Venous Diseases Flashcards
What are varicose veins?
Tortuous dilated segments of vein associated with valvular incompetence
What is the most common cause for varicose veins?
Primary idiopathic
Name some secondary cause of varicose veins?
DVT
Pelvic masses (pregnancy, fibroids, ovarian masses)
Ateriovenous malformations
What are the risk factors for varicose veins?
Prolonged standing
Obesity
Pregnancy
Family history
What are the some presentations of varicose veins?
Cosmetic issues
Aching/itching
Some complications of untreated varicose veins?
Skin changes Ulceration Thrombophlebitis Bleeding Venous insufficiency
What is saphena varix?
Dilation of the saphenous vein at the sphenofemoral junction in the groin - cough impulse
May be mistaken for femoral hernia
How do you distinguish saphena varix and femoral hernia?
Saphena varix :
Concurrent varicosities
Duplex ultrasound can be used and treatment is high saphenous ligation
What is used to classify varicose veins?
CEAP classification
Clinical features, aEtiology, Anatomical, Pathophysiology
Which two veins are commonly affecting in varicose veins?
Great/short saphenous veins
What is the gold standard investigation for varicose veins?
Duplex ultrasound
What are the non-invasive management options for varicose veins?
Patient education - avoid prolonged standing, weight loss, increase exercise
Compression stockings - check ABPI first, lifelong
For venous ulcerations - 4-layer bandaging unless evidence or arterial insufficiency.
What are the criteria for referral to vascular team for varicose veins?
Symptomatic primary or recurrent varicose veins
Lower-limb skin changes - chronic venous insufficiency
Superficial vein thrombosis - hard painful veins
Venous leg ulcer - below knee not healed after 2 week s
What surgical treatment is available for varicose veins?
Vein litigation and avulsion
Foam sclerotherapy
Thermal ablation
Name some complications of surgery for varicose veins
Haemorrhage Thrombophlebitis DVT Disease recurrence Nerve damage - saphenous or sural nerves)
What is deep venous insufficiency?
Chronic disease commonly caused by DVT/valvular insufficiency together with varicose veins
It is part of chronic venous insufficiency
What causes deep venous insufficiency?
Failure of the venous system
Causes:
Primary - underlying defect to the vein or valvular e.g. congenital and connective tissue disorder
Secondary - due to damage e.g. post-thrombotic, trauma and post-phlebitic disease
What are the risk factors for DVI?
Increasing age Female gender Pregnancy FH Long periods of standing Obesity Smoking Previous history
What are the clinical feature of DVI?
Chronically swollen lower limbs - aching, pruritic and painful
Venous claudication - pain worse on walking but doesn’t stop working, progressive through day and relived by rest.
What signs may be present on examination on someone with DVI?
Thrombophlebitis Haemosiderin staining Lipodermatosclerosis Atrophie Blanche Pedal oedema Venous ulcers
What are patients who have had a previous DVT at risk of?
Post-thrombotic syndrome
Use villalta scale to assess progression with treatment
What are the differential diagnosis with leg swelling for DVI?
Renal, hepatic and cardiac disease
What is the primary investigations for DVI?
Doppler ultrasound
Routine bloods
Documentation of foot pulses and ABPI
What is the conservative management for DVI?
Compression stockings and suitable analgesia control
Elevate feet above level of heart to reduce symptoms
What are the surgical options available for DVI?
Valvuloplasty only in deteriorating symptoms
Venous stenting — most severe symptoms when iliac vein becomes occluded
What are the complications of DVI?
Swelling, recurrent cellulitis, chronic pain, ulceration , DVT
What is venous gangrene?
It is when there is a significant occlusion of the venous system that the blood flow backs up into the arterial system and leads to gangrene.
What is the CEAP classification of varicose veins?
C1 - cosmetic concern only C2 - ache/pan +/- other symptoms e.g. heaviness/tiredness, restless legs, pruritus C3 - swelling C4a - Phlebitis C4b - eczema C5 - healed ulcers C6 - active ulcers
What are some venous related issues for varicose veins?
Reduced mobility -OA Thrombophilia - malignancy Venous obstruction - intra-abdominal mass, previous IVDA -intravenous drug addict Fluid retention Medications
What is superficial thrombophlebitis?
Inflamed varicose veins. Leading to pain and aching. Very tender to touch and doesn’t change when moving around or walking.
