Venous and Lymphatic Disease

Question 1

What are varicose veins?

Answer 1

Veins that have become enlarged and twisted

Question 2

Why do varicose veins happen?

Answer 2

Because the leaflet valves in veins are leaky and so veins swell and enlarge.

Question 3

Where are varicose veins usually found?

Answer 3

Greater saphenous vein

Lesser saphenous vein

Question 4

What is the prevalence of varicose veins?

Answer 4

20-25% in females

10-15% in men

Question 5

What are the signs and symptoms of varicose veins?

Answer 5

Localised or generalised discomfort in the leg
Nocturnal cramps
Swelling
Acute haemorrhage
Superficial thrombophlebitis
Pruritus - itching
Skin changes

Question 6

What should be asked when taking a history for varicose veins?

Answer 6

Occupation 
Pregnancies - twins or big babies 
Previous DVT (or good reason for DVT such as white leg of pregnancy) 
Family history 
When the veins appeared

Question 7

What are the indications for intervention with varicose veins?

Answer 7

Superficial thrombophlebitis
Signs of chronic venous insufficiency
Bleeding
Cosmetic

Question 8

What is the surgical treatment of varicose veins?

Answer 8

Superficial venous surgery 
Ligation of the sapheno-femoral or sapheno-popliteal junction 
Vein stripping 
Multiple stab avulsion 
Perforate invaginate stripping

Question 9

What are the contraindications for superficial venous surgery?

Answer 9

Previous DVT
Arterial insufficiency
Patients co morbidity
Morbid obesity

Question 10

What are common complications of varicose vein surgery?

Answer 10

Minor haemorrhage 
Thrombophlebitis 
Haematoma 
Wound problems 
Severe pain

Question 11

What is thrombophlebitis?

Answer 11

Vein inflammation related to thrombus

Question 12

What are the more rare complications of varicose vein surgery?

Answer 12

Damage to deep veins, arteries and nerves

DVT

Question 13

What are the minimally invasive treatments of main trunk varicosities?

Answer 13

Foam sclerotherapy
Endogenous laser ablation
Radio frequency ablation

Question 14

What is EVLA?

Answer 14

Endogenous laser ablation

Question 15

What is VNUS?

Answer 15

Radio frequency ablation

Question 16

How is EVLA done?

Answer 16

1. Micro puncture needle inserted into saphenous vein using ultrasound
2. Guidwire moved to saphenous junction with deep vein
3. Catheter and laser fibre put in 1cm below the junction

Question 17

How does VNUS work?

Answer 17

1. Catheter inserted into vein
2. Vein heated to 85 degrees and collapsed
3. Catheter slowly withdrawn, closing vein

Question 18

How is foam sclerotherapy done?

Answer 18

1. Needle inserted into vein using ultrasound

2. Foam injected

Question 19

What is the conservative option for varicose vain treatment?

Answer 19

Compression hosiery

Question 20

What is chronic venous insufficiency?

Answer 20

When veins cannot pump enough blood back to the heart

Question 21

What are the symptoms of chronic venous insufficiency?

Answer 21

Ankle oedema 
Telangiectasia 
Venous eczema 
Haemosiderin pigmentation 
Hypopigmentation 
Lipodermatosclerosis 
Venous ulceration

Question 22

What is the pathophysiology of CVI?

Answer 22

Venous hypertension
Venous engorgement and stasis
Imbalance of Starling forces and fluid exudate

Question 23

What is ambulatory venous pressure?

Answer 23

The blood pressure in the veins during active movement

Question 24

What is normal AVP?

Answer 24

30mmHg

Question 25

What does it mean if AVP is high?

Answer 25

Failure of muscle pump, valves or outflow obstruction | Venous hypertension

Question 26

What are some possible reasons for the failure of the calf muscle pump?

Answer 26

``` Superficial venous reflect Depp venous reflux Venous obstruction Neuromuscular Obesity Inactivity ```

Question 27

What is a leg ulcer?

Answer 27

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

Question 28

What is the differential diagnosis for leg ulceration?

Answer 28

``` Venous disease Arterial disease Diabetes Rheumatoid arthritis Vasculitis Connective tissue disease ```

Question 29

What investigations should be done on patients with leg ulceration?

Answer 29

Ankle brachial pressure index | Duplex ultrasonography

Question 30

Where are leg ulcers typically found in venous disease?

Answer 30

Above lateral and medial malleoli

Question 31

Where are leg ulcers typically found in atrial disease?

Answer 31

Over toe joint Anterior shin Over malleoli Under heel

Question 32

Where are leg ulcers typically found in neuropathic disease?

Answer 32

``` Over toe joint Under metatarsal head Under heel Over malleoli Medial side of the first metatarsal head ```

Question 33

What is the treatment of leg ulcers?

Answer 33

Compression therapy Dressings Systemic and topical therapy Exercise

Question 34

What are the surgical treatments of CVI?

Answer 34

``` Ligation Vein stripping Surgical repair Endovenous Laser Ablation Vein transplant Subfascial endoscopic perforator surgery ```

Question 35

What are the conservative treatment methods of CVI?

Answer 35

``` Manual compression Skin lubrication Sequential compression pump Ankle pump Compression stockings Blood pressure medication Elevating the legs above the heart level ```

Question 36

What is lymphoedema?

Answer 36

Localised fluid retention and tissue swelling because of a compromised lymphatic system

Question 37

What is Klippel-Trenaunay Syndrome?

Answer 37

A rare congenital medical condition in which blood vessels and/or lymph vessels fail to form properly.

Question 38

What are the primary types of lymphoedema?

Answer 38

Congenital Praecox Tarda

Question 39

What are the possible causes of secondary lymphoedema?

Answer 39

Malignancy Surgery Radiotherapy Infection

Question 40

What are the signs and symptoms of lymphoedema?

Answer 40

``` Swelling of the limbs A feeling of heaviness or tightness Restricted range of motion Aching or discomfort Recurring infections Hardening and thickening of the skin ```

Question 41

What is the treatment of lymphoedema?

Answer 41

Manual lymphatic drainage Compression bandages Skin care Exercise