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Junior Surgery- Vascular > Varicose Veins > Flashcards

Varicose Veins Flashcards

1
Q

What are varicose veins?

A
  • Tortuous dilated segments of vein associated with valvular incompetence
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2
Q

How do varicose veins occur?

A
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3
Q

What are the risk factors for varicose veins?

A
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4
Q

What are the different types of varicose veins?

A
  • 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
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5
Q

What is Virchows triad?

A
  • Hypercoaguability
  • Stasis of venous blood flow
  • Disruption of venous intimal lining
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6
Q

Clinical features of varicose veins?

A
  • Cosmetic issues
  • Worsening => pain, swelling, itch
  • Varicosities in the course of the saphenous veins
  • Features of venous insufficiency (ulcers, eczema, haemosiderin deposition)
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7
Q

Describe the investigations into suspected varicose veins?

A
  • Duplex ultrasound (gold standard)
    • Assesses valve competence
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8
Q

Describe the Tourniquet test?

A
  • (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
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9
Q

What is a saphena varix?

A
  • 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
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10
Q

What are the features of venous insufficiency?

A
  • Oedema
  • Varicose eczema
  • Lipodermatosclerosis
  • Haemosiderin skin staining
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11
Q

Treatment for varicose veins?

A
  • 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
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12
Q

Complications of varicose veins?

A
  • Bleeding
  • Ulceration
  • Thrombophlebitis
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13
Q

What is pictured here?

A

Varicose eczema

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14
Q

What is pictured here??

A
  • Superficial thrombophlebitis
    • Inflammatory process that causes a blood clot to form
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15
Q

What is pictured here?

A
  • Lipodermatosclerosis
    • inverted champagne bottle
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16
Q

Describe the classification of varicose veins?

A
  • CEAP classification
    • C => clinical features
    • E => etiology
    • A => anatomical
    • P => pathophysiology
17
Q

What is CEAP classification used for?

A

Assess manifestations of chronic venous disease

18
Q

Describe the C component of CEAP classification?

A
  • 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
19
Q

Describe the E component of CEAP classification?

A
  • E - etiological
  • Ep: Primary (develops independent of othe diseases)
  • Es: Secondary to another disorder
  • Ec: congeital (present at birth)
  • En: Absence of identifed aetiology
20
Q

Describe the A component of CEAP classification?

A
  • A(s1-s5)
    • Superficial venous system
  • A(d6-16)
    • Deep venous system
  • A(p17-p18)
    • Perforating veins
  • An
    • Unidentified anatomical location
21
Q

Describe the P component of CEAP classification?

A
  • P - pathophysiology
    • Pr : Reflux
    • Po: Obstruction
    • Pro: Reflux/obstruction
    • Pn: Unidentified venous pathophysiology
22
Q

What is pictured here??

A
  • Haemosiderin skin discolouration
    • Venous insufficiency
23
Q

Femoral hernia + varicosities in the rest of the limb = __________ ?

A

Saphena varix

24
Q

When should varicose veins be treated?

A
  • Refferred to a vascular service if:
    • Symptomatic
    • LL skin changes
    • Superficial vein thrombosis
    • Venous leg ulcer
25
Q

What investigation should be performed prior to compression bandaging?

A

Ankle-brachial pressure index

26
Q

Describe Vein ligation?

A
  • Incision made in groin or popliteal fossa
  • Vein is identified, tyed off then stripped away
  • Surgeon should be aware of saphenous and sural nerves
27
Q

Describe Foam scleropathy?

A
  • Sclerosing agent injected directed into varicosed veins under US guidance
  • Inflammatory response closes off the vein
  • Only requires local anaesthetic
28
Q

Describe radiofrquency ablation?

A
  • 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
29
Q

Describe the difference between a doppler and duplex ultrasound?

A
  • Duplex ultrasound
    • Valve competence
    • Meausre blood flow through the veins
  • Doppler ultrasound
    • Pulses?
30
Q

What is thrombophlebitis?

A
  • Inflammation of the vein
  • Usually caused by a blood clot
  • Increased risk in someone with varicose veins
31
Q

Describe Postphlebitic syndrome?

A
  • Also known as post-thrombotic syndrome
  • Symptomatic chronic venous insuffieicny after DVT
32
Q

Describe stasis sequelae?

A
  • (stasis dermatitis)
  • Inflammation of the skin due to chronic venous insufficiency
  • Itching, scaling, hyperpigmentation
33
Q

Describe the process of haemosiderin deposition

A
  • 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

Junior Surgery- Vascular (6 decks)

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