venous disease

Question 1

Have a clear understanding of the role and function of the venous system in the lower limbs.

Answer 1

veins have a wide diameter in terms of their lumen to outer diameter ratio. limited elastic fibres and contain valves. makes them much better at being a low pressure system and returning blood to the heart

Question 2

Recognise the difference between superficial and deep venous incompetence.

Answer 2

superficial- long and short saphenous vein
deep venous system- tibial, popliteal and femoral

Question 3

Be aware of the complications associated with venous incompetence and recognise the changes of chronic venous insufficiency.

Question 4

Have a basic understanding of what investigations are required to confirm the diagnosis and the different treatment options.

Question 5

Have a basic understanding of problems that may arise when the lymphatic system in the lower limbs is diseased.

Question 6

how do veins get blood back to the heart

Answer 6

deep venous system uses the calf pump where it acts with the popliteal vein to push against the blood and compress the vein to push against the blood to get venous return

Question 7

where does dorsal vein drain too

Answer 7

great saphenous vein

Question 8

function of perforator veins

Answer 8

transport blood from superficial to deep venous system

Question 9

where is the sole of the foot drained

Answer 9

short saphenous vein

Question 10

what is varicose veins

Answer 10

damage to valves of superficial within venous system. blood can flow back down the leg and cause oedema.

Question 11

why Is oedema bad in your legs

Answer 11

increases the distance between the veins and the tissues and therefore impaired tissue perfusion. So impaired healing, inflammation and further tissue damage

Question 12

how will patients present with venous disease

Answer 12

distended veins if mild which can progress to symptomatic Venous disease which is itching and burning.
ulceration, swelling, discolouration in the skin

Question 13

describe the trendeleburg test

Answer 13

lie patient flat on examination table and raise leg above the level of the heart and press at the level of the saphenofemoral junction. then ask patient to stand if vein doesn’t distend its an incompetent valve

Question 14

describe tap test

Answer 14

patient lays down and place hand on the sapenofemoral junction and tap on the long saphenous vein above the knee. if you can feel transmission then likely a backflow of blood

Question 15

venous duplex ultrasound scanning

Answer 15

shows size of vessel, flow within it and whether or not there is any backflow. usually done in secondary care

Question 16

CERP class

Answer 16

C4- changes to skin and subcutaneous tissue secondary to chronic venous disease. anything about C4 can be treated under SIGN in NHS Scotland. C5- healed ulcers and C6 is active ulcers

Question 17

conservative vs surgical

Answer 17

compression bandaging and elevation allows oedema to clear and ulcers to heal.
surgery is done for superficial varucose veins and first option is endovenous treatment which is done by laser or radiofrequency ablation

Question 18

foam sclerotherapy

Answer 18

medicine injected into vessel which makes it shrink

Question 19

surgical treatment of varicose veins

Answer 19

cut over the saperofemoral junction and disconnect the long saphenous vein and then you make stab incisions down the leg and pull out the long vein and compression is used post surgery