Venous Disease

Question 1

What are varicose veins? [2]

Answer 1

Tortuous, dilated veins [1] (usually superficial) that develop due to venous reflux. [1]

Question 2

What is venous reflux? [2]

Answer 2

Where the pressure of gravity on the veins causes the veins to dilate over time [1] until the valve is incompetent and blood flows backwards down the vein [1]

Question 3

In what superficial veins is varicosity common? [2]

Answer 3

The Long Saphenous

The Short Saphenous

Question 4

What are the risk factors for Varicose Veins? [6]

Answer 4

Female
Long time spent standing (often occupational)
Pregnancies (especially big babies or twins)
Previous DVT
Major Trauma
Family History

Question 5

What are the symptoms of Varicose Veins? [5]

What are 2 complications?

Answer 5

Discomfort
Nocturnal Cramps
Oedema
Pruritis
Skin colour changes

Complications:
Superficial Thrombophlebitis
Acute Haemorrhage

Question 6

What is superficial thombophlebitis? [2]

Presentation [3]

Answer 6

Inflammation of a vessel [1] due to clot formation (not unlikely in static varicose veins) [1]

Causes redness, pain and tenderness.

Question 7

How are varicose veins investigated? [2]

Answer 7

An ECHO

Looks at valves at sapheno-popliteal & sapheno-femoral junctions for incompetence & backflow

Question 8

When do we intervene in varicose veins? [5]

Answer 8

Indicators for surgery

• Superficial Thrombophlebitis
• Haemorrhage
• Anxiety about progression
• Serious cosmetic issues
• Signs its progress to CVI

Question 9

What groups of treatments are there for Varicose Veins? [3]

Answer 9

Conservative Treatment
Surgical Treatment
Low-Invasion Procedures

Question 10

What is conservative treatment for varicose veins? [4]

Answer 10

Anti-inflammatorys like ibuprofen
Graduated Compression stockings
Exercise
Anti-clotting agents

Question 11

What surgical treatments are there for varicose veins? [2]

Answer 11

Ligation of the junction where the incompetent valve is. (tying it up)
Vein Stripping with multiple stab avulsions (small holes through which its removed, also called phlebectomy)

Question 12

What are the low invasion treatments for Varicose Veins? [2]

Answer 12

Foam Sclerotherapy - A chemical reaction with endothelium closes the vein with foam

Endovenous Laser Ablation (EVLA) or Radiofrequency Ablation both close the vein.

Question 13

What are the advantages of low invasion treatments?

Answer 13

No theatre needed
Less time off work
Less risk

Question 14

What are the contraindications of surgery in varicose veins? [4]

Answer 14

Previous DVT
Arterial Insufficiency
Co-morbidity
Morbid Obesity

Question 15

What are the complications of surgery on varicose veins? [6]

Answer 15

Minor Haemorrhage
Thrombophlebitis
Haematoma
Infection
Nerve damage (sural/saphenous), Vein/artery damage
DVT

Question 16

How does Chronic Venous Insufficiency (CVI) arise from varicose veins?

Answer 16

Varicose veins cause the deep veins to act as collateral circulation [1]
Eventually they too can undergo venous reflux [1] and become tortuous & dilated, the now hypertensive veins ooze exudate which inflames surrounding tissue causing CVI

Question 17

What is ambulatory venous pressure? [1]

Answer 17

The venous pressure when upright and moving.

High readings indicate venous hypertension

Question 18

What possible causes are there for CVI? [5]

Answer 18

Superficial & deep Venous reflux (superficial can mean varicose veins)
Venous obstruction
Obesity
Neuromuscular causes
Inactivity

Question 19

What are the risk factors for CVI? [4]

Answer 19

Female
Prolonged Standing (often occupational)
Crossing Knees
Obesity