Varicose Veins Flashcards
What is a VV?
A twisting dilated superficial vein
Where are the most common sites for a VV?
Long/short saphenous veins
What gender has a higher prevalence?
Females
Pathophysiology of VV?
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
What should be looked for in the history?
Onset Previous trauma Family history Occupation Pregnancies - especially with twins/bigger babies Any other symptoms around the VVs
What are some signs/symptoms with VVs?
Visable disfiguration of vein Discomfort in leg Itch Nocturnal cramps Swelling Thrombophelbitis
What is superficial thrombophelbitis?
Inflammation and thrombus in a superficial vein
When would you consider interventions?
If any symptoms such as debilitating pain
If signs of a superficial thrombophelbitis
Signs of chronic venous insufficiency
Bleeding
What are some other issues not normally cause for treatment?
Cosmetic worry
Anxiety disease may progress
What sub-types of treatment are there?
Invasive surgery
Minimally invasive surgery
Compression
How is invasive surgery carries out and give some examples?
Under general anesthetic
High tie
Vein stripping
Multiple stab avulsions
Describe a high tie.
Ligation of the sapheno-femoral or sapheno-popliteal junctions
Contraindications of invasive surgery?
A previous DVT
Arterial insufficiency
Patient co-morbities
Morbid obesity
Complications of invasive surgery?
Bleeding Wound infection Pain Scarring Thrombophelbits Haematoma Damage to superficial veins or deep VANs DVT
Minimally invasive procedures (MIP) are the primary clinical option - true or false?`
True
Where are MIPs performed?
In main trunk varicosities
What sort of anesthetic is used in a MIP?
Local
What types of MIPs are there to treat VVs?
Foam sclerotherapy Endovenous laser ablation (EVLA) Radiofreqency albation (VNUS)
Describe a foam scleotherapy?
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
/Describe an EVLA
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
What does ablation mean?
Surgical removal of tissue
Describe radiofrequency ablation (VNUS)
Catheter inserted
Vein warmed to 85 degrees C and collapses
Advantages for MIPs?
Reduced trauma
Faster patient throughput
More cost effective
What is compression therapy
Using compression socks
For the MIPs - what imaging is used as a guide?
Ultrasound
