Venous and Lymphatic Disease

Question 1

what are varicose veins?

Answer 1

tortuous dilated superficial veins

Question 2

what creates varicose veins?

Answer 2

valvular dysfunction

Question 3

what should you get from a history from a person with varicose veins?

Answer 3

> age they appeared
> occupation
> pregnancies
> previous deep vein thrombosis
> family history

Question 4

what are common symptoms and signs associated with varicose veins?

Answer 4

> cosmesis (look bad)
> discomfort in the leg
> nocturnal cramps
> swelling
> acute haemorrhage
> superficial thrombophlebitis
> pruritis
> skin changes

Question 5

how would you assess varicose veins?

Answer 5

check the deep venous system is patent and the superficial system is draining

Question 6

what are the indications for intervention of varicose veins?

Answer 6

> superficial thrombophlebitis
signs of chronic venous insufficiency
bleeding

Question 7

what is the treatment for varicose veins?

Answer 7

> surgery
injection
minimally invasive procedures
compression

Question 8

what surgery can be performed on varicose veins?

Answer 8

> high tie
stripping
multiple stab avulsions

Question 9

what are the relative contraindications for performing surgery on varicose veins?

Answer 9

> previous deep vein thrombosis
arterial insufficiency
patient comorbidity
morbid obesity

Question 10

what are some common complications with varicose vein surgery?

Answer 10

> minor haemorrhage
thrombophlebitis
haematoma
wound problems

Question 11

what are some rare complications with varicose vein surgery?

Answer 11

> damage to deep veins, arteries or nerves

> deep vein thrombosis

Question 12

name some minimally invasive treatment for main trunk varicosities

Answer 12

> foam sclerotherapy
endovenous laser ablation
radiofrequency ablation

Question 13

what are the potential advantages of using a local anaesthetic during minimally invasive treatment?

Answer 13

> reduction in surgical trauma
reduce time off work
does not require operating theatre
potential increase patient through put

Question 14

describe laser surgery of varicose veins

Answer 14

1. micro puncture needle inserted into the incompetent vein using ultra sound
2. guide wire introduced and manoeuvred to the saphenous junction with deep vein using ultrasound
3. catheter and laser fibre introduces over guide wire to 1cm below the junction.

Question 15

describe the foam sclerotherapy surgery in varicose veins

Answer 15

1. needle inserted into the incompetent veins under ultrasound control
2. foam injected prevented form entering the deep venous system

Question 16

describe the pathophysiology of chronic venous insufficiency

Answer 16

venous hypertension leads to engorment and stasis. this creates an imbalance of starlings forces and fluid exudate.

Question 17

what is the aetiology of chronic venous insufficiency?

Answer 17

> failure of the calf muscle pump (superficial/deep venous reflux, venous obstruction, neuromuscular, obesity, inactivity)

Question 18

what is the definition of leg ulceration?

Answer 18

breach in the skin between the knee and ankle joint present for over 4 weeks

Question 19

what would you find on clinical examination of someone with a leg ulceration?

Answer 19

> signs of chronic venous insufficiency
oedema
locomotor system

Question 20

what investigations would you carry out on someone with a leg ulceration?

Answer 20

> ankle brachial pressure increase

> duplex

Question 21

where are venous ulcerations found on the leg?

Answer 21

above the lateral or medial malleoli

Question 22

are venous ulcers pinker or yellower compared to arterial ulcers?

Answer 22

pinker as they have a good blood supply

Question 23

what is the treatment for ulcerations?

Answer 23

> multi-layer graduated elastic high grade compression therapy with non-adherent dressings.
calf muscle pump.

Question 24

name some secondary causes of lymphoedema

Answer 24

> malignancy
surgery
radiotherapy
infection

Question 25

name some primary causes of lymphoedema

Answer 25

> congenital
praecox (before age 30)
tarda (after age 30)

Question 26

what is the management of lymphoedema?

Answer 26

> elevation
manual drainage
compression banages