Varicose Veins Flashcards
Definition
Dilated tortuous subcutaneous vein that is >3mm in the upright position
Varicosity can be main axial superficial veins or any tributaries of the veins
Risk factors
Non modifiable
- Age
- Family history
Modifiable
- Occupation
- Weight
- Posture
- Childbirth
- Increased abdominal pressure
- Tumours that compress deep veins
What is the pathophysiology of varicose veins
Inherent weakness in vein wall, leading to dilation and seperation of valve cusps to become incompetent
What are the causes of varicose veins
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
What is the clinical history of a varicose vein patient
Asymptomatic - cosmetic concern
Symptomatic
- Nonspecific pain. tingling, aching, burning cramps
- Swelling, itching, restless, tired, worse at the end of the day
- Better with stockings and elevating legs
Check risk factors
- Parity
- Family history
Rule out secondary causes
- Past history of DVT, thrombophlebitis
What is the clinical examination of a patient with varicose vein
On inspection
- Signs of CVI
- Previous surgical scars (stab avulsion)
- Course of the GSV and SSV for varicosities
- Check inguinal for saphena varix
- Infection
Palpation
- Feel for varicosities along the course of the saphenous veins
- Feel for any tenderness
- Check for saphena varix
- Cough test for saphena varix
- Tap test
- Peripheral pulses
- Inguinal lymph nodes
Move
1. Move the ankles - complication of advanced venous disease is reduced mobility
What are the special tests to conduct
Torniquet test
Trendelenburg test
Perthes test
How do you complete the examination of varicose veins
- Auscultate varicosity
- Examine abdomen for masses
- Examin inguinal region for lymphadenopathy
How do you use a doppler to detect varicosities
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
What investigations confirm varicosities
Venous duplex ultrasound
Check deep and superficial systems
Check valve closure time
Exclude DVT
What management strategies for varicose veins
- Conservative
- Lose weight
- Stop standing so much
- Compression stockings (grade 1 and 2)
- Daflon - Surgical indications
- CEAP class 3 and above
- Symptoms like pain or bleeding
- Cosemesis
What are the available surgical interventions
- Endovascular repair for ablation of the saphenous vein
Contraindicated by saphenous vein thrombosis, complications include thrombophlebitis, DVT, burns - Ultrasound guided sclerotherapy if VV is less than 3mm
Sclerosing agent of hypertonic saline
Can cause hyperpigmentation and cutaneous necrosis - Hie tie with GSV stripping and stab avulsions
Complications - DVT, saphenous nerve injury