Flashcards in Chap 55-56 CVI General Considerations Deck (40):
what conditions contribute to venous pathology?
valvular incompetence of the deep or superficial veins
muscle pump dysfunction
what does normal venous pressure do with exercise?
resting venous pressure drops with exercise >50%
returns to normal but takes >20sec
What are primary and secondary cause of valve dysfunction?
preexisting weakness in vessel or leaflets
secondary to direct injury superficial phlebitis
excessive venous distention from hormonal effects or high pressure
How does high venous pressure enter the superficial system?
failure of valves located at junctions b/w deep and superficial
failure of valves in communicating perforator
What are the most common tributaries with reflux?
What are obstructive causes of reflux?
destruction of valves from DVT
What is the genetic inheritance of VV?
autosomal dominant with variable penetrance
How does microangiopathy occur?
hemo changes in large veins are transmitted to microcirculation
What are features of microangiopathy?
elongation, dilatation, tortuosity of capillary beds
thickening of BM with increased collagen and elastic fibbers
increased pericapillary edema with 'halo' formation
what happens to the capillary once microangiopathy has started?
increase permeability and high venous pressure
accumulation of fluid, macromolecules and extravasated red blood cells in the interstitial
fragmentation and destruction of microlymphatics (impairs drainage)
What mechanisms have been postulated for devel of microangiopathy?
fibrin cuff formation (accumulation of fluid in pericapillary sapce)
this impairs fibrinolysis, increase diffusion barrier, inhibit repair process and maintain inflame process
WBC trapping in capillaries with activation of leuks and inflammation
growth factor activation (unavailable for healing)
What are skin changes in CVI?
hyper pigmentation from hemosiderin deposition
lipodermatosclerosis with scarring and thickening of the skin
what is lipodermatosclerosis?
inflammation of the fat under the epidermis
get fat necrosis
causes tapering at ankles
What is atrophie blanche?
smooth, ivory-white plaque stippled with telangiectases and is surrounded by hyper-pigmentation
What is the character of the edema associated with CVI?
then brawny and resistant to pitting
What is corona phlebectatica?
fan shaped appearance of intradermal veins on the ankle (inframalleolar ankle flare)
What is the Brodie-trendelenburg test?
distinguish deep and superficial
elevate leg to empty vein
tourniquet over superficial veins
with superficial reflux, release of tourniquet with have rapid filling of superficial veins
with deep reflow the superficial veins will fill despite tourniquet
normal will take >20sec to fill with removal of trouniquet
What is the C in the CEAP classification?
C0 no visible signs
C1 telangiectasia/reticular veins
C2 varicose veins
C4 changes in skin and sub cut
B lipodermatosclerosis/atrophie blanche
C5 healed ulcer
C6 active ulcer
What is the E in the CEAP classification?
Ec congenital (KTS)
Es secondary (DVT)
En no venous cause
What is the A in the CEAP classification?
An no venous location
What is the P in the CEAP classification?
Pr,o reflux and obstruction
Pn no venous patho
What is the best test a diagnosing CVI?
What is the best test a determining severity for CVI?
What is the best test for determining anatomy for CVI?
What is the best test for assessing hem significance?
What is the venous filling index?
90% of the venous volume divided by the time required to 90% of the venous volume (once upright)
What are invasive/non-invasive methods of measuring CVI?
Ambulatory venous P
What is early treatment recommendation for venous ulcer?
ablation superficial vein
What are exercise recommendations for CVI?
vigorous can worsen
leg elevation when resting
What are the classes for compression therapy?
class 3 30-40mmHg
What did the REACTIV trial show for C2-3 dz?
2 yr symptom relief, satisfaction, QoL
better with surgery (saph ligation)
sclero better then conservative
Surgery most cost efficient followed by sclera
How does compression work?
opposes reflux induced VHTN
improves muscle pump
What are some adjuncts for compression therapy?
layered elastic and non-elastic compression bandage
IPC (good if edema)
What is the evidence in compression?
improves healing times
What is evidence for compression in C6 dz?
ssurgery plus compression ;pwer recurrence then compression alone
What is the role of diuretics in CVI?
What is the role of zinc in CVI?
What is the role of fibrinolytics in CVI?
no proven benefit
What is the role of pentoxifylline in CVI?
evidence of benefit in combo with compression