Varicose veins Flashcards
definition of varicose veins
Tortuous, dilated veins of the superficial venous system
pathophysiology of varicose veins
- One-way flow from supficial → deep normally maintained by valves
- Valve failure → ↑ pressure in sup veins → varicosity
3 main sites for varicose veins
- Saphenofemoral Junction: 3cm below and 3cm lateral to pubic tubercle
- Saphenopopliteal Junction: popliteal fossa
- Perforators: draining Great saphenous vein
- 3 medial calf perforators (Cockett’s)
- 1 medial thigh perforator (Hunter’s)
primary causes of varicose veins
- Congenitally weak or absent valves
- Prolonged standing
- Pregnancy
- Obesity
- OCP
secondary causes of varicose veins
- Valve destruction or obstruction: DVT, foetus, pelvic mass, constipation
- Overactive pumps (e.g. cyclists)
- Klippel-Trenaunay (Port wine stain, varicose veins, limb hypertrophy)
symptoms of varicose veins
- Cosmetic defect
- Pain, cramping, heaviness
- Tingling
- Bleeding: may be severe
- Swelling
signs of varicose veins
- Skin changes
- Venous stars
- Haemosiderin deposition
- Venous eczema
- Lipodermatosclerosis (paniculitis)
- Atrophie blanche - Ulcers: medial malleolus / gaiter area
- Oedema
- Thrombophlebitis
investigations for varicose veins
- Duplex ultrasonography
2. Bloods: FBC, U+E, clotting, G+S, CXR, ECG
when to refer a patient with varicose veins
- Bleeding
- Pain
- Ulceration
- Superficial thrombophlebitis
- Severe impact on QoL
classification of chronic venous disease
CEAP classification
- Clinical signs (1-6 + sympto or asympto)
- Etiology
- Anatomy
- Pathophysiology
conservative management of varicose veins
- Treat any contributing factors (Lose weight, Relieve constipation)
- Education (Avoid prolonged standing, Regular walks)
- Class II Graduated Compression (Stockings 18-24mmHg, Symptomatic relief and slows progression)
- Skin Care (Maintain hydration with emollients, Treat ulcers rapidly)
indications for minimally invasive therapies for varicose veins
small below knee varicosities not involving great saphenous vein or short saphenous vein
minimally invasive therpay techniques for varicose veins
- local or GA
- Injection sclerotherapy: 1% Na tetradecyl sulphate
- Endovenous laser or radiofrequency ablation
post-operative care following minimally invasive therapy for varicose veins
- Compression bandage for 24hrs
- Compression stockings for 1mo
indications for surgical management of varicose veins
- Saphenofemoral Junction incompetence
- Major perforator incompetence
- Symptomatic: ulceration, skin changes, pain
