varicose veins- Cinical Features & Examination

comprehensive

1. VARICOSE VEINS
CLINICAL FEATURES and
EXAMINATION

2. SYMPTOMS
Dilated tortuous veins
Pain, Heaviness, Aching sensation
Itching
Ulceration, Bleeding

3. INSPECTION
Varicose Veins –Long Saphenous vein
Short Saphenous vein
Dermal flares/ Reticular varices
Skin tense, red, tender –Superficial
thrombophlebitis
Eczema
Pigmentation
Lipodermatosclerosis –thickened, fibrosed,
pigmented
Ulceration

4. Lipodermatosclerosis

5. Venous ulcer
Sloping edge
Shallow
Extremely painful

6. TESTS FOR VARICOSE VEINS
Brodie Trendelenburg Test
Multiple Tourniquet Test
Perthe’s Test
Modified Perthe’s Test
Fegan’s Test
Schwartz Test
Pratt’s Test
Morrissey’s cough impulse test

7. BRODIE TRENDELENBURG
TEST
To determine incompetency of the sapheno
femoral valve and other communicating systems
Patient asked to lie supine
Veins emptied
Compress the sapheno femoral junction
Ask the patient to stand up quickly
Observe veins without releasing pressure
Observe after releasing pressure

8. Interpretation
On
occluding
the SFJ
On releasing
pressure
Negative -Negative
Gradual filling of
veins from below
over 30s
Slow filling
Negative -Positive
Gradual filling of the
distal veins
Rapid retrograde filling
Positive -Negative
Rapid filling of
superficial
varicosities
Slow filling
Positive -Positive
Rapid filling Rapid retrograde filling

10. MULTIPLE TOURNIQUET
TEST
To localise the incompetent perforator
Variant of Brodie Trendelenburg Test
Patient asked to lie recumbent
Veins are emptied
Tourniquet tied at different levels separating the
perforators
Position of incompetent perforators indicated by
rapidly filling veins
** Oschner and Mahorner’s Test

12. PERTHE’S TEST
To determine the patency of the deep veins
Patient’s leg wrapped in elastic bandage
Asked to move around and exercise
Severe crampy pain indicates deep vein
thrombosis
* Rule out arterial occlusive disease

13. MODIFIED PERTHE’S TEST
To determine the patency of the deep veins
Tourniquet tied in the upper part of thigh
Patient asked to walk around
Shrinkage of varicose veins indicates normal
deep veins and perforators

14. FEGAN’S TEST
To indicate the site of perforators
Mark the varicosities with a skin marking pencil in
the standing position
Ask the patient to lie down
Veins emptied
Palpate along the line of marked varicosities
Site of perforators felt as gaps or pits in the deep
fascia

15. PRATT’S TEST
To localise the position of the perforators
Esmarch elastic bandage rolled from toes to
groin
Tourniquet tied at groin
Bandage taken off and applied in the
reverse direction
Blow outs seen at the site of perforators

16. SCHWARTZ TEST
Impulse felt at the saphenous opening
indicates incompetence of valves in the
long saphenous vein