Venous Disease Flashcards
What are varicose veins?
Long, tortuous, dilated veins of the superficial venous system
What is the underlying pathology of varicose veins?
Blood from superficial veins passes into deep veins via perforator veins (sapheno-fem/pop juncn)
Incompetent valves –> venous hypertension – DILATATION
What is the anatomical distribution of varicose veins?
Long saphenous (med mall, up inner thigh to groin) Short saphenous (popliteal, down back of leg)
What are the primary causes of varicose veins?
Unknown
Congenital valve absence (v. rare)
What are the secondary causes of varicose veins?
Superficial varicosities 2o to deep vein incompetence
- Prev DVT
- Raised systemic venous pressure (pelvic tumour, pregnancy, AVF)
What are the potential complications of varicose veins?
Ulcers (long term fluid buildup)
Blood clots
Bleeding
How are doppler ultrasound probes used to diagnose varicose veins?
Listen for flow in incompetent valves
- veins occluded
- on release flow >0.5-1 second indicates incompetence
What are the two main venous systems in the lower limb?
Superficial
Deep
Where does the deep venous system drain?
Muscular compartment
Where do the deep veins run?
Alongside the major arteries
What veins comprise the superficial venous system?
Long saphenous (medial) --> Saphenofemoral Short saphenous (lateral) --> Popliteal
Where does the superficial venous system drain?
Skin
Superficial Tissues
Where are the deep and superficial venous systems joined?
Saphenofemoral
Saphenopopliteal
What are perforating veins?
Communications between the two systems
What drives venous return to the heart?
Muscular pump action by the calf
Inspiration decreasing intrathoracic pressure
What are the main sx of varicose veins?
Unsightly apperance
Tirdeness, aching
Oedema of ankles
Itching/nocturnal cramps
What are the signs of deep venous insufficiency?
Haemosiderosis
Eczema
Lipodermatosclerosis
What is deep venous insufficiency?
POSTPHLEBITIC LIMB
Incompetent valves of deep venous system
Calf pump no longer efficiently returns blood to thoracic cavity
What are the causes of deep venous insufficiency?
Primary - Congenital absence of valves
2o - DVT, AVF
What are the sx/signs of deep venous insufficiency?
Lower limb pain/discomfort Oedema Varicose veins Haeomsiderin deposition (gaiter area) Eczema Atrophie blanche Lipodermatosclerosis Ulceration
What investigations are appropriate in suspected deep venous insufficiency?
Duplex Sonography/Venography
How can deep venous insufficiency be managed?
Only symptomatic management available
What investigations are commonly used in venous disease?
Hand-held Doppler –> Identifies reflux at sapheno-fem/pop junctions
Duplex scanning - Valvular/perforating vv incompetence, large vv occlusion
Venography - Fluoroscopy used to find deep vv occlusion/perf vv reflux
What is the Trendelenberg test?
No longer recognised method of diagnosis
Involves elevating the leg and applying tourniquets at different levels to identify the lowest point of deep-sup incompetence
