Varicose Veins and Leg Ulcers Flashcards
How many adults have varicose veins?
20% have trunk, 80% have reticular varicosities or telangiectasia.
What are varicose veins aggravated by?
Obesity, occupation, pregnancy, familial history.
What are varicose veins?
Tortuous, twisted, lengthened veins.
What are the types of varicose veins?
Trunk, reticular, telangiectasia.
What are the causes of varicose veins?
Primary cause 98%; secondary to DVT, pelvic tumours, or arterio-venous fistulae in 2%.
What are the symptoms of trunk varicose veins?
Heaviness, tension, aching, itching along vein.
What are the complications of varicose veins due to the veins itself?
Haemorrhage, thrombophlebitis.
What are the complications of varicose veins due to venous hypertension?
Oedema, skin pigmentation, varicose eczema, atrophie blanche, lipodemeratosclerosis, venous ulceration.
What are the important points to cover in a varicose veins history?
Symptoms, concerns (30% want reassurance), history of DVT, history of skin changes, on COCP or HRT.
What are the features of varicose veins on examinations?
Distribution of veins with patient standing (long or short saphenous, tap test), skin changes, Trendelenburg test, hand held Dopper examination.
What is the Trendelenburg test for varicosities?
Determines site of valvular incompetence in patient. Patient lies down, elevates leg. Use tourniquet to occlude superficial veins in upper thigh. Ask patient to stand and if tourniquet prevents veins from re-filling rapidly - site of incompetent valve is at this level. If the veins re-fill, the communication must be lower down so repeat lower down until you find the level.
What are the treatment options for varicose veins?
Reassurance, compression hosiery, surgery, injection sclerotherapy, endovenous laser/radiofrequency obliteration of long saphenous vein.
What are the types of leg ulcers?
Vascular, neuropathic, haematological, traumatic, neoplastic, sarcoidosis, tropical, pyoderma gangrenosum.
What are the types of vascular ulcer?
Venous 80-85%, arterial, vasculitis, lymphatic.
What are the causes of haematological leg ulcers?
Polycythaemia rubra vera, sickle cell anaemia.
What are the causes of traumatic leg ulcers?
Burns, cold injury, pressure sore, radiation, factitious.
What are the causes of neoplastic leg ulcers?
Basal or squamous cell carcinoma, melanoma, Marjolin’s ulcer, Bowen’s disease.
What is the distribution of venous ulcers along the leg?
87% in gaiter region, 8% in foot, 5% in calf.
What is the distribution of non-venous ulcers along the leg?
49% at the foot, 43% in gaiter region, 8% in calf.
What causes venous ulceration?
Venous hypertension due to calf muscle pump failure.
What can cause calf muscle pump failure?
Failure of calf muscle contraction due to immobility, obesity, reduced knee and/ankle movement; outflow tract obstruction; deep vein incompetence; volume overload - superficial vein incompetence.
What are the features on examination to be considered for ulcers?
Appearance/site of ulcer, signs of venous hypertension, peripheral pulses, sensation, mobility, footwear.
What are the features of venous ulcers on examination?
Appearance, eczema, staining (haemosiderin), induration, ankle flare, oedema, palpable foot pulses,
What is the management of venous ulcers?
Exclude arterial insufficiency, rule out other cause, venous duplex scanning, compression bandages.
What is the ABPI limit for compression bandaging?
> 0.8.
What are the layers of compression stockings?
Orthopaedic wool, cotton crepe, elastic extensible bandage, cohesive bandage.
How can ulcer recurrence be prevented?
Keep mobile, surgery to correct superficial venous reflux, below knee class 2 compression hosiery.
