Varicose veins and ulcers Flashcards
What are varicose veins
Torturous/dilated veins subsequent toleaky perforator veins
WHat are primary and secondary risks of varicose veins
Primary: Family history and weak vein walls
Secondary: DVT and its valvular damage
What are the symptoms of varicose veins
Leg discomfort/itching.heaviness
Leg pain/oedema/restlessness
Ulcers, eczema,
WHat are the investigations and examinations of varicose veins
Tourniquet test and duplex ultrasound
How do you manage varicose veins
Primary: Lifestyle, compression stockings, interventional treatment (radiofrequency ablation, foam sclerotherapy, or open surgery)
Secondary - Treat the underlying cause
How do primary venous ulcers form:
Venous insufficiency from valve dysfunction, increase in blood and protein leakage to interstitial space, capillary shutting leading to ischaemia
How do secondary venous ulcers form
Post thrombotic syndrome (DVT), venous obstruction, muscle pump dysfunction, valvular hypoplasia
How do venous ulcers present
Shallow ulcers, irregular borders, yelllow fibrinous exudate, gaiter region, mild-moderate pain, oedema is brown discoloured, varicose veins,
Investigated with duplex ultrasonography
How do arterial ulcers form
Peripheral arterial disease causes decrease in blood flow, fors plaque and haemmorrhage, ischaemia
(Late stage PAD)
WHat are the ABPI ranges
1-1.4 is normal (calcified upper end)
0.91-0.99 is borderline
<0.9 is PAD, less than 0.5 is severe
How do you investigate PAD
ABPI, Buergers test, arterial duplex, CT angio
How do you manage arterial ulcers
lifestyle, revascularisation (endovascular or open)
What are mixed ulcers
Ulcers influenced by both arterial and venous discrepancy
What causes neuropathic ulcers?
damage to peripheral nerves involved in sensation. diabetes causes sensory neuropathy.
How do arterial ulcers present
Minor wounds which dont heal, dry and painful, little bleeding, site at lateral side and over bony prominences (heel, malleoli and shin), shiny skin, local hair loss
