Varicose veins

Question 1

Definition

Answer 1

A dilated, tortuous (usually superficial) vein

usually found in lower limbs

Question 2

Where is most likely to occur?

Which nerves is it most likely to involve?

Answer 2

where?
-LSV
-SSV
-saphenofemoral junction 
nerves?
-saphenous nerve 
-sural nerve 
-superficial fibular nerve

Question 3

How is blood pumped back into the heart

Answer 3

• valves
• calf muscle
• superficial veins drain into deep veins. deep veins are found in muscle compartments and can withstand much higher pressures

Question 4

Causes

Answer 4

• pregnancy: release of hormones which can weaken the valves. can lead to mechanical obstruction in the deep veins
• surgery/trauma
• DVT: flow past the thrombus causes a high pressure flow which will weaken the valves
• pelvic floor tumour : mechanical obstruction of flow

Question 5

risk factors

Answer 5

• age
• gender- more common in women
• occupation e.g. standing long hours
• previous surgery
• pregnancy
• obesity

Question 6

how do they present

Answer 6

• itchiness
• swelling
• burning
• ulcers

Question 7

doppler test

Answer 7

• place doppler over saphenofemoral joint and press calf muscle
• if normal: one whoosh for blood moving up
• if faulty: 2 whoosh: one for blood going up- one for blood going down

Question 8

tap test

Answer 8

• place one hand on saphenofemoral joint and one on LSV

- tap saphenofemoral joint: if a tapping impulse is sent on LSV that is confirmation

Question 9

Tredelengberg test vs tourquet test

Answer 9

• ask patient to lie down
• empty the superficial veins by stroking in upwards direction
• keep hand firm on the saphenofemoral junction and ask patient to stand up.
• if blood Does not flow back then your hand is acting as the valve
• with torquet test use tourquet instead of hand

Question 10

who gets treatment?

Answer 10

• Ulcer presenting patients
• Patients with discolouration of the skin due to insufficient blood supply
• recurring symptomatic VV
• Bleeding VV
• superficial vein thrombosis

Question 11

Endovenous treatment and complications

Answer 11

• catheter used to enter LSV or SSV
• catheter moved up to saphenofemoral junction
• heat or laser leads to fibrosis= occlusion of vessel

complication: skin burns, phlebitis, DVT

Question 12

Foam scleropathy

Answer 12

• same as endogenous treatment but foam instead of heat/laser
• need to maintain pressure on vein to prevent foam from spreading which could lead to stroke

Question 13

open surgery and complications

Answer 13

• incision and saphenofemoral junction
• saphenous vein ligated from femoral
• instrument passed down length of saphenous and used to remove it
  complications:
• infection
• damage to nearby nerves
• bleeding