Venous Disease Flashcards

1
Q

What are varicose veins? [2]

A

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

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2
Q

What is venous reflux? [2]

A

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]

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3
Q

In what superficial veins is varicosity common? [2]

A

The Long Saphenous

The Short Saphenous

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4
Q

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

A

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

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5
Q

What are the symptoms of Varicose Veins? [5]

What are 2 complications?

A
Discomfort
Nocturnal Cramps
Oedema
Pruritis
Skin colour changes

Complications:
Superficial Thrombophlebitis
Acute Haemorrhage

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6
Q

What is superficial thombophlebitis? [2]

Presentation [3]

A

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

Causes redness, pain and tenderness.

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7
Q

How are varicose veins investigated? [2]

A

An ECHO

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

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8
Q

When do we intervene in varicose veins? [5]

A

Indicators for surgery

  • Superficial Thrombophlebitis
  • Haemorrhage
  • Anxiety about progression
  • Serious cosmetic issues
  • Signs its progress to CVI
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9
Q

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

A

Conservative Treatment
Surgical Treatment
Low-Invasion Procedures

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10
Q

What is conservative treatment for varicose veins? [4]

A

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

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11
Q

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

A

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)

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12
Q

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

A

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

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

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13
Q

What are the advantages of low invasion treatments?

A

No theatre needed
Less time off work
Less risk

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14
Q

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

A

Previous DVT
Arterial Insufficiency
Co-morbidity
Morbid Obesity

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15
Q

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

A
Minor Haemorrhage
Thrombophlebitis
Haematoma
Infection
Nerve damage (sural/saphenous), Vein/artery damage
DVT
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16
Q

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

A

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

17
Q

What is ambulatory venous pressure? [1]

A

The venous pressure when upright and moving.

High readings indicate venous hypertension

18
Q

What possible causes are there for CVI? [5]

A
Superficial & deep Venous reflux (superficial can mean varicose veins)
Venous obstruction
Obesity
Neuromuscular causes
Inactivity
19
Q

What are the risk factors for CVI? [4]

A

Female
Prolonged Standing (often occupational)
Crossing Knees
Obesity