Varicose veins Flashcards
Define varicose veins
Veins that become prominently elongated, dilated and tortuous, most commonly the superficial veins of the lower limbs.
Explain the aetiology/risk factors of varicose veins
Primary
Due to genetic or developmental weakness in the vein wall
Results in increased elasticity, dilatation and valvular incompetence
Secondary Due to venous outflow obstruction Pregnancy Pelvic malignancy Ovarian cysts Ascites Lymphadenopathy Retroperitoneal fibrosis - Due to valve damage (e.g. after DVT), Due to high flow (e.g. arteriovenous fistula)
RISK FACTORS Age Female Family history Caucasian Obesity
Summarise the epidemiology of varicose veins
COMMON
Incidence increases with age
10-15% of men
20-25% of women
Recognise the presenting symptoms of varicose veins
Patients may complain about the cosmetic appearance Aching in the legs Aching is worse towards the end of the day of after standing for long periods of time Swelling Itching Bleeding Infection Ulceration
Recognise the signs of varicose veins on physical examination
Inspect when the patient is standing
May feel fascial defects along the veins
Cough impulse may be felt over the saphenofemoral junction
Tap Test - tapping over the saphenofemoral junction will lead to an impulse felt distally (this would not happen if the valves were competent)
Palpation of a thrill or auscultation of a bruit would suggest an AV fistula
Trendelenburg Test - Allows localisation of the sites of valvular incompetence. Leg is elevated and the veins are emptied. A hand is placed over the saphenofemoral junction. The leg is put back down and filling of the veins is observed before and after the hand is released from the saphenofemoral junction
A Doppler ultrasound can be used to show saphenofemoral incompetence
Rectal or Pelvic Examination - If secondary causes are suspected
Signs of Venous Insufficiency - Varicose eczema. Haemosiderin staining, Atrophie blanche, Lipodermatosclerosis, Oedema, Ulceration
Identify appropriate investigations for varicose veins
Duplex Ultrasound - Locates sites of incompetence or reflux, Allows exclusion of DVT
Generate a management plan for varicose veins
Conservative
Exercise- improves skeletal muscle pump
Elevation of legs at rest
Support stockings
Venous Telangiectasia and Reticular Veins
Laser sclerotherapy
Microinjection sclerotherapy
Surgical
Saphenofemoral ligation
Stripping of the long saphenous vein
Identify possible complications of varicose veins
Venous pigmentation Eczema Lipodermatosclerosis Superficial thrombophlebitis Venous ulceration
Complications of Treatment
Sclerotherapy- skin staining, local scarring
Surgery - haemorrhage, infection, recurrence, paraesthesia, peroneal nerve injury
Summarise the prognosis for patients with varicose veins
Slowly progressive
High recurrence rates
