Vascular: Peripheral venous disease Flashcards
What are varicose veins?
Dilated and tortuous superficial veins, most often affecting the lower limb
What causes varicose veins?
They occur due to incompetence of the valves between the deep and superficial venous systems, resulting in retrograde flow and pooling of blood in the superficial venous system
Which veins are affected in varicose veins?
Superficial veins (lower limb)
What do the varicose veins look like?
Dilated + tortuous
How do varicose veins present?
1) Visible superficial veins
2) Pain
3) Cramping or heaviness
4) Oedema
5) Discolouration - due to increase haemosiderin deposits
6) Haemorrhage
7) ± venous ulcers
What causes discolouration in varicose veins?
Increase haemosiderin deposits
What are indications for treatment in varicose veins (otherwise not required)?
1) Bleeding
2) Pain
3) Ulceration
4) Thrombophlebitis
5) Significant psychological morbidity
What lifestyle modifications are recommended for varicose veins?
1) Reduce long periods of standing
2) Elevate lower limbs when possible
3) Support stockings
4) Weight loss
5) Walking
What are treatment options for varicose veins?
1) Radiofrequency ablation - destruction of the endothelium of the vein via high temperature catheter
2) Endovenous laser ablation - destruction of the vein using laser
3) Injection sclerotherapy - injection of sclerosant substance at several points in the vein, leading to occlusion
4) Surgery - avulsion therapy or stripping of the vein
What is first line intervention for varicose veins?
Radiofrequency ablation
Which patients are typically affected by venous ulcers?
Middle aged women
Where do venous ulcers occur?
Gaiter area (below the knee + above the ankle) - typically medial side incl. medial malleolus
How do venous ulcers/venous ulcer disease present?
1) Large
2) Shallow
3) Sloping edges
4) Bleed/ooze - sloughy
5) Oedema
6) Eczema
7) Skin thickening
8) Haemosiderin deposition of the lower leg
What do venous ulcers typically occur alongside?
Other features of chronic venous insufficiency - e.g. haemosiderin deposition, lipodermatosclerosis, atrophie blanche ± venous eczema, swelling
What are features of chronic venous insufficiency?
1) Haemosiderin deposition
2) Lipodermatosclerosis
3) Atrophie blanche
What are the most common form of skin ulcers?
Venous ulcers
What causes venous ulcer formation?
Long standing venous hypertension which leads to incompetence of venous valves
What type of condition is venous ulcer disease?
Common, chronic, recurring condition
What are risk factors for venous ulcer disease?
1) Obesity
2) Immobility
3) Varicose veins
4) Previous DVTs
5) Age
6) Previous trauma to the leg
What lifestyle advice is given for managing venous ulcer disease?
1) Keep ulcer clean
2) Encourage mobility
3) Weight reduction
4) Leg elevation at rest
What are topical treatments for venous ulcer disease?
1) Emollient treatment of the leg
2) Compression bandaging - aimed at improving venous return from the leg
What must patients with venous ulcer disease have before using compression bandaging?
ABPI - to exclude concomitant arterial disease as bandaging will worsen arterial supply to the leg
Which medication can be given for venous disease if patients don’t respond to initial treatment (lifestyle advice and bandaging)?
Pentoxifylline (a vasoactive agent that improves the flow of blood by reducing its viscosity)
What are surgical options for venous ulcer disease (not usually necessary)?
1) Debridement
2) Skin grafting
