Varicose Veins

Question 1

RF

Answer 1

Very common

Familial/genetic link

Question 2

Vein normal mechanism

Answer 2

Superficial veins = take blood from skin of leg and transfer up into deep veins via perforating veins or sapheno-femoral junction (long saphenous) or sapheno-popliteal junction (short saphenous)

• goes up via valves
• soleus and gastrocnemius contracts squeezes veins forcing blood up

Question 3

Varicose vein mechanism

Answer 3

• blood comes down veins
• column of blood sitting in vein
• vein gets stretched
• mostly superficial and short branches from skin emptying into superficial
• these are varicose veins

Question 4

How to assess varicose veins patient

Answer 4

Hx
Exam
Ix

Question 5

History

Answer 5

FH
Previous DVT = blocked deep vein so more flow through superficial veins, also get scarring of valves in deep veins
Multiple pregnancies
LT immobile? - undiagnosed DVT
Symptoms? - aching, look unpleasant?

Question 6

Examination

Answer 6

Bleeding?
Skin problems
Swelling of legs

Question 7

Ix

Answer 7

How good the deep veins are?

Confirm root cause

Question 8

Complications

Answer 8

Swelling - dilation of veins, venous HTN = swelling at ankles, leaks out into tissues, at end of day, go away when wake up
Discomfort
Itching
Eczema -
Haemosiderin deposition = red cells get out of veins, die, Hb release iron, oxidises to rust
Lipdermatosclerosis - dry purple skin, lesions from itching, narrow part of leg = champagne bottle legs
Bleeding - when knock high pressure veins
Ulceration - arterioles supplying skin with oxygen die so gets dry

Question 9

Differentials of varicose veins

Answer 9

Reticular veins

Spider/thread vines

Question 10

Methods of treatment

Answer 10

Conservative = elevate, compression stockings, active
Medical = topical creams
Surgical

Question 11

Surgical Options

Answer 11

1 - open ligation & stripping (old)
2 - foam sclerotherapy (if veins and not straight and are wiggly, poison of vein so goes into spasm)
3- endovenous solutions (radiofreq ablation, close vein which doesn’t work and force blood to go through other veins, heater elements)

Question 12

Early complications of open surgery

Answer 12

Bleeding
bruising
Discomfort
Infection
DVT/PE

Question 13

Late complications of open surgery

Answer 13

Recurrence Parasthesia

Question 14

Endovenous treatment benefits

Answer 14

1 hr treatment
Immediate ambulation
In physcian's office
Less expensive
Mild/infrequent complications