Venous lymphatics - Presentation, investigation and therapy Flashcards
Define what a varicose vein is
A varicose vein is a dilated and tortuous, often superficial, vein
most commonly found in lower limbs
Risk factors of varicose veins
Age Female (20-25% females, 10-15% men) Pregnancies DVT Standing for long periods (occupation) Family history
associated symptoms of varicose veins (11)
Burning Itching Heaviness Tightness Swelling Discolouration Phlebitis - blood clot blocks a vein close to the surface of your skin - not as risky as DVT Bleeding Disfiguration Eczema Ulceration
treatment options for lymphoedema
elevation
drainage
what vein does the saphenous vein enter?
the deep vein
where is the saphenofemoral junction found?
2.5cm below and lateral to the pubic tubercle
here the left saphenous vein perforates the cribiform fascia and empties into the femoral vein
Does the short saphenous vein run up the anterior or posterior side of the leg? what vein does it drain into
posterior
drains into the popliteal vein (deep system)
what is the function of perforating veins?
they connect the superficial and deep venous circulation
where are deep veins found?
within muscular compartments
they can withstand higher pressure
what 3 things assist low flow against gravity? (back to the heart)
Valves
Calf muscle pump
Perforating veins
Causes of valvular failure? (4)
surgical or traumatic disruption of the valve.
DVT: can initially cause obstruction to venous flow, and even as the vein re-canalises through the thrombus, this canal will be a high-pressure avalvular channel.
Hormonal changes in pregnancy can cause weakness of the veins and valves, leading to venous incompetence. The enlarged uterus can cause mechanical obstruction to venous flow within the deep system
Similarly a large pelvic tumour also could, leading to increased pressure within the distal venous systems.
what happens to venous pressure when a valve fails?
venous pressure increases, there is dilatation of the distal vein and further valvular incompetence
3 special tests to test competency of venous valves
tap test
Trendelenburg/tourniquet test
Doppler test
How does the tap test work and how does it test competency of venous valves?
Place one hand over the saphenofemoral junction and one over the long saphenous vein above the knee.
Tap the saphenofemoral junction - a transmitted impulse at the knee indicates an incompetence of the valves between the two hands.
Doppler test
Hold a doppler probe over the saphenofemoral junction. Squeeze the calf muscles.
In a patient with competent superficial veins you will hear a ‘whoosh’ as the blood flows upwards into the deep system.
In a patient with an incompetent saphenofemoral junction you will hear two waves as the blood flows upwards and then refluxes downwards again.
investigations for venous system
Ultrasound can demonstrate the valves, the anatomy of the varicose vein (e.g. tortuosity), and can be used to show dynamic blood flow e.g. reflux
Classification of venous disease C0 and C6?
C0 - no visible or palpable signs of venous disease
C6 - active venous ulcer
First line treatment for venous disease
endovenous treatement
Second line treatment for venous disease
Ultrasound guided foam sclerotherapy
third line treatment for venous disease
open surgery
when should intervention not be offered for varicose veins?
if the deep venous system is obstructed eg DVT or in pregnancy
what should be offered instead of intervention if no suitable?
compression hoisery
Endovenous treatment for varicose veins
The LSV or SSV is cannulated under ultrasound guidance.
Local anaesthetic is used for the small skin puncture, and then is infiltrated in the superficial tissues around the length of the vein.
The catheter causes injury to the whole vein wall – either by heat or laser. This causes fibrosis and occlusion of the vein, and subsequently
This causes the veins to close and eventually turn into scar tissue
which is the main superficial vein associated with varicose veins?
saphenous vein
