Varicose veins

Question 1

What are varicose veins

Answer 1

• Long, dilated, tortuous superficial veins

Question 2

Who gets them and how common

Answer 2

15-35% women (v common in pregnancy)

Question 3

What are the primary causes (95%)

Answer 3

• Idiopathic
• Congenital valve absence
• AV malformation (increase pressure)
• Overactive muscle pumps

Question 4

What are some secondary causes (5%)

Answer 4

• Obstruction - DVT, ovarian tumour, foetus
• Destruction - DVT
• Constipation

Question 5

What are some risk factors

Answer 5

• Female (pregnancy)
• prolonged standing
• Obesity
• FHx
• OCP
• Age

Question 6

What is the pathophysiology

Answer 6

Valves = incompetent = venous hypertension + dilation of superficial veins

Question 7

What are the signs

Answer 7

• ‘atrophice blanche’ - white scar (usually lower leg) after injury to area w. low blood supply
• Oedema
• Eczema
• Ulcers
• Haemosiderin –> causes brown staining of skin
• haemorrhage
• Phlebitis
• Skin hardening

Question 8

What are some DDx

Answer 8

• Osler-Weber-rendu syndrome
• Cellulitis
• Superficial phlebitis
• DVT

Question 9

How do you investigate this

Answer 9

• Doppler
• USS
• colour flow imaging

Question 10

How do you treat varicose veins

Answer 10

NON-PHARM
- lose weight/exercise, avoid long standing, support stockings

ENDOVASCULAR Tx

• Radio frequency ablation
• Endo-venous laser ablation
• Injection scleropathy –> all seal in long saphenous vein

SURGERY

• Avulsion
• Veins tripping
• Saphofemoral ligation - trendelenburg procedure

Question 11

What are some complications

Answer 11

• lipodermatosclerosis
• eczema
• oedema
• venous ulcer
• thrombophlebitis
• DVT/PE - bc of Tx