2013 Quiz - Pathophysiology of Varicose Veins:
Phlebology. 5th Ed 2008. Ramelet et al.
1.
Reflux of blood in veins is the most common cause of CVD
2.
Primary valve dysfunction occurs from superficial thrombophlebitis
3.
Reflux can result from asymmetry of valves or the valve sinus
4.
Secondary valve dysfunction can occur following deep vein thrombosis
5.
Reflux is rarely found beyond the superficial venous system
6.
A syphon effect contributes to extension of reflux to adjacent vein segments
7.
The Hach classification assumes reflux progresses distally from the SFJ
8.
Isolated perforator disease is relatively common necessitating ligation
9.
Post-thrombotic syndrome does not change the compliance of the vein wall
10.
Pelvic congestion syndrome is associated with ovarian vein reflux
11.
Abolition of proximal reflux will often result in restoration of normal function in
previously incompetent perforators
12.
Perforator reflux following post-thrombotic syndrome is not associated with
superficial incompetence
13.
Superficial venous obstruction has major haemodynamic consequences
14.
May-Thurner and Nutcracker syndromes are examples of external venous
compression syndromes
15.
Severe CVI may limit foot dorsiflexion
16.
Patients who have suffered fractures above L1, resulting in spastic paralysis of the
lower limbs, are subject to osteoporosis and lipodermatosclerosis.
17.
Orthodynamic pressure (while walking) may be doubled (around 60mmHg) due
to lipodermatosclerosis
18.
The top-down theory from the saphenous junctions is no longer considered
correct.
19.
Flush ligation at the SFJ may destroy normal drainage channels contributing to
recurrence
20.
Endothelial damage causes vasoconstriction and promotes the development of
varicose veins
21.
Superficial thrombophlebitis results in the adventitia of varicose veins becoming
less adherent to neighbouring structures
22.
A combination of haemodynamic factors and the wall hypothesis contribute to the
causation of varicose veins
23.
Reflux into calf perforators is found in approximately 50% of people who have
suffered a DVT
24.
Skin blood flow is higher in areas affected by varicose veins, but reduced in areas
affected by lipodermatosclerosis
25.
Reflux and/or venous obstruction are associated with reduced flow velocity in
capillaries.
26.
Extravasation of erythrocytes results in haemosiderin deposits in the skin
27.
CVI does not generally affect the lymphatics
28.
Microthrombi are commonly found in the capillaries of the papillary dermis
in CVI
29.
Blood circulates faster in a limb subjected to venous hypertension when
tissue-blood metabolic exchanges are reduced
30.
31.
32.
33.
34.
Persistent interstitial oedema stimulates fibroblasts
Lymphatic damage in CVI patients may predispose to cellulitis
Vein wall distensibility during pregnancy is an oestrogenic effect
Progesterone receptors are not found in the vein wall in men
Venous incompetence seen during pregnancy rarely regresses in the
post-partum period
35.
The right ovarian vein usually drains into the right renal vein
36.
Mechanical venous obstruction during pregnancy is usually significant
beyond the 5th month
37.
Anti-thrombin 111 and protein S levels increase during pregnancy
38.
Factors VII, VIII, IX, X and XII increase in the third trimester of pregnancy
39.
Obesity can cause lipodermatosclerosis in the absence of any underlying
venous abnormalities
40.
Telangiectasiae are sub-dermal dilatations of the infra-papillary
venous plexus
41.
There are no studies that indicate HRT or the OCP should be stopped during the
treatment of leg veins
O’Hare and Earnshaw. Editorial Phlebology 2008;23:101-102
42.
43.
44.
Many elderly patients with uncomplicated varicose veins simply need
reassurance that the risk of future complications is low
The use of lightweight compression has been shown to improve the symptoms
of, and protect against oedema, leg fatigue, aching and tightness
30 to 40mmHg graduated compression stockings have been shown to
protect against the complications of venous hypertension
Seidel et al Prevalence of Varicose Veins and Venous Anatomy…..
EJVES 2004;28:387-390
45.
46.
Varicose veins may occur in any vein and do not depend on trunkal
saphenous incompetence
Reflux is relatively rare in calf tributaries in the absence of saphenous reflux
Gloviczki and Glovczki. Guidelines for the management of Varicose Veins.
Phlebology 2012;27 Supp1:2-9
47.
48.
49.
50.
51.
52.
Guidelines recommend against compression stockings as the primary
treatment if the patient is a candidate for saphenous vein ablation
Compression therapy should be used as the primary treatment to aid
healing of venous ulcers
Recurrence of venous ulcers is not avoided by ablation of the associated
incompetent superficial veins
For the treatment of incompetent GSV, endothermal ablation is recommended
above high ligation and stripping
Phlebectomy or sclerotherapy is recommended to treat varicose tributaries
Foam sclerotherapy should not be used to treat saphenous trunks
Robertson et al. Epidemiology of Chronic Venous Disease.
Phlebology 2008;23:103-111
53.
54.
55.
56.
57.
58.
The prevalence of varicose veins in women is around 25 to 30%
The prevalence of varicose veins in men is leass than 5%
The prevalence of venous disease increases with age
Family history, obesity, prolonged standing and diet may be causative factors
for varicose veins
Women are more proactive when reporting varicose veins
Pregnancy may be a causative and exacerbating factor for varicose veins