Vascular system 2: Varicose veins and chronic venous insufficiency Flashcards
What would you inspect the legs for?
Varicosities, particularly in long saphenous vein (medial thigh and leg) and short saphenous (lateral leg) distributions
Venous eczema
Hair loss
Oedema
Lipodermatosclerosis (scarring of skin and fat)
Haemosiderin deposition (brown pigmentation)
Venous ulceration
Scars
How do you perform the cough test?
Locate the saphenofermoral junction (SFJ) - 4cm lateral and inferior to pubic tubercle
Place finger on SFJ and ask patient to cough, palpate for thrills
How do you perform the tap test?
Put your finger on the SFJ and a finger of your other hand on any of the varicosities in the long saphneous vein distribution
Tap on the SFJ and if it is incompetent, you will feel the percussion wave in the varicosities in the leg
How do you perform the Trendelenburg test (torniquet test)?
Ask patient to lie flat, raise the leg and keep it raised for 2 mins to exsanguinate as much blood as possible
Apply a tourniquet high around the thigh and ask patient to stand
Inspect whether the varicosities refill - if they do not, the problem arises at the SFJ; if they do, repeat the test at the mid-thigh perforators, saphenopopliteal junction and mid-calf perforators
How do you perform Perthe’s test?
To assess the patency of the deep veins
Ask the patient to lie down and apply a tourniquet without exsanguinating the thigh
Ask patient to stand and rock up and down on his toes 10x
If the superficial veins empty, deep veins must be patent
What else must you do to assess the leg veins?
Perform a Doppler probe auscultation on the SFJ
Squeeze the thigh and you should hear a ‘whoosh’ of blood flowing from long saphenous to femoral veins
A second ‘Whoosh’ indicates SFJ incompetence
Repeat this at the saphnopopliteal junction, ensuring patient is relaxed in the leg being tested
Examine the abdomen to exclude abdominal or pelvic cause of raised venous pressure
