Varicose veins Flashcards
What are the different types of varicose veins?
- Primary
- Uncomplicated saphenofemoral valvular incompetence
- Greater saphenous distribution, positive tourniquet test
- No stasis sequelae or morning ankle oedema
- Secondary
- Perforator venous incompetence
- Secondary to postphlebitic syndrome
Clinical features of varicose veins?
- Cosmetic issues
- Worsening => pain, swelling, itch
- Varicosities in the course of the saphenous veins
- Features of venous insufficiency
What are the features of venous insufficiency?
- Oedema
- Varicose eczema
- Lipodermatosclerosis
- Haemosiderin skin staining
Complications of varicose veins?
- Bleeding
- Ulceration
- Thrombophlebitis
What is a saphena varix?
- Dilatation of saphenous vein at saphenofemoral junction in the groin
- Displays a cough impulse
- Can be mistaken for a femoral hernia
- Tx: High saphenous ligation
What is pictured here??
Varicose eczema
What is pictured here??
- Superficial thrombophlebitis
- Inflammatory process that causes a blood clot to form
What is pictured here??
- Lipodermatosclerosis
- inverted champagne bottle
Describe the classification of varicose veins?
- CEAP classification
- C => clinical features
- E => etiology
- A => anatomical
- P => pathophysiology
Describe the investigations into suspected varicose veins?
- Duplex ultrasound (gold standard)
- Assesses valve competence
What is pictured here??
- Haemosiderin skin discolouration
- Venous insufficiency
Femoral hernia + varicosities in the rest of the limb = __________ ?
Saphena varix
When should varicose veins be treated?
- Refferred to a vascular service if:
- Symptomatic
- LL skin changes
- Superficial vein thrombosis
- Venous leg ulcer
Treatment for varicose veins?
- Patient education
- Prolonged standing, weight loss, increase exercise
- Compression stockings
- If interventional treatment is inappropriate
- Invasive treatments
- Foam scleropathy
- Radiofrequency ablation
- Ligation
- High saphenous vein ligation
- Ligation of incompetent perforators
What investigation should be performed prior to compression bandaging?
Ankle-brachial pressure index
What is Virchows triad?
- Hypercoaguability
- Stasis of venous blood flow
- Disruption of venous intimal lining
Describe Vein ligation?
- Incision made in groin or popliteal fossa
- Vein is identified, tyed off then stripped away
- Surgeon should be aware of saphenous and sural nerves
Describe Foam scleropathy?
- Sclerosing agent injected directed into varicosed veins under US guidance
- Inflammatory response closes off the vein
- Only requires local anaesthetic
Describe radiofrquency ablation?
- Heating of the vein from the inside under US guidance
- Irreversible damage to the vein which closes it off
- Performed under local or general anaesthetic
What is CEAP classification used for?
Assess manifestations of chronic venous disease
Describe the C component of CEAP classification?
- C - clinical features
- C0: No signs
- C1: Telangiectasias, reticular veins
- C2: Varicose veins
- C3: Oedema
- C4: Secondary skin alterations
- C4a: Pigmentation, eczema or both
- C4b: Lipodermatosclerosis
- C5: Healed venous ulcer
- C6: Open venous ulcer
- A: asymptomatic
- B: symptomatic
Describe the E component of CEAP classification?
- E - etiological
- Ep: Primary (develops independent of othe diseases)
- Es: Secondary to another disorder
- Ec: congeital (present at birth)
- En: Absence of identifed aetiology
Describe the A component of CEAP classification?
- A(s1-s5)
- Superficial venous system
- A(d6-16)
- Deep venous system
- A(p17-p18)
- Perforating veins
- An
- Unidentified anatomical location
Describe the P component of CEAP classification?
- P - pathophysiology
- Pr : Reflux
- Po: Obstruction
- Pro: Reflux/obstruction
- Pn: Unidentified venous pathophysiology
Describe the difference between a doppler and duplex ultrasound?
- Duplex ultrasound
- Valve competence
- Meausre blood flow through the veins
- Doppler ultrasound
- Pulses?
What is thrombophlebitis?
- Inflammation of the vein
- Usually caused by a blood clot
- Increased risk in someone with varicose veins
Describe Postphlebitic syndrome?
- Also known as post-thrombotic syndrome
- Symptomatic chronic venous insuffieicny after DVT
Describe the Tourniquet test?
- (if using fingers = Trendelenburg test)
- Position patient flat
- Elevated leg as far as posiible to empty superficial veins
- Place a tourniquet over saphenofemoral junction
- Ask patient to stand and observe for filling of the veins
- If they do not fill -> venous valve incompetence at level of SFJ
- If they do fill -> repeat 3cm down to find level of incompetence
Describe stasis sequelae?
- (stasis dermatitis)
- Inflammation of the skin due to chronic venous insufficiency
- Itching, scaling, hyperpigmentation
Describe the process of haemosiderin deposition
- Blood pools in the venous due to poor valvular function
- Haem is broken down and the iron is stored in the tissues
- Haemosiderin is an iron-storage complex
