Venous and Lymphatic Disease Flashcards
What are varicose veins?
Tortuous dilated superficial veins
What are the most common vessels that develop varicosities?
Long saphenous - ~80%
Short saphenous - ~20%
What do you want to know when taking a history in someone with varicose veins?
Age when veins appeared Occupation Pregnancies (particularly twins) Previous DVT, major trauma FH Complications
What are the signs and symptoms of varicose veins?
Localised or generalised discomfort in the leg Nocturnal cramps Swelling Acute haemorrhage Superficial Thrombophlebitis Pruritus Skin changes
When might you consider intervention in varicose veins?
Symptoms Superficial thrombophlebitis Signs of chronic venous insufficiency Bleeding Cosmetic reasons, anxiety
How are varicose veins treated in general terms?
Compression stockings
Surgery
Injection (sclerotherapy) and othe rminimally invasive procedures
What are the surgical procedures in varicose veins? What are some contraindications?
Surgery under GA
- ligation of sapheno-femoral or sapheno-popliteal junctions
- vein stripping and multiple stab avulsions
PIN = perforate invaginate stripping
Contraindications
- Previous DVT
- Arterial insufficiency
- Patient comorbidities
- Morbid obesity
What are the minimally invasive therapies of main trunk varicosities?
Foam sclerotherapy
Endovenous laser ablation
Radiofrequency ablation
Reduces surgical trauma, less pain
Reduced time off work
No need for operating theatre
Cost effective?
Just as effective as surgery in short/medium term
What is chronic venous insufficiency? What symptoms/conditions can it cause?
Problem with the veins reducing flow back to the heart
Can cause:
- ankle oedema
- telangectasia
- venous eczema
- haemosiderin pigmentation
- hypopigmentation ‘atrophie blanche’
- lipodermatosclerosis
- venous ulceration
What causes chronic venous insufficiency?
Venous hypertension
Venous engorgement and stasis
Imbalance of starling forces and fluid exudate
Failure of muscle pump and/or valves
Outflow obstruction
Obesity and inactivity
What is a leg ulcer? What causes them and what investigations might you do?
Breach in skin between knee and ankle joint, present for over 4 weeks.
80% purely venous in origin
20% have arterial disease
Diabetes, Rheumatoid arthritis, locomotion, vascular
Ankle brachial pressure index
Duplex ultrasound
What is the treatment for leg ulceration?
Multi-layer graduated, elastic, high-grade compression therapy unless arterial disease present
Non-adherent dressings
Systemic and topical therapy not proven
Exercise
What are the different types of lymphoedema?
Primary:
- Congenital Lymphoedema - birth
- Lymphoedema Praecox - teenage
- Lymphoedema Tarda - adult
Secondary
- Malignancy
- Surgery
- Radiotherapy
- Infection
What is the treatment for lymphoedema?
Elevation and manual drainage
Compression
