Venous and Lymphatic Disease

Question 1

Common sites of varicose veins

Answer 1

Long saphenous (80-87%)
Short saphenous (21-30%)
Alone (13%)
Combined (21%)

Question 2

Symptoms/signs of varicose veins

Answer 2

Cosmesis
Localised/general discomfort in leg
Nocturnal cramping
Swelling
Acute haemorrhage
Superficial thrombophlebitis
Skin changes e.g. bruising, eczema, spider veins

Question 3

Signs of Chronic Venous insufficiency (CVI)

Answer 3

Ankle oedema
Telangiectasia (dilation of capillaries)
Venous eczema
Haemosiderin pigmentation 
Hypopigmentation "atrophie blanche"
Lipodermatosclerosis
Venous ulceration: (worst complication)

Question 4

Complications of chronic venous insufficiency

Answer 4

Age
Failure of veins to pump blood back to the heart
Compression affecting renal failure

Question 5

Causes of chronic limb ischaemia

Answer 5

Due to the failure of the calf muscle pump

1. Superficial venous reflux
2. Deep venous reflux
3. Venous obstruction
4. Neuromuscular
5. Obesity
6. Inactivity

Question 6

Signs of a leg ulcer

Answer 6

Signs of CVI
Oedema
Locomotor system
Vascular

Question 7

Investigations for leg ulceration

Answer 7

Doppler

ABPI

Question 8

Investigations for varicose veins

Answer 8

Duplex to confirm blood flow

Check DVS is competent

Question 9

Indications for intervention in varicose veins

Answer 9

Symptoms
Superficial thrombophlebitis
Bleeding
Signs of CVI
Others: cosmetic, anxiety that disease may progress

Question 10

Treatment of varicose veins

Answer 10

Surgery 
Injection (sclerotherapy)
Minimally invasive procedures (laser or heat)
Compression
Conservative

Question 11

Minimally invasive treatments of main trunk varicosities

Answer 11

Foam sclerotheraphy
Endovenous vein ablation
Radiofrequency ablation (VNUS)

Question 12

Treatment of CVI

Answer 12

Multi-layer granulated, elastic, high grade compression therapy
Dressings (Non-adherent)
Systemic and topical therapy (not proven)
Exercise calf muscle pump

Question 13

Primary Lymphodema - onset of timings

Answer 13

Congenital
Praecox (Aged 9-25 years)
Tarda (over 35 yrs)

Question 14

Secondary Lymphodema can be due to…

Answer 14

• Malignancy (glands full of malignant deposits)
• Surgery (could have accidently damaged the lymph nodes)
• Radiotherapy
• Infection (TB/pyogenic etc)

Question 15

Management of lymphoedema

Answer 15

Elevation and manual drainage

Compression