CME - Management of Varicose Veins and Venous Insufficiency

Varicose veins in both legs - marking on left side

Varicose veins are common as the age advances. Chronic venous disease presents with a spectrum of signs and symptoms, including cosmetic spider veins, asymptomatic varicosities, large painful varicose veins, edema, hyperpigmentation and lipodermatosclerosis of skin, and ulceration. But there is no definitive stepwise progression from spider veins to ulcers and, in fact, severe skin complications of varicose veins are not seen in some with extensive varicose veins.

1. Precipitating factor for varicose veins include 

A. nulligravida pregnancy status. 

B. normotension.  

C. prolonged standing. 

D. autosomal-recessive genotype with complete penetrance.

2. Symptoms of chronic venous insufficiency 

A. include swelling, restlessness, limb heaviness and fatigue, aching/throbbing sensation, burning, tingling, direct tenderness, itch, and nocturnal leg cramps. 

B. are usually worse at the beginning of the day. 

C. decrease during the menstrual cycle and in cold weather. 

D. are not relieved by elevation.

3. In varicose veins patients, what can compression stockings do?

A. control pain and edema.  

B. help patients lose weight. 

C. are most practical for patients who are elderly, are obese, or have skin damage. 

D. slow the progression of venous insufficiency.

4.  When there are cosmetic spider angiomas (≤3 mm) any of one these therapies - sclerotherapy, thermocoagulation, or cutaneous laser therapy will 

A. seldom necessitates more than 1 treatment. 

B. leads to complete resolution of varicosities in most patients.  

C. induces endothelial damage leading to venous thrombosis and fibrosis.  

D. All of the above

5. When high volumes of dilute local anesthetic is injected into a treatment area of VVs, it  is called 

A. truncal reflux.  

B. transilluminated powered phlebectomy.  

C. tumescent anesthesia. 

D. micronized purified flavonoid fraction. 

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 Answers

C,A,A,C,C