Varicose Veins

 

Varicose Veins

Aim of examination

  1. The anatomical distribution of the veins
  2. Type primary or secondary
  3. Competence of saphenofemoral junction and other communicating veins
  4. Condition of deep system
  5. Presence of complication

Inspection

  1. Site and size of varicosities including Saphena varix
  2. Skin changes, ulcers and scars
  3. Swelling of the ankle

Palpation

  1. State of skin and subcutaneous tissue
  2. Sites of fascia defects
  3. Site of incompetence (Trendelenburg test + cough impulse)

Percussion 

  1. Tape test (Chevrier’s tape sign)
  2. palpation of the varicosities and pulse

Complete by Auscultation

  1. Spheno-femoral incompetence by hand-held Doppler
  2. If any bruit
  3. Examine the abdomen

History Taking for a patient with Varicose Veins

Follow the general scheme (on this page)  and use the following set of symptoms in the part of “Other symptoms in Relation to the main complaint

  • Cosmetic disfigurement
  • Pain (Discomfort, restless leg – Dull, heavy, bursting with sense of hotness – At end of the day – On prolonged standing – Relieved by elevating the limb)
  • Night cramps
  • Vermiculation
  • Symptoms of complication
    • Haemorrhage – Thrombophlebitis – Oedema – Skin pigmentation – Atrophie blanche – Varicose eczema – Lipodermatosclerosis – Venous ulceration
  • Possible cause
  • Predisposing factors
    • Primary varicose veins
      • Female sex – High parity – Marked obesity – Constricting clothes – Estrogen intake e.g. contraceptive pills – Occupation requiring prolonged standing
    • Secondary varicose veins
      • Presence of complication – History of DVT – History of Traumatic or congenital AV fistula – History of pelvic tumors – Pregnancy