Venous Disease

Question 1

Superficial vein role

Answer 1

Valves that direct blood centrally to deep veins and oppose reflux

Question 2

Deep vein role

Answer 2

Direct blood back to heart

Have valves in the limbs

Question 3

Perforating vein role

Answer 3

Valves which direct flow from superficial to deep

Question 4

Lower limb venous anatomy

Answer 4

Long saphenous vein-medial leg -> common femoral vein-sapheno-femoral junction in the saphenous opening

Short saphenous vein-posterior calf-> popliteal vein- short sapheno-popliteal in the popliteal fossa

Hunterian perforator- medial mid thigh

Cocketts perforators- medial leg

Question 5

Physiology of venous return

Answer 5

Inspiration decreases interthoracic pressure
Muscle pumps in thigh, calf and feet
Muscles are contained within facia compartments-> pressure increases when the contract
-> veins are compressed-> blood pushed upwards
Reflux prevented by perforator valves
Muscle relaxation allows flow down perforators

Question 6

Varicose veins epidemiology

Answer 6

2%
F:M 3:1
Less common in young

Question 7

Primary varicose veins aetiology

Answer 7

Disputed
Familial element
Obesity
Multiple pregnancy

Question 8

Secondary varicose veins aetiology

Answer 8

Less common
DVT
obstruction
AV fistula

Question 9

Varicose veins symptoms

Answer 9

Discomfort that is relieved by elevation 
Bursting pain on exercise -> with tourniquet, Perthes test
Restless legs
Ankle swelling-> CVH
Venous eczema/itching 
Superficial phlebitis 
Bleeding- internal/external 
Ulceration

Question 10

Varicose veins signs

Answer 10

Skin changes-> lipodermatosclerosis
-inflammation
-pigmentation, haemosiderin
-subcut thinkening
-atrophy blanche
Variceal pattern
Blow outs, localised dilatiations
Oedema

Question 11

Investigations for venous disease

Answer 11

Duplex scanning, colour Doppler shows reflux

Venous pressure and volume

Question 12

Conservative management of varicose veins and indications

Answer 12

Compression hose, pressure highest at ankle

• > mild symptoms
• > no skin changes
• > elderly
• > pregnant

Question 13

Varicose veins-compression sclerotherpy and indications

Answer 13

Sclerosant used to cause sterile inflammation
Vein kept empty using compression-> lumen obliterated
Risk of embolism!
->isolated perforators
->vulval varices
-> telangectasia

Question 14

Surgical management of varicose veins and indications

Answer 14

Ligate points of major incompetence and remove
Remove saphenous trunk by stripping 
Endoluminal venous obliteration 
-> causal pain
-> causal phlebitis
-> bleeding
-> skin changes
-> ulceration