🔵 Varicose veins #shortnote

●Definition and anatomy:-

Tortuous, dilated superficial veins, usually in the legs.

Usually due to valve incompetence. Common sites:

-The sapheno-femoral junction of the long saphenous vein, which runs along the medial leg.

-Sapheno-popliteal junction of the short saphenous vein, which runs along the lateral calf.

-Perforator veins (from deep to superficial), which are on the medial calf.

●Signs and symptoms:-

*Varicosities:

-Often asymptomatic, but can cause an aching pain, worse on standing. Check this is not due to other disease – e.g. PVD, arthritis – being wrongly attributed to the more visible veins.

-Poor cosmesis.

-Saphena varix: venous dilation at the sapheno-femoral junction.

*Signs of venous disease:-

-Venous ulcers.

-Venous eczema.

-Haemosiderin deposition in legs.

-Lipodermatosclerosis.

-These changes are commoner with perforator vein incompetence.

●Risk factors:-

-Family history.

-Prolonged standing.

-Abdominal or pelvic masses compressing IVC or iliac veins e.g. pregnancy, obesity.

●Investigations:-

Doppler US.

●Management:-

*Conservative:

-Compression therapy: stockings or graded compression bandaging.

-Weight loss.

-Avoid prolonged standing.

*Medical:-

-Simple analgesia.

*Surgery:-

-Indications: pain, ulceration, cosmesis (usually not on NHS).

-Options: SFJ ligation and vein stripping, stab avulsions, radiofrequency or laser ablation, injection of sclerosing foam.

-Stop oral contraceptive pill 4-6 weeks pre-op due to DVT risk.