Vascular: varicose veins and chronic venous insufficiency Flashcards
What are varicose veins?
Distended superficial veins >3mm in diameter. Usually in the legs
Describe the pathophysiology of varicose veins
- incompetent valves in perforating veins
connecting deep and superficial veins. - backflow of blood from deep veins into
superficial veins - superficial veins overloaded and become
dilated and engorged
What are RF for varicose veins?
Increasing age, FHx, female, pregnancy, obesity, prolonged standing, DVT causing damage to valves
What are symptoms of varicose veins?
can be asymptomatic
heavy dragging sensation in legs
aching
itching
burning
oedema
muscle cramps
restless legs
Name two conservative options for varicose veins
Weight loss
Physical activity
Elevate leg
Compression stockings
What are surgical options available for varicose veins?
endothermal ablation
sclerotherapy - inject irritant causing vein
closure
stripping- veins ligated and removed
What are complications associated to varicose veins?
Excessive bleeding post trauma
Superficial trombophlebitis
DVT
Issues associated to venous insufficiency
What is chronic venous insufficiency?
Blood does not drain efficiently back to the heart,
pools in the veins in the leg and causes venous
hypertension.
This can lead to changes in the skin
What are RF for chronic venous insufficiency?
increased age
immobility
obesity
prolonged standing
DVT causing damage to valves
association with varicose veins
Where are skin changes in chronic venous insufficiency?
In gaiter area - below knee and above the ankle
What skin changes are seen in chronic venous insufficiency?
Haemosiderin staining
Venous eczema
Lipodermatosclerosis
Atrophie blanche
What complications can arise from chronic venous insufficiency?
Cellulitis
Poor wound healing
Skin ulcers
Pain
How is skin managed in chronic venous insufficiency?
Monitor skin health, regular emollients, topical steroids for flare of venous eczema or lipodermatosclerosis
How can venous drainage be improved in chronic venous insufficiency?
Weight loss
Physical activity
Elevate legs
Compression stockings
How can complications of chronic venous insufficiency be managed?
Infection - abx flucloxacillin
Analgesia
Wound care and dressings
