Varicose Veins and Leg Ulcers

Question 1

How many adults have varicose veins?

Answer 1

20% have trunk, 80% have reticular varicosities or telangiectasia.

Question 2

What are varicose veins aggravated by?

Answer 2

Obesity, occupation, pregnancy, familial history.

Question 3

What are varicose veins?

Answer 3

Tortuous, twisted, lengthened veins.

Question 4

What are the types of varicose veins?

Answer 4

Trunk, reticular, telangiectasia.

Question 5

What are the causes of varicose veins?

Answer 5

Primary cause 98%; secondary to DVT, pelvic tumours, or arterio-venous fistulae in 2%.

Question 6

What are the symptoms of trunk varicose veins?

Answer 6

Heaviness, tension, aching, itching along vein.

Question 7

What are the complications of varicose veins due to the veins itself?

Answer 7

Haemorrhage, thrombophlebitis.

Question 8

What are the complications of varicose veins due to venous hypertension?

Answer 8

Oedema, skin pigmentation, varicose eczema, atrophie blanche, lipodemeratosclerosis, venous ulceration.

Question 9

What are the important points to cover in a varicose veins history?

Answer 9

Symptoms, concerns (30% want reassurance), history of DVT, history of skin changes, on COCP or HRT.

Question 10

What are the features of varicose veins on examinations?

Answer 10

Distribution of veins with patient standing (long or short saphenous, tap test), skin changes, Trendelenburg test, hand held Dopper examination.

Question 11

What is the Trendelenburg test for varicosities?

Answer 11

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.

Question 12

What are the treatment options for varicose veins?

Answer 12

Reassurance, compression hosiery, surgery, injection sclerotherapy, endovenous laser/radiofrequency obliteration of long saphenous vein.

Question 13

What are the types of leg ulcers?

Answer 13

Vascular, neuropathic, haematological, traumatic, neoplastic, sarcoidosis, tropical, pyoderma gangrenosum.

Question 14

What are the types of vascular ulcer?

Answer 14

Venous 80-85%, arterial, vasculitis, lymphatic.

Question 15

What are the causes of haematological leg ulcers?

Answer 15

Polycythaemia rubra vera, sickle cell anaemia.

Question 16

What are the causes of traumatic leg ulcers?

Answer 16

Burns, cold injury, pressure sore, radiation, factitious.

Question 17

What are the causes of neoplastic leg ulcers?

Answer 17

Basal or squamous cell carcinoma, melanoma, Marjolin’s ulcer, Bowen’s disease.

Question 18

What is the distribution of venous ulcers along the leg?

Answer 18

87% in gaiter region, 8% in foot, 5% in calf.

Question 19

What is the distribution of non-venous ulcers along the leg?

Answer 19

49% at the foot, 43% in gaiter region, 8% in calf.

Question 20

What causes venous ulceration?

Answer 20

Venous hypertension due to calf muscle pump failure.

Question 21

What can cause calf muscle pump failure?

Answer 21

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.

Question 22

What are the features on examination to be considered for ulcers?

Answer 22

Appearance/site of ulcer, signs of venous hypertension, peripheral pulses, sensation, mobility, footwear.

Question 23

What are the features of venous ulcers on examination?

Answer 23

Appearance, eczema, staining (haemosiderin), induration, ankle flare, oedema, palpable foot pulses,

Question 24

What is the management of venous ulcers?

Answer 24

Exclude arterial insufficiency, rule out other cause, venous duplex scanning, compression bandages.

Question 25

What is the ABPI limit for compression bandaging?

Answer 25

> 0.8.

Question 26

What are the layers of compression stockings?

Answer 26

Orthopaedic wool, cotton crepe, elastic extensible bandage, cohesive bandage.

Question 27

How can ulcer recurrence be prevented?

Answer 27

Keep mobile, surgery to correct superficial venous reflux, below knee class 2 compression hosiery.