Varicose Veins Flashcards

1
Q

Definition

A

Dilated tortuous subcutaneous vein that is >3mm in the upright position

Varicosity can be main axial superficial veins or any tributaries of the veins

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2
Q

Risk factors

A

Non modifiable

  1. Age
  2. Family history

Modifiable

  1. Occupation
  2. Weight
  3. Posture
  4. Childbirth
  5. Increased abdominal pressure
  6. Tumours that compress deep veins
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3
Q

What is the pathophysiology of varicose veins

A

Inherent weakness in vein wall, leading to dilation and seperation of valve cusps to become incompetent

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4
Q

What are the causes of varicose veins

A

Primary - valve incompetence/multifactorial from posture and structure of vein wall

Secondary - previous DVT, deep vein obstruction, superficial thrombophlebitis, arteriovenous fistula causing increased flow and pressure

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5
Q

What is the clinical history of a varicose vein patient

A

Asymptomatic - cosmetic concern

Symptomatic

  1. Nonspecific pain. tingling, aching, burning cramps
  2. Swelling, itching, restless, tired, worse at the end of the day
  3. Better with stockings and elevating legs

Check risk factors

  1. Parity
  2. Family history

Rule out secondary causes
- Past history of DVT, thrombophlebitis

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6
Q

What is the clinical examination of a patient with varicose vein

A

On inspection

  1. Signs of CVI
  2. Previous surgical scars (stab avulsion)
  3. Course of the GSV and SSV for varicosities
  4. Check inguinal for saphena varix
  5. Infection

Palpation

  1. Feel for varicosities along the course of the saphenous veins
  2. Feel for any tenderness
  3. Check for saphena varix
  4. Cough test for saphena varix
  5. Tap test
  6. Peripheral pulses
  7. Inguinal lymph nodes

Move
1. Move the ankles - complication of advanced venous disease is reduced mobility

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7
Q

What are the special tests to conduct

A

Torniquet test
Trendelenburg test
Perthes test

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8
Q

How do you complete the examination of varicose veins

A
  1. Auscultate varicosity
  2. Examine abdomen for masses
  3. Examin inguinal region for lymphadenopathy
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9
Q

How do you use a doppler to detect varicosities

A

Place in popliteal fossa over small saphenous vein and squeeze the calf - until you hear a whoosh. Relaxation of the calf should not normally have a second sound, but in varicosities there will be a second sound

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10
Q

What investigations confirm varicosities

A

Venous duplex ultrasound
Check deep and superficial systems
Check valve closure time
Exclude DVT

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11
Q

What management strategies for varicose veins

A
  1. Conservative
    - Lose weight
    - Stop standing so much
    - Compression stockings (grade 1 and 2)
    - Daflon
  2. Surgical indications
  3. CEAP class 3 and above
  4. Symptoms like pain or bleeding
  5. Cosemesis
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12
Q

What are the available surgical interventions

A
  1. Endovascular repair for ablation of the saphenous vein
    Contraindicated by saphenous vein thrombosis, complications include thrombophlebitis, DVT, burns
  2. Ultrasound guided sclerotherapy if VV is less than 3mm
    Sclerosing agent of hypertonic saline
    Can cause hyperpigmentation and cutaneous necrosis
  3. Hie tie with GSV stripping and stab avulsions
    Complications - DVT, saphenous nerve injury
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