Venous disease

Question 1

what is the relevance of varicose veins?

Answer 1

varicose veins affect at least a third of the population

Question 2

what is the definition of varicose veins?

Answer 2

a varicose vein is a dilated and tortuous, often superficial vein most commonly found in the lower limb

Question 3

where does the short saphenous vein drain into?

Answer 3

the popliteal vein

Question 4

where does the great saphenous vein drain into?

Answer 4

the great saphenous vein perforates the cribriform fascia at the saphenofemoral junction and empties into the femoral vein

Question 5

where is the saphenofemoral junction found?

Answer 5

found 2.5cm below and lateral to the pubic tubercle

Question 6

what assists the flow of blood in the veins back up to the heart?

Answer 6

valves
calfe muscle pump (skeletal muscle pump)
perforating veins which drawn blood into the deep veins (because they are surrounded by muscle they can withstand higher pressure and the higher pressure favours better blood flow compared to low pressure)

Question 7

what are the causes of valvular failure in veins?

Answer 7

DVT
hormonal changes in pregnancy
large pelvic tumour

Question 8

how can hormonal changes in pregnancy cause valvular failure?

Answer 8

The hormonal changes can cause weakness of the veins and valves, leading to venous incompetence.
The enlarged uterus can cause mechanical obstruction to venous flow within the deep system.

Question 9

consequently, what happens if one valve has failed in the venous system?

Answer 9

this causes an increase in venous pressure, dilatation of the distal vein and further valvular incompetence

Question 10

what are the risk factors for varicose veins?

Answer 10

age
female
pregnancy
DVT
standing for long periods
family history

Question 11

what are the symptoms/signs of varicose veins?

Answer 11

burning
itching
heaviness
tightness
swelling
discolouration
phlebitis
bleeding
disfiguration
eczema
ulceration

Question 12

how is the diagnosis of varicose veins carried out?

Answer 12

Take a history
Look 
Feel
Tap last
Tendelburg/tourniquet test
Doppler

Question 13

What tests can be carried out to diagnose varicose veins/ location of the valvular incompetence?

Answer 13

Tap test
Tenderburg/tounirguet test
Doppler
Ultra sound

Question 14

when should treatment for varicose veins be given?

Answer 14

Symptomatic  
Recurrent symptomatic
Bleeding varicose vein 
Lower limb skin changes of chronic venous insufficiency
Superficial venous thrombosis
Venous leg ulcer (active or healed)

Question 15

what are the treatment options for varicose veins?

Answer 15

first line: endogenous treatment
second line: ultrasound guided foam sclerotherapy
third line: open surgery

Question 16

what would you offer a patient is intervention is unsuitable?

Answer 16

compression hosiery

stockings

Question 17

when should intervention not be offered?

Answer 17

If the deep venous system is obstructed e.g. DVT

Or in pregnancy

Question 18

what are the complications of endogenous treatment for varicose veins?

Answer 18

skin burns
paraethesiae
phlebitis
deep vein thrombosis

Question 19

what are the complications for foam sclerotherapy for varicose veins?

Answer 19

Foam migration which can cause possible complications such as;
stroke, MI or TIA
Thrombophlebitis
Skin pigmentation

Question 20

what are the complications of open surgery for varicose veins?

Answer 20

anaesthetic risk
wound infection
damage to nearby nerves (saphenous and dural nerves)
bleeding

Question 21

what are the mechanical causes of venous insufficiency?

Answer 21

failure of calf muscle pump
superficial venous reflux
deep venous reflux (surgery, DVT, congenital)
venous obstruction (heart failure, potral hypertension, obesity)

Question 22

what can chronic venous insufficiency cause?

Answer 22

oedema
telangiectasia
eczema
haemosiderin pigmentation
hypopigmentation
lipodermatosclerosis
ulceration

Question 23

where do venous ulcers normally appear?

Answer 23

between the knee and ankle joint

Question 24

what test is carried out to exclude arterial disease?

Answer 24

ABPI

Question 25

what treatment is given for venous ulceration?

Answer 25

wound care (little role for systemic antibiotics)
elevation
compression bandaging
shockwave therapy

Question 26

what is the aetiology of lymphoedema?

Answer 26

primary:

• congenital
• praecox: around puberty
• tarda: age > 35

secondary:

• malignancy
• surgery
• radiotherapy
• infection

Question 27

what are the 2 different pathophysiologies of lymphedema?

Answer 27

obliteration or hyperplasia of the lymphatics

Question 28

what is the treatment for lymphedema?

Answer 28

elevation

drainage

Question 29

what causes painless ulceration?

Answer 29

chronic venous insufficiency

Question 30

venous ulcers are characterised by breaches in the skin for longer than how many weeks?

Answer 30

> 4 weeks

Question 31

describe the features of venous ulcers

Answer 31

granulomatous red base
shallow
irregular margin
exudative, oedematous
painless
pulses present

Question 32

where do venous ulcers occur in the legs?

Answer 32

above lateral and lateral malleoli

arterial on malleoli, anterior shin, over toe joints and under heel

Question 33

what vein does the dorsal arch drain into?

Answer 33

long saphenous vein

Question 34

what vein does the plantar venous arch drain into?

Answer 34

short saphenous vein