Varicose Veins

Question 1

What are they?

Answer 1

Tortuous dilated segments of vein associated with valvular incompetence.

Question 2

Aetiology:

Answer 2

Arrise from incompetent valves that allow blood to flow from deep venous system to superficial system.

98% of varicose veins are primary idiopathic varicose veins. Secondary causes may include DVT, pelvic masses (e.g. pregnancy, uterine fibroids, and ovarian masses), or arteriovenous malformations (such as Klippel-Trenaunay Syndrome).

Question 3

RF:

Answer 3

• Pregnancy
• Prolonged standing
• Obesity
• FH

Question 4

Clinical features:

Answer 4

Cosmetic issues

Painful, aching, swelling or itching

May present with venous insufficiency: oedema, varicose eczema, ulcers

Question 5

What is saphena varix?

Answer 5

Dilatation of the saphenous vein at the saphenofemoral junction in the groin. As it displays a cough impulse, it is commonly mistaken for a femoral hernia; suspicion should be raised in any suspected femoral hernia if the patient has concurrent varicosities present in the rest of the limb.

Use duplex USS.

Question 6

How do we classify?

Answer 6

Question 7

Ix:

Answer 7

Duplex USS

Question 8

What is the non-surgical treatment?

Answer 8

Prolonged standing, weight loss, and increase exercise

Compression stockings

Question 9

Who qualifies for surgical treatment?

Answer 9

• Symptomatic primary or recurrent varicose veins
• Lower‑limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency
• Superficial vein thrombosis (characterised by the appearance of hard, painful veins) with suspected venous incompetence
• A venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks)

Question 10

Surgical treatment options?

Answer 10

• Vein ligation, stripping, and avulsion – making an incision in the groin (or popliteal fossa) and identifying the responsible, refluxing vein, before tying it off and stripping it away. The surgeon must be aware of surrounding arterial and nervous structures, such as the saphenous and sural nerves.
• Foam sclerotherapy – injecting a sclerosing (irritating) agent directly into the varicosed veins, causing an inflammatory response that closes off the vein. This is done under ultrasound guidance to ensure the foam does not enter the deep venous system, however this method only requires a local anaesthetic.
• Thermal ablation – which involves heating the vein from inside (via radiofrequency or laser catheters), causing irreversible damage to the vein which closes it off. This is done under ultrasound guidance and also may be performed under local (or general) anaesthetic.