Venous and lymphatic disease Flashcards
What fraction of the population is affected by varicose veins?
1/3
Give the definition of a varicose vein
A varicose vein is a dilated and tortuous, often superficial, vein
Where in the body are varicose veins most commonly found?
The lower limb
What is the cause of varicose veins?
Leaky valves
What are the causes of leaky valves?
Surgery/trauma
DVT
Hormonal changes (e.g. pregnancy)
Large obstructive pelvic tumours
List the 6 risk factors associated with DVT
- Age
- Female
- Pregnancy
- Deep vein thrombosis
- Standing for long periods (occupational)
- Family history
Name the three methods that can be used to investigate varicose veins
- Doppler
- The tap test
- Trendelenburg/tourniquet test
Explain the tap test
Place one hand over the saphenofemoral junction and one over the long saphenous vein above the knee.
Tap the saphenofemoral junction – a transmitted impulse at the knee indicates an incompetence of the valves between the two hands.
Explain the Trendelenburg/tourniquet test
Lie the patient flat. Drain the superficial veins by raising the leg and stroking the veins towards the trunk
Apply pressure over the saphenofemoral junction. Keep this pressure on as you ask the patient to stand.
If the varicose veins don’t dilate on standing, you are preventing this by ‘acting’ as a competent valve preventing backflow of blood. If you release your hand you will see the veins refill as the patient’s saphenofemoral junction valve is incompetent.
The Tourniquet test is a similar test, using a tourniquet instead of your hand, and repeating the test at 10cm intervals down the leg (the approximate distance between perforating veins) to find the level of incompetence.
Explain how doppler is used to assess varicose veins
Hold a doppler probe over the saphenofemoral junction. Squeeze the calf muscles. In a patient with competent superficial veins you will hear a ‘whoosh’ as the blood flows upwards into the deep system.
In a patient with an incompetent saphenofemoral junction you will hear two waves as the blood flows upwards and then refluxes downwards again
What is the most commonly used method to assess varicose veins clinically?
Doppler
What is the classification system used to classify chronic venous disease?
CEAP classification of chronic venous disease
What is the lowest CEAP classification that would mean the patient can qualify for treatment?
C3
List all of the CEAP classifications
C0= no visible or palpable signs of venous disease
C1= Teleangiectasies or reticular veins
C2= Varicose veins
C3= Oedema
C4a= Pigmentation or ezema
C4b= Lipodermatosclerosis or athrophie blanche
C5= Healed venous ulcer
C6= Active venous ulcer
On the NHS, NICE guidelines state that treatment should be offered to patients with varicose veins suffering from….
- Bleeding varicose veins
- Symptomatic varicose veins (including aching, discomfort, swelling, heaviness and itching)
- Recurrent symptomatic varicose veins
- Lower limb skin changes of chronic venous insufficiency
- Superficial venous thrombosis
- Venous leg ulcer – active or healed
