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Cardiovascular system SA > Venous and lymphatic disease - presentation, investigation and therapy > Flashcards

Venous and lymphatic disease - presentation, investigation and therapy Flashcards

1
Q

Define varicose viens

A

Dilated superficial veins in the lower limbs

affects largely middle aged woman

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2
Q

What is the cause of varicose veins

A

Failure of venous valves as they become leaky and lead to back flow of blood

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3
Q

What sites are affected by varicose veins

A

Long saphenous - 80-87%,

Short saphenous - 21-30%

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4
Q

What is the potential history of a varicose veins pattern

A 
Standing occupation 
Pregnancy - twins 
previous DVT
Previous major trauma 
Family history - can be hereditary 
Complications
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5
Q

What is the signs and symptoms of varicose veins

A

Cosmesis - disfiguring

Localised or generalised discomfort in the leg

Nocturnal cramps

Swelling

Acute haemorrhage

Superficial thrombophlebitis (inflammation of the wall of a vein associated with thrombosis)

Pruritus - itching

Skin changes

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6
Q

Why does acute haemorrhage occur in varicose veins

A

Skin becomes fragile over dilated veins so is therefore more prone to bleeding

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7
Q

What skin changes can be seen with varicose veins

A

discolouration

spider veins

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8
Q

How is varicose veins assessed

A

With duplex ultrasound:

Non-invasive evaluation of blood flow through arteries and veins

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9
Q

When is intervention for varicose veins required

A

When symptoms are present
superficial thrombophlebitis
signs of chronic venous insufficiency
bleeding

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10
Q

What is the treatment options for varicose veins

A

Surgery

Minimally invasive procedures involving thermal ablation:
Endovenous Laser removal
Radio frequency ablation
Injection - sclerotherapy

Compression

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11
Q

What occurs in superficial venous surgery

A

Happens under general anaesthetic

Tiring of the saphenous vein’s junction and then several tiny cuts are made in the skin through which the varicosed vein is removed

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12
Q

What occurs in the injection of foam sclerotherapy for the treatment of varicose veins

A

Needle inserted into the incompetent veins under ultrasound control

Foam injected

Foam creates a chemical reaction with endothelium

Thermal ablation occurs destroying incompetent vein tissue with heat

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13
Q

What is the purpose of the ultrasound control when injecting foam

A

prevented from entering deep venous system

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14
Q

What is the steps in the endogenous later removal technique

A

Uses ultrasound

Micro puncture needle inserted into the incompetent long or short saphenous veins
Guidewire introduced, and manoeuvred to saphenous junction with deep vein

Catheter and laser fibre introduced over
guide wire to 1cm below junction

and thermal ablation occurs

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15
Q

What occurs in radio frequency ablation (VNUS)

A 
Catheter inserted 
(thermal ablation) 
Vein warmed to 85ºC
and collapses 
catheter slowing withdrawn and loses vein
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16
Q

What is the purpose of compression therapy

A

wear stockings to create a pressure that may drain the vein

17
Q

What contradictions do you need to consider when performing superficial venous surgery

A

Previous DVT (collaterals)
Arterial insufficiency
Patient co morbidity
Morbid obesity

18
Q

What is the possible complications of superficial venous surgery

A 
Minor haemorrhage 
thrombophlebitis 
heamatoma 
wound problems 
severe pain 
sural/saphenous nerves are affected

Rare:
Damage to deep veins, arteries and nerves
DVT

19
Q

What is the advantages of minimally invasive option over surgery for the treatment of varicose veins

A

reduce surgical trauma (bruising, scarring: no incisions)
less pain

reduce time off work

do not require an operating theatre

potential to increase patient throughput

potentially cost effective

20
Q

Define chronic venous insufficiency

A

a condition where veins cannot pump enough blood back to the heart

21
Q

What is the characteristics signs of chronic venous insufficiency

A

Ankle oedema

Telangectasia - spider veins

Venous eczema

Haemosiderin pigmentation - orangey colour in the lower limbs

Hypopigmentation “atrophie blanche” - white patches

Lipodermatosclerosis - inflammation of subcutaneous fat in the legs

Venous ulceration

22
Q

What causes the Haemosiderin pigmentation (orange limbs) in CVI

A

ruptured blood vessels

23
Q

What causes hypo pigmentation (white patches) in CVI

A

loss of nutrients

24
Q

What is the pathophysiology of CVI

A

Venous hypertension

Venous engorgement and stasis

Imbalance of Starling forces and fluid exudate

25
Q

What is ambulatory venous pressure

and what does a high AVP indicate

A

The fall in pressure from standing motionless to active movements

High =
failure of muscle pump
valves or outflow obstruction
Venous hypertension

26
Q

What is the potential aetiology of the failure of call muscle pump resulting in CVI

A

Superficial venous reflux

Deep venous reflux

Venous obstruction

Neuromuscular

Obesity

Inactivity

27
Q

What is the definition of leg ulceration

A

Breach in the skin between the knee and the ankle

28
Q

What is the cause of leg ulcerations

A 
Chronic venous insufficiency 
arterial disease
diabetes, 
rheumatoid arthritis, vasculitis, 
Connective tissue disease
29
Q

What can also be found on examination of leg ulceration

A

oedema

signs of chronic venous insufficiency

30
Q

What investigations is needed for leg ulcerations

A

ABPI (Ankle Brachial Pressure Index) - ratio between the systolic arterial pressure at the ankle and the brachial systolic pressure

Duplex ultrasound

31
Q

What is the treatment for leg ulceration

A

Compression therapy - excludes arterial disease

Dressing

Systemic and topical therapy

Exercise - calf muscle pump

32
Q

What is the primary cause of lymphedema, and when can it occur

A

Idiopathic:
Congenital - born with
Praecox - before 30
Tarda - after 30

33
Q

What is the secondary causes of lymphedema

A

Malignancy

Surgery
(Radical mastectomy; groin/axillary dissection)

Radiotherapy

Infection (Filariasis/tuberculosis/pyogenic)

34
Q

What is the treatment of lymphedema

A

Manual drainage - elevation to try and drain the fluid out

compression - to try and rain the fluid out

35
Q

Define lymphedema

A

condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system

36
Q

What is the signs and symptoms of lymphedema

A

Swelling of part or all of your arm or leg, including fingers or toes.

A feeling of heaviness or tightness.

Restricted range of motion.

Aching or discomfort.

Recurring infections.

Hardening and thickening of the skin (fibrosis)

Cardiovascular system SA (43 decks)

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