Venous disorders - Varicose veins, chronic venous insufficiency Flashcards
What is chronic venous insufficiency?
A condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. CVI causes blood to “pool” or collect in these veins, and this pooling is called stasis. This term is often assigned to when both the superficial and deep veins of the legs begin to fail.
What are primary causes of varicose veins?
- Unknown
- Congenital valve absence
What are secondary causes of varicose veins?
- Obstruction - DVT, ovarian tumour, foetus
- Valve destruction
- Arteriovenous malformation
- Contipation
- Overactive muscle pumps
What are symptoms of varicose veins?
- Nocturnal cramps
- Leg swelling
- Localised discomfort
- Pruritis
What are signs of varicose veins?
- Oedema
- Exczema
- Ulceration
- Haemorrhage
- Superficial thrombophlebitis
- Lipodermatosclerosis
- Atrophe blanche
What is the following?
Lipodermatosclerosis - skin hardening from subcutaneous fibrosis caused by chronic inflammation and fat necrosis
What is the following?
Atrophe blanche - white scarring ay the site of a previous, healed ulcer
What is the following?
Superficial thrombophlebitis
How would you examine varicose veins?
- Inspect - ulceration, long and short saphenous distribution
- Palpate - tenderness, hardness, pulses (if ulceration so arterial cause can be ruled out)
- Cough reflex at SFJ, Percussion test
- Auscultate - bruits for AV malformation
- Abdominal examination for masses
What is the purpose fo the cough reflex at the SFJ?
To test for saphena varix - a dilation of the saphenous vein at its junction with the femoral vein in the groin. Can be mistaken for femoral hernia
What is the Trendelenburg test?
- Ask the patient to sit on the edge of the examination couch.
- Elevate the limb as far as is comfortable for the patient and empty the superficial veins by ‘milking’ the leg towards the groin.
- With the patient’s leg still elevated, press with your thumb over the sapheno-femoral junction (2–3 cm below and 2–3 cm lateral to the pubic tubercle). A high thigh tourniquet can be used instead.
- Ask the patient to stand while you maintain pressure over the saphenofemoral junction.
- If SFJ reflux is present, the patient’s varicose veins will not fill until your digital pressure, or the tourniquet, is removed. This is becuase all collaterals have functional valves, whereas the SFJ does not
What other invesigations other than examination would you perform is someone had varicose veins?
Doppler ultrasound - listen for flow in incompitent valves e.g. the SFJ. or short saphenous behind the knee
How would you manage someone with varicose veins?
- Education - avoid long standing and elevate legs, support stockings, lose weight, regular walks
-
Endovascular treatment
- Radiofrequency ablation
- Endovenous laser ablation
- Injection sclerotherapy
- Surgery
What is radiofrequency abliation therapy?
https://www.youtube.com/watch?v=vSE9YQLWVDY
A catheter is inserted into the vein and heated to 120oC destroying the endothelium and closing the vein
What is Endovenous laser ablation?
https://www.youtube.com/watch?v=lwtKctuByIQ
Similar to radiofrequency ablation, but uses laser instead
What is injection sclerotherapy?
https://www.youtube.com/watch?v=wmZVZ6jlHxo
Aither liquid or foam can be used. Sclerosant is injected into the varicosities at multiple sites and the vein compressed for a few weeks to avoid thrombosis
