Varicose veins Flashcards
What are varicose veins
Tortuous, twisted or lengthened superficial veins
Pathophysiology of varicose veins
Increased pressure on valves (obesity, pregnancy, heart failure) in lower limb leads to valve failure and so blood pools in superficial lower limb veins
Secondary causes of varicose veins
DVT
Pelvic tumours
AV fistula
Describe types of varicose veins
Trunk - ache, feel heavy, itchy
Reticular - 2mm, deeper than telangiectasia, don’t protrude
Telangiectasia - 0.5-1mm, surface (spider veins)
Complications of varicose veins
Thrombophlebitis Haemorrhage Oedema Skin pigmentation Ulceration Venous eczema Atrophie Blanche Lipodermatosclerosis
Why does overlying skin become pigmented
Capillaries leak RBCs
Macrophages enter interstitial fluid to destroy RBCs
Haemosiderin is deposited in skin
What is atrophie blanche
Scarring over overlying skin due to chronic inflammation
What does lipodermatosclerosis look like
Upside down champagne bottle
Fibrosis of subcutaneous tissue around ankle draws in skin
What is trendelenberg test for varicose veins
Ask the patient to lie down. Elevate the leg, and empty the veins by massageing distal to proximal.
Using a tourniquet, occlude the superficial veins in the upper thigh. Ask the patient to stand. If the tourniquet prevents the veins from re-filling rapidly, the site of the incompetent valve must be above this level i.e. at the sapheno-femoral junction. If the veins re-fill, the communication must be lower down.
Repeat above the knee and below the knee
Management for varicose veins
Nothing
Compression hosiery - can make worse
Endovenous laser or ablation of vein
Surgery (valve reconstruction or rediversion)
Causes of calf muscle pump failure
Immobility
Incompetent deep veins
Incompetent superficial veins
Obstruction
Examining venous ulcers
Site, shape, size Pulses to rule out arterial ulcer Sensation Mobility Induction Ankle flare
Management of venous ulcers
Compression bandaging if:
Ruled out arterial ulcer
ABPI >0.8
