Varicose Veins Flashcards
What are varicose veins?
Long, tortuous and dilated veins of the superficial venous system in the legs
What happens?
Incompetence of the vein walls and the valves results in backwards flow of blood and venous pooling
What causes it? (2)
- Primary are unknown or congenital valve absence
- Secondary due to obstruction e.g DVT, Foetus, Ovarian tumour; Valve destruction; arteriovenous malformation; constipation; overactive muscle pumps e.g cyclists
What is trendenlenburgs test?
Varicose veins are either a problem with the vein itself or the sapheno-femoral junction so this test is used to distinguish
Are they common?
Very, 10-20% of men and 25-30% of women
Risk factors
Age, pregnancy, obesity, prolonged standing, family history, COCP
Symptoms (6)
Pain, cramp, aesthetic issues, tingling, heaviness, restless legs
Signs (7)
Bulging lumpy veins, venous eczema, haemosiderin, haemorrhage, phlebitis, atrophic blanche (white ulcer scar), lipodermatosclerosis
Differentials (3)
Cellulitis, Superficial Phlebitis, DVT
Investigations (5)
Duplex ultrasound, venous physiology tests, trendelenburgs test, feel for cough impulse, auscultate for bruits
What is the referral criteria? (4)
Pain, bleeding, ulceration and superficial thrombophlebitis
Treatment (10)
Treat any underlying cause, avoid prolonged standing and elevate legs, support stockings, weight loss, regular walks to aid venous return, endothermal ablation, ultrasound guided foam scleropathy, stripping, phlebectomy, sapheno-femoral junction ligation
Complications (8)
Haemorrhage, thrombophlebitis, venous ulcers, oedema, skin pigmentation, varicose eczema, DVT and P.E, saphenous nerve paraesthesia
Is there a good prognosis?
untreated can cause significant reflux resulting in chronic venous ulceration, but the main issues are aesthetic. 13% treated with surgery will recurr
