Venous and lymphatic disease : Presentation, investigations and therapy Flashcards
What is a varicose vein?
A varicose vein is a dilated and tortuous, often superficial vein.
- Most commonly found in the lower limbs
Anatomical landmarks in venous and lymphatic disease
- Course of the long
saphenous vein - Saphenofemoral junction
- Short saphenous vein
Describe the coarse of the long saphenous vein
Dorsal venous arch drains into the long saphenous vein, which passes anterior to the medial malleolus, up the medial aspect of the leg
Describe the Saphenofemoral junction
- Found 2.5cm below and lateral to the pubic tubercle
- Here the long saphenous vein perforates the cribiform fascia and empties into the femoral vein (deep system)
Describe the role of the short saphenous vein
The plantar venous arch drains into the short saphenous vein which travels posterior to the lateral malleolus, up the posterior aspect of the leg and drains into the popliteal vein (deep system)
What helps to assist low flow against gravity (back to the heart)?
- Valves
- Calf muscle pump
- Perforating veins to drain blood into the deep system: deep veins are within muscular compartments and can withstand higher pressure
What are causes of valvular failure?
- Surgical or traumatic disruption of the valve.
- DVT: can initially cause obstruction to venous flow, and even as the vein re-canalises through the thrombus, this canal will be a high-pressure valvular channel.
- Hormonal changes in pregnancy can cause weakness of the veins and valves, leading to venous incompetence.
- A large pelvic tumour also could, lead to increased pressure within the distal venous systems.
Pathophysiology: What occurs once one valve has failed?
Venous pressure increases, there is dilatation of the distal vein and further valvular incompetence.
Risk factors for venous and lymphatic disease
- Age, veins become more elastic and weaken
- Female (20-25% females, 10-15% men)
- Pregnancies
- DVT
- Standing for long periods (occupation)
- Family history
Diagnosis: History
Symptoms and signs for VV
- Burning
- Itching
- Heaviness
- Tightness
- Swelling
- Discolouration
- Phlebitis
- Bleeding
- Disfiguration
- Eczema
- Ulceration
Examination for varicose veins
Look and Feel
Special tests for diagnosis of Varicose veins
- Tap test
- Tendeleburg/ tourniquet test
- Doppler
What do you do in a 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 indicates an incompetence of the valves between the two hands.
What do you do in a tourniquet test?
- Lie the patient flat. Drain the superficial veins by raising the leg and stroking the veins towards the trunk.
- Apply pressure over the saphenofemoral junction. Keep this pressure on as you ask the patient to stand.
- If the varicose veins don’t dilate on standing, you are preventing this by ‘acting’ as a competent valve preventing backflow of blood. If you release your hand you will see the veins refill as the patient’s saphenofemoral junction valve is incompetent.
What do you do in a doppler test?
- Hold a doppler probe over the saphenofemoral junction.
Squeeze the calf muscles. - In a patient with competent superficial veins you will hear a ‘whoosh’ as the blood flows upwards into the deep system.
- In a patient with an incompetent saphenofemoral junction you will hear two waves as the blood flows upwards and then refluxes downwards again.
