Varicose Veins

Question 1

What is a VV?

Answer 1

A twisting dilated superficial vein

Question 2

Where are the most common sites for a VV?

Answer 2

Long/short saphenous veins

Question 3

What gender has a higher prevalence?

Answer 3

Females

Question 4

Pathophysiology of VV?

Answer 4

Valvular incompetence (of veins)

Veins normally work against gravity - valves compartmentalize the blood leading to a better equalization of pressure throughout veins which prevents reflux

Blood pools when valves don’t work properly which leads to increased pressure and distension of vein

Question 5

What should be looked for in the history?

Answer 5

Onset
Previous trauma 
Family history
Occupation 
Pregnancies - especially with twins/bigger babies
Any other symptoms around the VVs

Question 6

What are some signs/symptoms with VVs?

Answer 6

Visable disfiguration of vein
Discomfort in leg
Itch
Nocturnal cramps
Swelling
Thrombophelbitis

Question 7

What is superficial thrombophelbitis?

Answer 7

Inflammation and thrombus in a superficial vein

Question 8

When would you consider interventions?

Answer 8

If any symptoms such as debilitating pain
If signs of a superficial thrombophelbitis
Signs of chronic venous insufficiency
Bleeding

Question 9

What are some other issues not normally cause for treatment?

Answer 9

Cosmetic worry

Anxiety disease may progress

Question 10

What sub-types of treatment are there?

Answer 10

Invasive surgery
Minimally invasive surgery
Compression

Question 11

How is invasive surgery carries out and give some examples?

Answer 11

Under general anesthetic

High tie
Vein stripping
Multiple stab avulsions

Question 12

Describe a high tie.

Answer 12

Ligation of the sapheno-femoral or sapheno-popliteal junctions

Question 13

Contraindications of invasive surgery?

Answer 13

A previous DVT
Arterial insufficiency
Patient co-morbities
Morbid obesity

Question 14

Complications of invasive surgery?

Answer 14

Bleeding
Wound infection
Pain
Scarring
Thrombophelbits
Haematoma
Damage to superficial veins or deep VANs
DVT

Question 15

Minimally invasive procedures (MIP) are the primary clinical option - true or false?`

Answer 15

True

Question 16

Where are MIPs performed?

Answer 16

In main trunk varicosities

Question 17

What sort of anesthetic is used in a MIP?

Answer 17

Local

Question 18

What types of MIPs are there to treat VVs?

Answer 18

Foam sclerotherapy
Endovenous laser ablation (EVLA)
Radiofreqency albation (VNUS)

Question 19

Describe a foam scleotherapy?

Answer 19

Needle inserted into the incompetent veins using USS as a guide

Foam injected and is prevented from entering the deep veins

Has a chemical reaction with the endothelium

Question 20

/Describe an EVLA

Answer 20

Micro-punture needle inserted into incompetent short/long saphenous vein

Guidewire introduced and maneuvered to the saphenous junction with deep vein using USS as a guide

Catheter and laser fibre introduced over the guidewire 1cm below the junction

Causes thermal ablation

Question 21

What does ablation mean?

Answer 21

Surgical removal of tissue

Question 22

Describe radiofrequency ablation (VNUS)

Answer 22

Catheter inserted

Vein warmed to 85 degrees C and collapses

Question 23

Advantages for MIPs?

Answer 23

Reduced trauma
Faster patient throughput
More cost effective

Question 24

What is compression therapy

Answer 24

Using compression socks

Question 25

For the MIPs - what imaging is used as a guide?

Answer 25

Ultrasound