Vascular: Varicose Veins

Question 1

Outline the pathophysiology of varicose veins

Answer 1

Tortuous dilated segments of vein associated with valvular incompetence

Incompetent valves = blood flow from deep –> superficial venous system = venous hypertension and dilation of the superficial venous system

Question 2

What are the causes of varicose veins

Answer 2

98% = primary idiopathic varicose veins

Secondary = DVT, pelvic masses (pregnancy, uterine fibroids, and ovarian masses), arteriovenous malformations

Question 3

What are the risk factors for varicose veins?

Answer 3

Prolonged standing

Obesity

Pregnancy

FH

Question 4

How do varicose veins present?

Answer 4

Cosmetic issues = unsightly visible veins or discolouration of the skin

Pain

Aching

Swelling = often worse on standing or at the end of the day

Itching

Skin changes

Ulceration

Thrombophlebitis (inflam of vein)

Varicosities = present in the course of the great and / or short saphenous veins

Features of venous insufficiency = oedema, varicose eczema, thrombophlebitis, ulcers, haemosiderin skin staining, lipodermatosclerosis (tapering of legs above ankles, an “inverted champagne bottle” appearance), or atrophie blanche

Saphena varix = dilatation of the saphenous vein at the saphenofemoral junction in the groin

Question 5

How should varicose veins be investigated?

Answer 5

Duplex US = assessing valve incompetence at the great/short saphenous veins and any perforators, deep venous incompetence, occlusion (deep venous thrombosis) and stenosis

Question 6

Outline the management of varicose veins

Answer 6

Education = avoiding prolonged standing, weight loss, and increase exercise (promotes calf muscle action)

Compression stockings

Venous ulceration = 4 layer bandaging (graduated compression aiming to move blood from distally to proximally)

Vein ligation, stripping, avulsion

Foam sclerotherapy = inject sclerosing agent causing inflam and closing the vein

Thermal ablation = heating the vein from the inside closing it off

Question 7

Outline the possible complications of varicose veins

Answer 7

Post op = haemorrhage, thrombophlebitis, DVT, disease recurrence, nerve damage

Untreated varicose veins will worsen over time