Venous and Lymphatic Disease

Question 1

What is a COMMON PATHOLOGY of the VENOUS system in the LOWER LIMBS?

Answer 1

Varicose Veins (VV)

Question 2

Which VEINS does VV, predominantly, affect?

Answer 2

Superficial Veins

Long (Great) Saphenous Veins - 80-85% of cases

Short (Small) Saphenous Veins - 20-30%

Question 3

What is AETIOLOGY of VV?

Answer 3

Valvular Incompetence

Leaflets of the Valves Do Not Meet Properly; Causing Blood to Flow Backwards, leading to Venous Distension

Question 4

What are some of the CAUSES of VV?

Answer 4

1) > Age
2) Occupation - Prolonged Standing
3) Obesity
4) Pregnancy
5) Previous DVT/Major Trauma
6) Family History

Question 5

What are some of the SYMPTOMS of VV?

Answer 5

1) Localised or Generalised Discomfort/Pain in Leg(s)
2) Nocturnal Cramps
3) Tingling
4) Heaviness
5) Restless Legs

Question 6

What are some of the SIGNS of VV?

Answer 6

1) Peripheral Oedema
2) Acute Haemorrhage
3) Superficial Thrombophlebitis
4) Pruritus
5) Skin Changes

Question 7

What are some of the INVESTIGATIONS for VV?

Answer 7

1) Examination - Have the patient Stand Up; Inspect for Signs and Symptoms
2) Doppler/Duplex Ultrasound

Question 8

What are the TREATMENTS for VV?

Answer 8

*Affecting QOL; Not for Cosmetic Reasons Alone

1) Surgery
- Ligation (High-Tie)
- Stripping
- Multiple Stab Avulsions
2) Sclerotherapy
- Inject Foam or Liquid
3) Endovenous Laser Ablation (EVLA)
3) Compression - TED Stockings
4) Patient Education
- Modify diet, Lose Weight, etc

Question 9

What are the potential CONTRAINDICATIONS for SURGERY to treat VV?

Answer 9

1) Previous DVT
2) Arterial Insufficiency
3) Comorbidities
4) Morbid Obesity

Question 10

What are some of the common COMPLICATIONS of VV surgery?

Answer 10

1) Minor Haemorrhage
2) Thrombophelibitis
3) Haematoma
4) Wound Problems
5) Severe Pain

Question 11

What are the ADVANTAGES of endovascular/minimally invasive treatments for VV?

Answer 11

1) < Surgical Trauma
2) < Time Off Work
3) Only Local Anaesthetic
4) Cost-Effective

Question 12

How does CHRONIC VENOUS INSUFFICIENCY (CVI) differ from VV?

Answer 12

Incompetent DEEP Venous System as opposed to superficial

Question 13

What are the CAUSES of CVI?

Answer 13

1) Inactivity
- Leads to Venous Engorgement and Stasis
2) > Venous HTN - Due to Failure of Skeletal Muscle Pump, Valves or Outflow Obstruction

Question 14

What are some of the SIGNS of CVI?

Answer 14

1) Leg Ulceration

2) Peripheral Oedema

Question 15

Do LEG ULCERATIONS caused by CVI cause PAIN?

Answer 15

No

Question 16

What INVESTIGATIONS would be used for CVI?

Answer 16

1) Ankle-Brachial Pulse Index (ABPI)

2) Doppler/Duplex Ultrasound

Question 17

What are the TREATMENTS for CVI?

Answer 17

1) Compression Therapy *Be Sure to Measure ABPI and Exclude Arterial Disease Beforehand
2) Dressings
- Non-adherent
3) Systemic and Topical Therapies
4) Legs Elevated at Rest
- For Oedema
5) Exercise

Question 18

What are the CAUSES of LYMPHOEDEMA?

Answer 18

Primary = Idiopathic

Secondary

1) Malignancy
2) Surgery
3) Radiotherapy
4) Infection, i.e. Filariasis or TB

Question 19

What are the TREATMENT OPTIONS for lymphoedema?

Answer 19

*Limited

1) Elevation and Manual Drainage
2) Pneumatic Compression