathogenesis

Answer 7

primary valvular incompentence

weakness of the vein wall due to abnormalities or collagen + elastin

Question 8

what other factors could affect varicose vein formation

Answer 8

venous hypertension

hormonal changes

Question 9

investigations

Answer 9

imaging

-duplex USS to locate incompetence or reflux + exclude DVT

Question 10

conservative management

Answer 10

• exercise
• elevate legs
• stockings to increase venous return + reduce swelling

Question 11

management

Answer 11

1 surgical
-SFJ ligation (tying a ligature around a blood vessel)
-long saphenous vein stripped + avulsion of varicosities
-short saphenous vein ligated to avoid sural nerve damage
2 endovenous procedures
-endovenous laser treatment to ablate the long saphenous vein
-radiofrequency ablation

Question 12

what does avulsion mean

Answer 12

pulling/tearing away

Question 13

complications

Answer 13

1 venous ulceration

2 eczema

Question 14

complications of treatment

Answer 14

1 embolism
2 DVT
3 haemorrhage
4 parasthesia/nerve injury

Question 15

prognosis

Answer 15

slowly progressive

recurrence post surgery 40%