varicose veins

Question 1

what are the two main causes of varicose veins?

Answer 1

1. primary - idiopathic (most common)
2. secondary - minority have an underlying cause
   - pelvic mass : occludes venous return (pregnancy, fibroids, ovarian tumor)
   - previous DVT

Question 2

what are the risk factors for varicose veins?

Answer 2

1. female (x5)
2. age
3. pregnancy
4. smoking
5. obesity

Question 3

what is the anatomy of venous drainage in lower limbs?

Answer 3

1. superficial - drains the skin and subcutaneous tissue
   - formed by long and short saphenous veins
2. saphenofemoral junction/saphenopopliteal junction - superficial veins drain into deep veins
3. deep veins lie within the fascia and drain the calf

Question 4

what is the pathology of varicose veins?

Answer 4

1. failure of valves in the superficial saphenous veins
2. results in venous pooling and chronic venous hypertension
3. dilatation of vessels - varicosities

Question 5

what are the main clinical features?

Answer 5

1. dilated tortous veins

Question 6

how does thrombophlebitis present?

Answer 6

1. inflammation of superficial veins caused by venous stasis causing pain
2. heaviness, aching, itching

Question 7

what is lipodermatosclerosis?

Answer 7

1. venous pooling causing chronic venous hypertension
2. leakage of blood vessels
3. brown haemosiderin blood vessels
4. ‘inverted champagne bottle’ appearance

Question 8

what are the main complications of varicose veins?

Answer 8

1. thrombophlebitis
2. haemorrhage
3. lipodermatosclerosis
4. venous ulcers

Question 9

Ix

Answer 9

1. doppleter ultrasound

Question 10

Conservative mx

Answer 10

1. weight loss

2. regular walking and avoid prolonged standing

Question 11

Medical mx

Answer 11

1. injection scleropathy
2. compression stocking
3. manage venous ulceration with 4 layer bandaging and compression

Question 12

Surgical mx

Answer 12

1. saphenophemoral ligation

2. below knee saphenous vein stripping