Ref: Varicose Veins Exam
- General considerations
- Cough impulse test
- Trendelenberg test
- Perthes' test
- 2 sets of veins, deep and superficial. "Deep veins" means deep to the fascia.
- Flow is superficial veins to deep veins.
- Arise by: calf pumps up, pushing blood out into superficial veins. Superficial veins
then dilate, spreading their own valves apart, so the superficial veins become torturous.
- Walking with a pressure tourniquet on leg
- If competent valves, gets better as walk.
- If incompetent valves between deep and superficial, no effect.
- If DVT, gets more painful as walk [since exit is blocked].
- Can optionally use a Doppler after physical examination.
- Management: graduated compression stockings or surgery.
- Surgery complications: infection from groin crease, hematoma from strip, scarring,
- Possibly hemorrhage or thrombophlebitis.
- Ask about prior varicose operations and results.
- Pt stands, both legs completely visible.
- Looking for "dilated, tortuous veins that you will examine for site of
- Inspect from anterior of thighs to lateral of legs (long saphenous vein).
- Inspect back of calves (short saphenous vein).
- Look for poor skin nutrition:
- Venous ulcers, esp on medial malleolus. See Ulcers examination.
- Venous eczema.
- Hemosiderin deposition [brown].
- Thin skin.
- DDx from femoral hernia, since varicose veins:
- Are blue.
- Disappear when lie flat.
- Show a positive cough impulse.
- Tenderness (thrombophlebitis).
- Hard (thrombosis).
- Dermatosclerosis [thick, indurated skin].
- Atrophie blanche [scarred, white skin].
- Pt stands.
- Dr's fingers held over saphenofemoral opening [5 cm below and medial to femoral pulse].
- Pt. coughs.
- If saphenofemoral incompetent, cough makes a fluid thrill.
- Purpose is to find how far up the leg the imcompetent valves are.
- Pt lies flat, leg is elevated.
- Tie tourniquet around thigh at saphenous opening [5 cm below and medial to femoral
- If Dr doen't have a tourniquet, use 2 fingers instead.
- Pt stands.
- If normal valve at tourniquet site, will see blood slow filling from below
- Take off tourniquet: if a incompetent valve there, will have a sudden
gush filling from above when remove tourniquet.
- Can repeat procedure down the leg, until find the incompetent valve.
- Note: there's a different Trendelenberg test
for proximal myopathy of hip.
- Similar to Trendelenberg test.
- Release a bit of tourniquet, but pt raises up and down on toes after releasing.
- If perforating calf veins have competent valves, calf pump will function, making
varicosities less tense.