Please enable JavaScript.
Coggle requires JavaScript to display documents.
CR - Venous disease - Varicose Veins (i) (Classification = CEAP (clinical,…
CR - Venous disease - Varicose Veins (i)
intro
v common - in 30% of women + 20% of men
wide spectrum
asymptomatic, min superficial dilation, minor stigmata (physical marks)
varicose veins
dilated, tortuous, elongated superficial veins
severe chronic skin changes + ulceration
Classification = CEAP (clinical, etiologic, anatomic, pathophysiologic
C0
no visible/palpable signs
C1
telangiectasis (aka reticular/spider veins)
not clinical significant
tx purely cosmetic
C2
varicose but no skin damage
associated with venous hypertension
tx to prevent ulcers
C3
oedema
@ risk of ulcers
C4
skin changes
permanent tx won't get rid of them
venous eczema
inverted champagne-bottle leg (advanced sign, usually with ulcer)
pigmentation
@ risk of ulcers
C5
healed ulcer
C6
active ulcer
causes
primary
valve failure (reflux)
most common in great/short saphenous veins
incompetent perforating veins
perforate deep fascia of muscle, superficial veins drain into deep veins via these
venous thrombosis
secondary
chronic deep venous insufficiency
oedema
hyperprigmentation
ulcer
lipodermatosclerosis
type of panniculitis (inflamm of subcut fat)
obstructions (e.g. cirrhosis)
trauma
pelvic tumours
prevalence
minor stigmata: 50-55% in women, 40-55% in men
visible varicose veins: 20-25% in women, 10-15% in men
ulceration: 1.4% in women, 0.7% in men
risk factors
female (mostly due to previous pregnancies)
pregnancy
increased age
+ve family hx
prolonged standing
major (truncal) superficial veins in leg
greater saph
med leg
affected in 90% of cases (above or below knee
lesser saph
post (but greater can also be post)
lat tributary vein (on lat aspect)
NB superficial fem vein is NOT superficial (affected by DVT not varicosity)
telangiectasia
affects 50% of pop
no ulcers/pain
widened venules
threadlike pattern on skin
venous ulceration
pigmentation (due to haemosiderin - brown freckles) + erythema around it
venous eczema
oedema
use compression bandage (non-adherent dressing)
presentations
discomfort, leg heaviness, pruritus (esp @ end of long day on feet)
shouldn't be more painful @ night (leg empty)
pain on palpation
clinical exam
cough impulse
place hand on saph-fem junction (2-3cm below + lat to pubic tubercle) + ask patient to cough
+ve if impulse felt (indicates dilation @ saph-fem junction)
not done much anymore, outdated
Trendelenburg test
not done much anymore, outdated
patient supine - lift leg to empty veins
place tourniquet over saph-fem junction + ask patient to stand
if veins fill incompetency is inf to SFJ (i.e. perforating veins)
if veins remain collapsed incompetency is @ SFJ
NB to check art pulses
mixed art + venous disease predicts poor ulcer healing
if pulses not present then can't use compression (risk of digital ischaemia)
investigations
Ankle-Brachial Index (ABI)
ratio of BP in ankle:BP in upper arm
excludes any art components
Duplex US
assesses deep + superficial veins for incompetency/reflux (not DVT)