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Surgery.(General 2).Vascular > Venous.2. Varicose veins > Flashcards

Venous.2. Varicose veins Flashcards

1
Q

Varicose veins of the Lower Limbs

A
  1. Definition
  2. Incidence
  3. Etiology
  4. MORPHOLOGICAL PICTURE
  5. CLINICAL PICTURE
  6. INVESTIGATIONS
  7. TREATMENT
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2
Q

Definition of Varicose veins of the Lower Limbs

A

Dilated, elongated & tortuous veins affecting the superficial venous system of the L.L.

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3
Q

Incidence of Varicose veins of the Lower Limbs

A

5 - 10%

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4
Q

Etiology of Varicose veins of the Lower Limbs

A
  1. Primary Varicose Veins

2. Secondary Varicose Veins

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5
Q

Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A
  1. Unknown
  2. Theories
  3. Aggravating factors
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6
Q

Theories in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A
  1. Significance

2. List

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7
Q

Significance of Theories in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A

neither of which satisfactorily explains all cases

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8
Q

List of Theories in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A
  1. The valvular incompetence theory

2. The weak wall theory

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9
Q

The valvular incompetence theory in List of Theories in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A

Postulates that incompetence of valves either in the main saphenous trunks or in the.communicating veins are responsible for the condition

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10
Q

The weak wall theory in List of Theories in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A
  1. Assumes an inherited weakness of the vein wall, producing venous dilatation even with normal pressures.
  2. Secondary valvular incompetence will occur
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11
Q

Aggravating factors in Etiology of Primary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A
  1. Female sex. The condition is commoner in females.
  2. High parity.
  3. Marked obesity.
  4. estrogens intake e.g. contraceptive pills
  5. Occupations requiring prolonged standing.
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12
Q

Etiology of Secondary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A
  1. Pregnancy : Most common cause
  2. Deep venous thrombosis
  3. Pelvic tumours
  4. Arterio-venous fistula
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13
Q

pathogenesis of Pregnancy in Etiology of Secondary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A

Oestrogen & progesterone cause smooth muscle vein wall relaxation

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14
Q

Deep venous thrombosis in Etiology of Secondary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A
  1. Pathogenesis

2. Timing

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15
Q

Pathogenesis of Deep venous thrombosis in Etiology of Secondary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A

Recanalization of the thrombosed deep veins leaves the valves of the deep system & perforating veins incompetent leading to reflux of blood.

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16
Q

Timing of Deep venous thrombosis in Etiology of Secondary Varicose Veins in Etiology of Varicose veins of the Lower Limbs

A

Occurs 2-5 years after DVT.

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17
Q

MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Large vein varicosities :
  2. Reticular varicosities :
  3. Spider varicosities
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18
Q

Large vein varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Site

2. Diameter

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19
Q

Site of Large vein varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs

A

Affecting the LSV or SSV themselves or one of their main tributaries.

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20
Q

Diameter of Large vein varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs

A

Large in diameter : 5-15 mm.

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21
Q

Reticular varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Site

2. Diameter

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22
Q

Site of Reticular varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs

A

Lying immediately beneath the skin.

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23
Q

Diameter of Reticular varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs

A

1-5 mm in diameter

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24
Q

Alternative name for Spider varicosities in MORPHOLOGICAL PICTURE of Varicose veins of the Lower Limbs

A

Telangiectasia

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25
Q

CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Symptoms

2. Examination

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26
Q

Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

A) Early and mild cases

B) Late and severe cases

C) Determining factors

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27
Q

Early and mild cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Complain of

  1. Cosmetic disfigurement
  2. Swelling of the lower limb
  3. Postural discomfort & dull aching pain of the limb
  4. Night muscular cramps.
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28
Q

Swelling of the lower limb in Early and mild cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Usually at the end of the day

or

  1. On prolonged standing.
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29
Q

Postural discomfort & dull aching pain of the limb in Early and mild cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Usually at the end of the day

or

  1. On prolonged standing.
  2. Relieved by leg elevation.
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30
Q

Late and severe cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Present with classical picture of chronic venous insufficiency

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31
Q

classical picture of chronic venous insufficiency in Late and severe cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

1- Pigmentation, itching & eczema.

  1. Venous ulcer.
  2. Lipodermatosclerosis.
  3. Venous claudication
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32
Q

Venous claudication in classical picture of chronic venous insufficiency in Late and severe cases in Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Patients with severe CVI may develop claudication or bursting pain during walking
  2. due to very high venous pressure
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33
Q

Determining factors of Symptoms in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Severity and duration of venous hypertension

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34
Q

Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Status of Examination
  2. Exposure
  3. Points required to be fulfilled
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35
Q

Status of Examination in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

The patient should be examined while STANDING

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36
Q

Exposure in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

The patient should be exposed up to the umbilicus.

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37
Q

Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Determining

  1. Etiology of Varicose veins
  2. Which saphenous system is affected
  3. The competency of the sapheno-femoral junction
  4. The competency of the perforators
  5. The condition of the deep system of veins
  6. The presence of complications
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38
Q

Determining Etiology of Varicose veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Using

  1. History
  2. inspection
  3. palpation
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39
Q

Using History in Determining Etiology of Varicose veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

In case of secondary Varicose veins

There will be history Of DVT, previous leg injury, fracture or abdominal surgery

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40
Q

Using inspection in Determining Etiology of Varicose veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

In case of secondary Varicose veins

  1. Varicose veins may be arranged haphazardly
  2. Presence of complications as oedema, eczema, or ulceration
  3. Presence of veins crossing the inguinal ligament (with reversed flow)
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41
Q

Using palpation in Determining Etiology of Varicose veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Palpation of a thrill over the veins denotes the existence of an A-V fistula.

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42
Q

Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Using

  1. Inspection
  2. Tap lest
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43
Q

Using Inspection in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

The site & anatomical distribution of the varicosities

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44
Q

The site & anatomical distribution of the varicosities in Using Inspection in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Lateral and then posterior )> Short saphenous system

Medial )> Long saphenous system

Any varicosities above knee )> Long saphenous system even if lateral as no short saphenous above knee

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45
Q

Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

a. Chevrier test

b. Schwartz’s Test

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46
Q

Chevrier test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Steps

2. Results

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47
Q

Steps of Chevrier test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. With the patient erect, place the fingers of the left hand at the saphenous opening (or any vein above knee).
  2. Percuss the main bunch of varicosities once with the right middle finger.
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48
Q

Results of Chevrier test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

If an upward wave of blood is perceived at the saphenous opening, this indicates that these varicosities belong to the LSS

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49
Q

Schwartz’s Test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Steps
  2. Results
  3. Disadvantages
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50
Q

Steps of Schwartz’s Test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

The saphenous vein is percussed by the index of one hand & palpated distally by the fingers of the other hand.

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51
Q

Results of Schwartz’s Test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Only if the valves are incompetent, the wave is transmitted distally

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52
Q

Disadvantages of Schwartz’s Test in Using Tap lest in Determining Which saphenous system is affected in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Other opinion is that the impulse is transmitted along the vessel wall & not the blood column.

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53
Q

Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Using

  1. Inspection
  2. Palpation
  3. Special tests
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54
Q

Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Saphena-varix may be present

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55
Q

Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Definition
  2. Examination
  3. Differential Diagnosis
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56
Q

Definition of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

This is saccular dilatation of upper end of great saphenous vein opposite incompetent sapheno-femoral valve.

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57
Q

Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Swelling with the following characters

  1. Site
  2. Size
  3. Shape
  4. Edge
  5. Surface
  6. Consistency
  7. Color
  8. Special character
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58
Q

Site of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

A. Subcutaneous mass in upper part of femoral triangle

B. 4 cm below & lateral to pubic tubercle

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59
Q

Size of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Variable

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60
Q

Shape of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

rounded or ovoid

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61
Q

Edge of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Well defined

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62
Q

Surface of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Smooth

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63
Q

Consistency of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

soft or cystic

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64
Q

Color of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

bluish

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65
Q

Special character of the swelling in Examination of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Compressible

2. Expansible impulse and thrill on cough

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66
Q

Differential Diagnosis of Saphena-varix in Using Inspection in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Femoral hernia ( 99% irreducible ) and other swellings of femoral triangle

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67
Q

Using Palpation in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Palpation of a thrill over sapheno-femoral junction on cough
  2. denotes an incompetent sapheno-femoral junction
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68
Q

Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Trendlenburg test

2. Morrisey cough impulse test

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69
Q

Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Aim
  2. Steps
  3. Results
70
Q

Aim of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

a. Detection of sapheno-femoral incompetence

b. Detection of incompetence of communicating veins

71
Q

Steps of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

a. The patient lies supine and raises his leg to empty the veins.
b. A venous tourniquet is applied just below the SFJ.
c. The patient is then asked stand up.
d. The tourniquet is then released after 10 seconds

72
Q

Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Results when the tourniquet is still in place

2. Results when The tourniquet is then released after 10 seconds

73
Q

Results when the tourniquet is still in place in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

a. NO varicosities appear

b. The veins fill rapidly

74
Q

NO varicosities appear in Results when the tourniquet is still in place in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Means Incompetent SFJ & competent perforators

75
Q

The veins fill rapidly in Results when the tourniquet is still in place in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Means Incompetent perforators

2. In this case ONLY the multiple tourniquet test is done to identify the site of the incompetent perforators

76
Q

Results when The tourniquet is then released after 10 seconds in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

a. The veins will fill slowly “minimum 10 seconds” from below upward (normal venous filling)
b. The veins will fill rapidly from below upward Or will fill from above downwards

77
Q

The veins will fill slowly from below upward in Results when The tourniquet is then released after 10 seconds in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Means competent sapheno-femoral valve

78
Q

The veins will fill rapidly from below upward Or will fill from above downwards in Results when The tourniquet is then released after 10 seconds in Results of Trendlenburg test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Incompetent sapheno-femoral valve

79
Q

Morrisey cough impulse test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Steps

2. Results

80
Q

Steps of Morrisey cough impulse test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. The patient lies flat & elevate the limb for 30 degree
  2. Ask the patient to cough forcibly.
81
Q

Results of Morrisey cough impulse test in Using Special tests in Determining The competency of the sapheno-femoral junction in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

If there is retrograde filling )> Incompetent SFJ

82
Q

Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

a. Multiple tourniquet test
b. Manual Localization of Blow-Outs
c. Fegan’s Method

83
Q

Multiple tourniquet test in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Steps

2. Results

84
Q

Steps of Multiple tourniquet test in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Application of three tourniquets
  2. The patient is then asked to stand up
  3. The tourniquets are released one by one from below upwards
85
Q

Sites of Application of three tourniquets in Steps of Multiple tourniquet test in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. One below the knee.
  2. The second at the junction of the lower third of the thigh with the upper two thirds.
  3. The third tourniquet is just below the SFJ.
86
Q

Results of Multiple tourniquet test in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Rapid filling beyond any segment indicates the site of incompetent perforator

87
Q

Manual Localization of Blow-Outs in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Alternative name
  2. Significance
  3. Steps
  4. Results
88
Q

Alternative name for Manual Localization of Blow-Outs in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Two Fingers Test

89
Q

Significance of Manual Localization of Blow-Outs in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Simple alternative test to multiple tourniquet test

90
Q

Steps of Manual Localization of Blow-Outs in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Patient stands.
  2. The 2 index are pressed at a point on great saphenous vein & then moved in opposing directions to empty a segment.
  3. Whole vein is tested segment by segment from above down.
91
Q

Results of Manual Localization of Blow-Outs in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. If this segment remains empty, it has no underlying blowout but
  2. if it fills, an underlying blow-out exists.
92
Q

Fegan’s Method in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Steps

2. Results

93
Q

Steps of Fegan’s Method in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Mark the varicosities with a skin pen while the patient stands.
  2. Ask him to lie down & raise the affected limb & rest the heel against the examiner’s upper chest.
  3. Palpate the line of the marked varicosities carefully for gaps in the deep fascia through which the perforating veins pass
94
Q

Results of Fegan’s Method in Determining The competency of the perforators in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Gaps in the deep fascia through which the perforating veins pass are felt as circular openings with sharp edges & are marked.

95
Q

Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

a. Modified Perthe’s test
b. Perthe’s test ( not done as it’s subjective)
c. Hoffman’s modification of Modified Perthe’s test :

96
Q

Modified Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Steps

2. Results

97
Q

Steps of Modified Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. While the patient is standing, a tourniquet is applied just below the SFJ
  2. The patient is asked to walk quickly in situ for five minutes
98
Q

Results of Modified Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

One of the following

  1. Varicose veins disappear
  2. Varicose veins become more engorged
99
Q

Varicose veins disappear in Results of Modified Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

A. Deep system is patent & competent

B. 1ry Varicose veins or 2ry Varicose veins with canalized deep veins

100
Q

Varicose veins become more engorged in Results of Modified Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

A. Deep system is occluded or incompetent

B. 2ry Varicose veins with uncanalized deep veins

101
Q

Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Significance
  2. Steps
  3. Results
102
Q

Significance of Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Not done as it’s subjective

103
Q

Steps of Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Patient lies down, his leg is raised & massaged to empty the V.V.
  2. Elastic bandage is applied from toes to groin, to occlude superficial veins.
  3. The patient then walks in situ for 10 min
104
Q

Results of Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

One of the following

  1. No pain
  2. Pain occurs
105
Q

No pain in Results of Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Means Deep system is patent.

106
Q

Pain occurs in Results of Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Means Deep system is occluded

107
Q

Hoffman’s modification of Modified Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Argument

2. Modification

108
Q

Argument in Hoffman’s modification of Modified Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

If the patient is having incompetent perforators, modified Perthe’s test will show venous engorgement even if the deep system is patent.

109
Q

Modification in Hoffman’s modification of Modified Perthe’s test in Determining The patency of deep system of veins in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

Application of the tourniquet just below the incompetent perforator & test the veins below.

110
Q

Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Incidence of complications

2. List of complications

111
Q

Incidence of complications in Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

more common with secondary Varicose veins

112
Q

List of complications in Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

a. Recurrent superficial thrombophlebitis
b. Haemorrhage
c. CVI with its complications

113
Q

Haemorrhage in List of complications in Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. Pathogenesis

2. Management

114
Q

Pathogenesis of Haemorrhage in List of complications in Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A

May occur due to rupture of a varicose vein especially when the overlying skin is thin.

115
Q

Management of Haemorrhage in List of complications in Determining The presence of complications in Points required to be fulfilled in Examination in CLINICAL PICTURE of Varicose veins of the Lower Limbs

A
  1. It can be initially stopped by elevation and compression bandage.
  2. Later treatment is by injection sclerotherapy
116
Q

INVESTIGATIONS of Varicose veins of the Lower Limbs

A
  1. Bedside test for competency of SFJ.

2. Gold standard Investigation

117
Q

Bed side test for competency of SFJ in INVESTIGATIONS of Varicose veins of the Lower Limbs

A

Doppler

118
Q

Gold standard Investigation in INVESTIGATIONS of Varicose veins of the Lower Limbs

A

Venous Duplex

119
Q

TREATMENT of Varicose veins of the Lower Limbs

A
  1. Aim
  2. Management of primary Varicose veins
  3. Management of Secondary Varicose veins
120
Q

Aim of TREATMENT of Varicose veins of the Lower Limbs

A

Overcome venous congestion.

121
Q

Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Conservative Treatment
  2. Injection sclerotherapy
  3. Surgical Treatment
  4. Recent Modalities
122
Q

Conservative Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Indications

2. Lines of management

123
Q

Indications of Conservative Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Patients with minor varicosities.

2. High risk patients unfit for surgery.

124
Q

Lines of management in Conservative Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

a. Reassurance & avoid prolonged standing.
b. Regular exercise is required
c. Compression elastic stockings are used
d. There is NOTHING called venotonic drugs

125
Q

The reason why Regular exercise is required in Lines of management in Conservative Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Improve the muscle pump

2. Overcome mild venous hypertension.

126
Q

Compression elastic stockings are used in Lines of management in Conservative Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Supports the Varicose veins

2. Abolishing the effect of venous reflux

127
Q

Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Indications
  2. Contraindications
  3. Principle & Technique
  4. The key point
  5. Complications
128
Q

Indications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

a. Cosmetic for reticular veins.
b. Residual varicosities after operation.
c. Small localized bunch of varicosities via a single perforator.

129
Q

Contraindications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

a- Pregnancy.

b. 2ry V.V with uncanalized deep system

130
Q

Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Injection of Sclerosant material in an empty vein
  2. Compression by elastic bandage
  3. Instructing The patient to walk for a long distance
131
Q

Sclerosant material in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

A. Sodium tetradecyl sulfate “STD

or

B. 5% ethanolarnine oleate.

132
Q

The reason of Injection of Sclerosant material in an empty vein in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. To induce injury of the endothelial layer of intima.
  2. If injection is done with the vein full of blood, thrombosis will occur which later recanalizes with recurrence of V.V.
133
Q

Compression by elastic bandage in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Site of application
  2. Duration of application
  3. The reason of application
134
Q

Site of application of Compression by elastic bandage in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

Applied immediately over the whole leg from the toes to the knee

135
Q

Duration of application of Compression by elastic bandage in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

is left for 4-6 weeks.

136
Q

The reason of application of Compression by elastic bandage in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

to let the two walls of the vein adhere together

137
Q

Instructing The patient to walk for a long distance in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Timing

2. The reason

138
Q

Timing of Instructing The patient to walk for a long distance in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

Immediately after application of the bandage

139
Q

The reason of Instructing The patient to walk for a long distance in Principle & Technique of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

in order to flush any amount of sclerosant that might have reached the deep veins.

140
Q

The key point of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

is that the saphenofemoral junction should be competent To avoid regurge of blood and recanalization of the sclerosed vein

141
Q

Complications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Extravasation of sclerosant material under the skin

2. DVT

142
Q

Extravasation of sclerosant material under the skin in Complications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

Leads to

  1. Sloughing of the skin
  2. Poor cosmetic results
143
Q

DVT in Complications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Pathogenesis

2. Guarding against DVT

144
Q

Pathogenesis of DVT in Complications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

May occur if a large amount of the sclerosant material reaches the deep system undiluted

145
Q

Guarding against DVT in Complications of Injection sclerotherapy in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. No more than 1 ml is injected at any point

2. No injection is done above the knee.

146
Q

Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

A. Trendelenburg’s operation

B. Stripping of the Long saphenous vein

C. Triple ligation of incompetent perforators

147
Q

Steps of Trendelenburg’s operation in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. FLUSH disconnection of the LSV from the femoral vein
  2. Ligation and dividing of All tributaries of the LSV near the saphenous opening to avoid recurrence
  3. Some surgeons routinely do Stripping of the LSV above the knee with Trendelenburg’s operation to avoid recurrence even if the LSV was healthy with no varicosities.
148
Q

Meaning of FLUSH disconnection of the LSV from the femoral vein in Steps of Trendelenburg’s operation in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. No saphenous stump

2. To avoid recurrence from this stump

149
Q

Oral question

How to differentiate between saphenous and femoral intraoperative ?

A

Saphenous vein has tributaries while femoral vein has no tributaries in this area

150
Q

Steps of Stripping of the Long saphenous vein in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Start with Trendlenburg’s operation
  2. The long saphenous is stripped
  3. Extent of Stripping
151
Q

Extent of Stripping in Steps of Stripping of the Long saphenous vein in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

One of the following

  1. Stripping from the medial malleolus to the groin
  2. Stripping is usually performed to a hand-breadth just below the knee
152
Q

The reason why Stripping is usually performed to a hand-breadth just below the knee in Extent of Stripping in Steps of Stripping of the Long saphenous vein in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. as below this the saphenous nerve is more closely related to the vein
  2. Resulting in an increased risk of injury )> Unaccepted paresthesia & numbness in the medial aspect of the leg & foot
153
Q

Triple ligation of incompetent perforators in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Transverse incision is made over each one.
  2. Application of 3 ligatures on the perforator and on the saphenous vein above and below
  3. Excision of The intervening T segment
154
Q

Components of The intervening T segment in Triple ligation of incompetent perforators in Surgical Treatment in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

Part of superficial system and part of perforator

155
Q

Recent Modalities in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Hook phlebectomy
  2. EVLA: Endovenous laser ablation.
  3. RFA : Radiofrequency ablation.
  4. Valvuloplasty.
156
Q

Hook phlebectomy in Recent Modalities in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Alternative name
  2. Indications
  3. Contraindications
157
Q

Alternative name for Hook phlebectomy in Recent Modalities in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

Ambulatory phlebectomy

158
Q

Indications of Hook phlebectomy in Recent Modalities in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Residual varicosities
  2. Reticular varicosities
  3. Varicosities of Tributaries of long and short saphenous
159
Q

Contraindications of Hook phlebectomy in Recent Modalities in Management of primary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Varicosities of the main trunk of LSV and SSV

2. Reflux in sapheno-femoral junction )> recurrence

160
Q

Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Treatment of post phlebitic Varicose veins
  2. Treatment of Varicose veins complicating acquired A-V fistula
  3. Treatment of Varicose veins complicating Congenital A-V fistula
  4. Treatment of Varicose veins occurring during pregnancy
161
Q

Treatment of post phlebitic Varicose veins in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

Management of :

  1. The majority of cases
  2. Some rare cases with large varicosities
162
Q

Management of The majority of cases in Treatment of post phlebitic Varicose veins in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

Conservative Treatment by ELASTIC STOCKING.

163
Q

Management of Some rare cases with large varicosities in Treatment of post phlebitic Varicose veins in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Require active treatment
  2. Precautions of active treatment
  3. Treat as primary varicose veins in cases of recanalized deep system
164
Q

Precautions of active treatment in Management of Some rare cases with large varicosities in Treatment of post phlebitic Varicose veins in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

Verifying recanalization of the deep system Clinically and by duplex

165
Q

The reason of Verifying recanalization of the deep system Clinically and by duplex in Precautions of active treatment in Management of Some rare cases with large varicosities in Treatment of post phlebitic Varicose veins in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

because Surgery will be contraindicated if the deep system is occluded as the superficial system has the main role in venous drainage of the Lower limb

166
Q

Treatment of Varicose veins complicating acquired A-V fistula in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Surgical treatment of the fistula is usually followed by marked regression of varicosities.
  2. If residual veins remain, treat as primary varicose veins
167
Q

Treatment of Varicose veins complicating Congenital A-V fistula in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Conservative Treatment

2. Precautions

168
Q

Precautions of Treatment of Varicose veins complicating Congenital A-V fistula in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. It is important to know that deep venous system hypoplasia or aplasia are common with congenital fistulae
  2. Removal of the superficial Varicose veins may lead to a disaster “venous gangrene” as they may be the only veins draining the L.L
169
Q

Treatment of Varicose veins occurring during pregnancy in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. A complete ELASTIC STOCKING

2. After labour any residual veins are treated as 1ry Varicose veins

170
Q

A complete ELASTIC STOCKING in Treatment of Varicose veins occurring during pregnancy in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A
  1. Site of application

2. Duration

171
Q

Site of application of A complete ELASTIC STOCKING in Treatment of Varicose veins occurring during pregnancy in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

from the toes up to the groin

172
Q

Duration of A complete ELASTIC STOCKING in Treatment of Varicose veins occurring during pregnancy in Management of Secondary Varicose veins in TREATMENT of Varicose veins of the Lower Limbs

A

Applied all through the period of pregnancy.

Surgery.(General 2).Vascular (16 decks)

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