Venous and lymphatic disease Flashcards
What are varicose veins?
-a dilated vein ( usually superficial) located in the lower limbs
Describe the pathology of DVT
- normally, calf muscle pump and valves help with BF to the heart. Superficial > deep veins which can withstand higher pressure
- In varicose veins there is a failure in the valves, so this will cause distension/pooling of veins in the legs > incompetence
- Once one valve has failed, venous pressure increases anf there will be a dilation of distal vein > valvular incompetence
Causes of valvular failure
- surgical/trauma
- DVT can initially cause obstruction to venous flow even as the vein recanalises through the thrombus, this canal will be a high pressure avalvular channel
- hormonal changes during pregnancy causes weakness of veins + valves > venous incompetance ; enlarged uterus can cause mechanical obstruction to venous flow within deep system
- pelvic tumour can also do the same > increased pressure within distal venous systems
Risk factors of varicose veins
- age
- female
- pregnancies
- DVT
- standing for long periods ( occpation)
- FMX
Examination of varicose veins
Burning Itching Heaviness Tightness Swelling Discolouration Phlebitis Bleeding Disfiguration Eczema Ulceration
Tests for diagnosis
- Tap test
- Trendelenburg/touriquet test
- Doppler test
Explain the Tap test
- place one hand over the saphenofemoral junction and one over the long saphenous vein above the knee
- Tap the saphenofemoral junction - a transmitted impulse at the knee will indicate incompetance of the valves between the 2 hands
Explain the trendelenburg/tourinquet test
- Lie patient flat + drain superficial veins by raising the leg and stroking the veins towards the trunk
- Apply pressure over saphenofemoral junction + keep this pressure on as you ask patient to stand
- If varicose veins don’t dilate on standing, you are preventing this by ‘ actining; as a competent balve, preventing backlow of blood. Once release, you will see veins refill as patients saphenofemorak junction valve is incompetent
The tourinwuet test is simlar ; use of tourinquet instead of hand
Explain the doppler test
- use a doppler probe over the saphenofemoral junction and squeeze the calf muscles. In a patient with competent superficial veins you should hear a ‘swoosh’ as the blood flows uowards into deep system
- If incompetent saphenofemoral junction, yo will head 2 waves as the blood flows upwards and then refluxes downwards again.
Investigations of varicose veins
-Ultrasound ( view valves + anatomy/tortuosity of varicose vein). Can also be used to show dynamic BF.
When should you administer treatment to a patient suffering from varicose veins?
Bleeding varicose veins
Symptomatic varicose veins (including aching, discomfort, swelling, heaviness and itching)
Recurrent symptomatic varicose veins
Lower limb skin changes of chronic venous insufficiency
Superficial venous thrombosis
Venous leg ulcer – active or healed
Treatment of varicose veins
- endovenous treatment
- ultrasound guided foam sclerotherapy
- open surgery
Intervention shouldnt be offered if deep venous system is obstructed ( DVT or in pregnancy, hosiery instead)
If intervention not suitable, offer compression hosiery.
Describe the endovenous treatment
- LSV or SSV is cannulated under the ultrasound guidance
- A catheter is passed up to the length of the vein distal to the spahenofemoral and saphenopoliteal junction
- Under anaesthetic, used for small skin puncture + is infiltrated in the superficial tissues around the length of the vein.
- The catherter causes injury to the vein wall either by heat/laser which causes fibrosis and occlusion of the vein and subsequent ablation/disappearance of the vein
Complications of endovenous treatment
- skin burns
- parasthesia
- phelbitis
- DVT
Describe foam sclerotherapy
-under USS guidance, a chemical foam is injected into the affected vein and the foam damages the venous walls causing fibrosis and occlusion
