Varicose Veisn

Question 1

What are varicose veins?

Answer 1

Distension of tortuous superficial veins resulting from incompetent valves in deep, superficial or perforator systems.

Question 2

Primary aetiology of varicose veins?

Answer 2

Main: inherited predisposition, previous DVT

2”: increasing age, female, OCP use, long standing periods, pregnancy, obesity.

Question 3

Clinical features of varicose veins?

Answer 3

• Diffuse aching, fullness, nocturnal cramping
• Worse after prolonged standing
• Visible long dilated veins
• Skin changes
• Pitting oedema

Question 4

What is the Brodie-Trendelenburg test?

Answer 4

Pt supine, raise leg and compress saphenous vein at thigh; have pt stand. If veins fill quickly from top down, then incompetent valves.

Question 5

Complications of varicose veins?

Answer 5

• Recurrent superficial thrombophlebitis
• Haemorrhage: external or subcutaneous
• Ulceration, eczema, lipodermatosclerosis, hyperpigmentation

Question 6

Treatment of varicose veins?

Answer 6

Mostly cosmetic issue.

• Conservative: elevation, compression stockings
• Surgical: high ligation and stripping of long saphenous, sclerotherapy, endovenous laser therapy.

Question 7

What are primary v secondary varicose veins?

Answer 7

Primary: superficial veins or perforators in absence of deep incompetence
Secondary: ass/w deep venous incompetence from recanalisation of previous DVT / venous obstruction

Question 8

Skin changes associated with chronic venous disease / varicose veins?

Answer 8

• varicose eczema,
• pigmentation
• Ulceration
• oedema / induration.
• Lipodermatosclerosis (inverted champagne bottle)
• Atrophie blanche (confluence of white / depressed scars)

Question 9

Ix in varicose veins?

Answer 9

• Venous duplex

- Descending venography