Varicose veins and venous ulcers Flashcards Preview

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Flashcards in Varicose veins and venous ulcers Deck (26)
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1

Differentiate the great and lesser saphenous veins

  • Great saphenous vein: Dorsum of foot (medial) ➔ anterior to medial malleolus ➔ medial leg and thigh ➔ saphenous opening of deep fascia of thigh ➔ saphenofemoral junction ➔ femoral vein
  • Lesser saphenous vein: Dorsum of foot (lateral) ➔ posterior to lateral malleolus ➔ deep fascia of leg ➔ saphenopopliteal junction ➔ popliteal vein

2

Define varicose veins

Tortuous, dilated, superficial leg veins, associated with valvular incompetence

3

Describe the classification of varicose veins

  • Thread: intradermal dilated veins (pink/purple)
  • Reticular: subdermal 1-2mm diameter (blue)
  • Truncal: long or short saphenous

4

Why is it important to classify varicose veins?

Reticular and thread varicose veins are not associated with lower limb symptoms ➔ no pathological significance.

Truncal varicose veins are associated with lower limb symptoms

5

How must varicose veins be assessed and why?

Patient must be standing, otherwise trunkal varicose veins will not be visible.

This is due to gravity's effect on venous blood.

6

How can the aetiology of varicose veins be grouped?

  • Congenital
  • Primary idiopathic (98%)
  • Acquired

7

Name a congenital cause of varicose veins

Klippel-Trenaunay syndrome: failure to form blood and/or lymph vessels

Characterised be port-wine stain, venous/lymphatic malformation, soft tissue hypertrophy

8

Name two acquired causes of varicose veins

  • Pelvic mass:
    • Pregnancy
    • Tumour
    • Uterine fibroids
    • Ovarian mass
  • Pelvic venous abnormality:
    • AV fistula
    • DVT
    • Post-pelvic surgery
    • Irradiation

9

Name three risk factors for varicose veins

  • Increasing age
  • FHx
  • Female
  • Pregnancy
  • Obesity
  • Prolonged standing or sitting
  • PMH of DVT

10

Name four symptoms in varicose veins

Majority are asymptomatic

Symptoms are associated with trunk varices:

  • Pain
  • Aching
  • Itching
  • Swelling
  • Heaviness

11

When are symptomatic varicose veins worse?

  • End of day
  • Hot weather
  • Premenstruation

12

Name three complications of varicose veins

  • Bleeding
  • Thrombophlebitis
  • Venous HTN:
    • Oedema
    • Atrophy blanche; haemosiderin
    • Venous eczema
    • Lipodermatosclerosis
    • Ulceration (commonly at gaiter region)

13

Conduct one examination for varicose veins

Request two investigations

  • Examinations:
    • Trendelenburg (tourniquet) test
    • Tap test
  • Investigations:
    • Handheld doppler
      • Most accurate outpatient tool for Dx of primary varicose veins
    • Colour duplex
      • Gold standard for defining anatomy and incompetence

14

Describe Trendelenburg (tourniquet) test for varicose veins

  • Whilst supine, raise leg to empty veins
  • Apply tourniquet high in the thigh (SFJ)
  • Ask patient to stand
  • Look for varicose filling
    • No filling: release tourniquet, reassess
      • filling after release suggests SFJ incompetence
    • Filling: suggests incompetent perforators below level of SFJ
  • Repeat above (mid-thigh) and below knee (SPJ)

15

Outline primary care treatment options of varicose veins

  • Reassurance: majority unlikely to cause complications
    • Common in pregnancy; tend to improve afterwards
  • Lifestyle advice:
    • Weight loss and exercise
    • Avoid prolonged sitting/standing
    • Elevate legs when possible.
  • Compression stockings
  • Referral to Vascular services - requires criteria to be met

16

How does superficial thrombophlebitis present?

  • Tender, inflamed varicose vein
  • Overlying redness and heat
  • Feels firm due to venous thrombosis

Tx:

  • Elevation; warm compress; encourage activity
  • Consider compression stocking; NSAIDS

17

Outline the NICE criteria for varicose vein referral to secondary care vascular services

  • Symptomatic primary/recurrent varicose veins
  • Lower limb skin changes
    • Potential chronic venous insufficiency
  • Superficial vein thrombosis
  • Suspected venous incompetence
  • Venous leg ulcer ➔ 2 week referral
  • Healed venous leg ulcer

18

Outline secondary care treatment options of varicose veins

  • Surgical removal or ligation
  • Foam sclerotherapy
  • Endothermal ablation

19

Define leg ulcer

  • Break in the skin below the knee
  • Has not healed within 2 weeks

20

Name four vascular causes of leg ulcers

  • Venous (85%):
    • Venous HTN
    • Varicose veins
  • Arterial:
    • Atherosclerosis
    • AV malformation
    • Vasculitis: SLE, RA, scleroderma, PAN, GPA
  • Lymphatic

21

Name a neuropathic cause of leg ulcers

  • Diabetic neuropathy
  • Peripheral neuropathy

22

Name a haematological cause of leg ulcers

  • Polycythaemia rubra vera
  • Sickle cell anaemia

23

Name two traumatic causes of leg ulcers

  • Burns
  • Cold injury
  • Pressure sore
  • Radiation

24

Describe the distribution of venous leg ulcers

  • Calf
  • Gaiter
    • Calf muscle pump failure ➔ venous ulcer
  • Foot

25

Outline the management of venous ulcers

  • Exclude arterial insufficiency and other causes
  • Venous duplex colour scan
  • Compression bandages
    • ABPI >0.8 ➔ 4-layer bandaging
    • ABPI >0.5 ➔ 3-layer bandaging

26

Describe preventative measures of venous ulcer recurrence

  • Keep mobile
  • Varicose vein surgery
    • remove, ligate, or fuse
  • Below-knee class 2 (anti-emboli) compression stocking