Varicose vein examination:
Dilated, tortuous veins.
(Sapheno-femoral junction: 4cm inferolateral to pubic tubercle)
1) Look at lower limbs of varicose veins:
a. Distribution of short saphenous veins (post to lat. Malleolus over lat calf into popliteal fossa)
b. Long saphneous vein (ant to medial maellolus, pass medial to knee and up medial calf to SF junction)
2) Examine around the gaiter area for : VVV LAPS
a. Varicose Veins (are blue, disappear when lie flat)
b. Venous stars / spider veins
c. Venous ulcer (Sign of chronic venous insufficiency, medial gaiter area, maybe filled with granulation tissue at base, or slough)
d. Lipodermatosclerosis (scarring of skin and fat. Acute & chronic phase. Acute = rbc rush into tissue, brown hemosiderin fills the space. Chronic = lots of hemosiderin, fibrin deposition, skin looks thick and shiny. Inverted champagne bottle seen)
e. Atrophy blanche (active and healed ulcers leave a white patch)
f. Pitting edema
g. Scars
Inspect for PVD.
3) Palpation:
a. Temperature, Tenderness.
b. Palpate along course of veins
c. Offer to palpate pedal pulses
d. Offer to palpate abdomen (may have mass compressing IVC / Illiac veins > venous hypertension)
e. Cough impulse (Patient standing, locate SFJ, saphena varix which is a lump at growing where saphenous vein and femoral vein joins, smooth swelling and palpable thrill.)
4) Tredelenburg / Torniquet test
a. Elevate patient leg and slowly empty the veins
b. Tie a torniquet on SFJ and ask patient to stand.
c. Normal valve at torniquet site: blood slowly filling from below torniquet; Valvular incompetence of communicating veins: Superficial veins fill more rapidly.
d. Remove torniquet : Veins fill rapidly from above = SF junction incompetence.
e. Repeat test at 3 positions : SJ junction, slightly above knee, and slightly above medial malleolus,.
5) Modified Perthes’ test
a. Walking with torniquet on SF Junction, normally gets better with walking; incompetent valves: no effect; DVT = painful when walk
b. Calf pump function, making varicosities less.
6) Doppler examination
a. Doppler probe put at Sfjunction, calf is squeezed. Increase venous return = whoosh sound, followed by plop sound = valve prevents regurgitation.
General considerations:
Causes:
-Primary: Idiopathic / Familial/hereditary (in teens)
- Secondary: Obstruction (pelvic mass), DVT, AV fistulae, Klippel Trenaunay Syndrome (congenital av fistalae), pregnancy (progesterone ~ collagen, increase pressure)
Presenting complains: *Saphena varix, varicosities, heaviness, tension, itching (after standing)
RF: Female, age, occupation, ethnicity, pregnancy, obesity, smoking. Previous Hx for abdominal cancer, DVT, other venous complaints
Veins: Deep and superficial vs long and short saphenous veins
