Venous disease Flashcards
what is the relevance of varicose veins?
varicose veins affect at least a third of the population
what is the definition of varicose veins?
a varicose vein is a dilated and tortuous, often superficial vein most commonly found in the lower limb
where does the short saphenous vein drain into?
the popliteal vein
where does the great saphenous vein drain into?
the great saphenous vein perforates the cribriform fascia at the saphenofemoral junction and empties into the femoral vein
where is the saphenofemoral junction found?
found 2.5cm below and lateral to the pubic tubercle
what assists the flow of blood in the veins back up to the heart?
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)
what are the causes of valvular failure in veins?
DVT
hormonal changes in pregnancy
large pelvic tumour
how can hormonal changes in pregnancy cause valvular failure?
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.
consequently, what happens if one valve has failed in the venous system?
this causes an increase in venous pressure, dilatation of the distal vein and further valvular incompetence
what are the risk factors for varicose veins?
age female pregnancy DVT standing for long periods family history
what are the symptoms/signs of varicose veins?
burning itching heaviness tightness swelling discolouration phlebitis bleeding disfiguration eczema ulceration
how is the diagnosis of varicose veins carried out?
Take a history Look Feel Tap last Tendelburg/tourniquet test Doppler
What tests can be carried out to diagnose varicose veins/ location of the valvular incompetence?
Tap test
Tenderburg/tounirguet test
Doppler
Ultra sound
when should treatment for varicose veins be given?
Symptomatic Recurrent symptomatic Bleeding varicose vein Lower limb skin changes of chronic venous insufficiency Superficial venous thrombosis Venous leg ulcer (active or healed)
what are the treatment options for varicose veins?
first line: endogenous treatment
second line: ultrasound guided foam sclerotherapy
third line: open surgery
what would you offer a patient is intervention is unsuitable?
compression hosiery
stockings
when should intervention not be offered?
If the deep venous system is obstructed e.g. DVT
Or in pregnancy
what are the complications of endogenous treatment for varicose veins?
skin burns
paraethesiae
phlebitis
deep vein thrombosis
what are the complications for foam sclerotherapy for varicose veins?
Foam migration which can cause possible complications such as;
stroke, MI or TIA
Thrombophlebitis
Skin pigmentation
what are the complications of open surgery for varicose veins?
anaesthetic risk
wound infection
damage to nearby nerves (saphenous and dural nerves)
bleeding
what are the mechanical causes of venous insufficiency?
failure of calf muscle pump
superficial venous reflux
deep venous reflux (surgery, DVT, congenital)
venous obstruction (heart failure, potral hypertension, obesity)
what can chronic venous insufficiency cause?
oedema telangiectasia eczema haemosiderin pigmentation hypopigmentation lipodermatosclerosis ulceration
where do venous ulcers normally appear?
between the knee and ankle joint
what test is carried out to exclude arterial disease?
ABPI
