Editing Varicose veins (section)

== Examination: ==

* Examine in the standing position
* Note location of all varicosities
** In obese patients, may be palpable but not visible
* Ankle flare
* Corona phlebactica
* Lipodermatosclerosis
** Venous hypertension -> increased leucocytes -> proinflammatory state -> increased collagen production and deposition
** Leakage of fibrinogen and formation of fibrin cuffs around vessels also contributes to perfusion deficits
* Often see telangiectasias (dilated intradermal venules about 1mm in size) and reticular veins (non-palpable subdermal veins 1-3mm)
* Trendelenburg test ('tourniquet test' if using a tourniquet instead of manual compression): 
** Used to locate the site of incompetent valves
** Patient supine, with leg lifted by examiner to empty the varicosities
** Manual compression used to occlude proximal great saphenous vein, then the patient stands upright. 
*** If the veins don't fill, the SFJ was the problem
*** If the veins still fill, there are other incompetent valves.
** Repeat the test at different levels to isolate the incompetent valves
* Perthes test
** Used to differentiate between insufficiency from deep, superficial and perforator systems
** Tourniquet on mid-thigh while the patient ambulates, leading to markedly distended varicosities.
** Varicosities are less distended: no deep venous insufficiency
** Remain distended, or more distended: likely deep venous system problem