Chronic Venous Pathophysiology Flashcards by Kate Grimeau

chronic post-thrombotic changes occur ___ to ____ after the initial event

months
years

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the remaining material in a chronic clot is mainly _____

collagen

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a chronic clot has _____ echogenicity and can be _____ to surrounding tissue

moderate to high
isoechoic

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a DVT _____ as it ages, making the vein difficult to assess

retracts

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when recanalization occurs, it can mimic a ______, which is called ______

partial thrombus
post-thrombotic scarring

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Recanalization

the process of reopening a blocked or narrowed blood vessel, or restoring flow to a bodily tube

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fibrous strands are not at a risk of ______

embolism

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fibrous material creates a site that is predisposed to recurrent ______ DVT

acute

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CVI

chronic venous insufficiency

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CVI AKA

chronic venous disease

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CVI can occur when a DVT results in _______ and can involve ______(4)

incompetent valves

superficial/deep veins, perforators, combo

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in the chronic stage, thrombus can _______ over time

recanalize

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permanent damage from chronic thrombus can leave the valve leaflets ____ and _____

immobile
fixed to the vein wall

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there can also be permanent ______ where the vein retracts

occlusion

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both recanalization and occlusion can lead to ______ and increased _____

chronic outflow obstruction
hydrostatic pressure

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with dysfunctional valves there will be _____

reflux

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if there is reflux due to dysfunctional valves, when standing there is a prolonged period of _______ blood in the leg

de-oxygenated

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initial symptoms of CVI (4)

mild ankle swelling (edema) that resolves with limb elevation
heaviness/ache in lower limbs
telangiectasia
reticular veins dilated

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telangiectasia

spider veins

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4 symptoms of CVI as pressure increases and what they define

swelling/pitting edema
brawny discolouration/hyperpigmentation in gaiter zone
redness
varicose veins

define post-thrombotic syndrome

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another name for redness

rubor

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severe signs/symptoms of CVI

venous claudication
stasis dermatitis
ulcers

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venous claudication

intense burning/cramping in calf with exercise

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stasis dermatitis

inflammation of the skin (dry, flaky, red skin)

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ulcers for CVI are normally seen around

medial malleolus

spider veins (size, colour, may have)

measure 1-1.5mm pink/red/purple may have pain/discomfort

reticular veins (size, colour, often has)

2mm in diameter green-blue to purple often has burning/itching

varicose veins (size, colour, often has)

larger than 2.5mm in diameter dark blue/purple veins often protrude above the surface of the skin and can lead to pain, burning and spasm

dysfunctional valves 2 types

primary secondary

primary dysfunctional valves

congenital (absence, structural defects)

secondary dysfunctional valves

damaged from DVT post-thrombotic syndrome

is reflux a primary or secondary effect

both

_____ (time) = normal amount of reflux

less than or equal to 0.5s

varicose veins are _____ veins

dialted

varicose veins are typically greater than ____ in diameter (but are considered varicose when above 2.5mm)

4mm

varicose veins examples (3)

GSV SSV subdermal veins

where are subdermal veins located

superficial to fascia

primary varicose veins involves the _____ system with no underlying _______ disease

superficial deep venous

treatment for primary varicose veins

surgical ligation ablation

surgical ligation

tie off vein

ablation

laser/radio F to heat + burn vein from inside

secondary varicose veins are due to (2)

obstructive conditions (previous DVT) incompetent deep system

treatment for secondary varicose veins (2)

compression stockings surgical ligation of perforators

does vein stripping resolve secondary varicose veins

the role of US assessing CVI (4)

1. rule out DVT 2. assess deep system (phasicity/reflux) 3. assess superficial for reflux (GSV/SSV) 4. assess perforators

assessing the deep system patient position

standing on platform with a handrail, leg externally rotated, weight transferred of of leg scanned

if patient can't stand on one leg to assess the deep system how do you position them

lying with extreme reverse trendelenberg sitting with legs dangling over the side of the bed for calf veins

assessing deep system 3 steps and what veins for each step

vein compression/phascicity (CFV, prox FV, Pop V) Valsalva maneuver (reflux in CFV/Prox FV) augmentation (Pop V)

for deep system Valsalva maneuver in CFV/prox FV, ____ of reflux is abnormal

>1s

when measuring GSV diameter, ____ at SFJ, ____ at mid-thigh, and ____ a calf is highly predictive of incompetence

>9mm >7mm >5mm

for superficial veins, use Doppler with Valsalva ____ and augmentation ___ to look for reflux

proximally distally

for sup veins, reflux times _____ = abnormal

>0.5s

assess the GSC from ____ to ____, between teh ____ and ____ planes, and look for ______ veins

SFJ ankle superficial deep accessory

SFJ

saphenofemoral junction

assess the SSV from ____ to ____ and you may continue to the _____ vein

mid calf pop v Giacomini

the SSV is found between the 2 bellies of the _________ muscle

gastrocnemius

SSV usually measures _____ AP

<2mm

assess SSV with _____ and _____. _____ to look for reflux (_____ = abnormal)

colour spectral augment >0.5s

what is the most commonly visualized perforator and where

Cockett's (medial calf)

scan cockett's in the ____ plane from the ____ to the _____

trans tibial condyle medial malleolus

when assessing the perforators you scan the ______ of the calf

circumference

abnormal perforators will show _____ with augmentation

bi-directional flow

if perforators are abnormal with colour, perform ____ and measure _____

spectral reflux time

perforators are best assessed with ____ Doppler

colour

abnormal reflux times: deep: sup: perf:

>1s >0.5s >0.35s

endovenous thermal ablation (what/2 benefits)

laser/high F RF creates intense heat that collapses veins/seals it shut less pain/faster healing time than surgical

sclerotherapy (what/3 benefits)

solution injected into spider veins or small varicose veins to cause them to collapse or disappear can reduce pain/discomfort improves appearance cost effective

US role in endovenous thermal ablation (3 before, 2 after)

rule out DVT/map veins for treatment diameters assessed to ensure suitability access points determined during to oversee access site/introduction of catheter follow up to see if successful

2 surgical treatments

ligation/stripping vein bypass

ligation/stripping

ligation = cutting/tying off stripping = removes vein through 2 small incisions

vein bypass

healthy vein used to reroute blood around the problem vein

CABG

coronary artery bypass graft

venous mapping

duplexUS is used to asses sup veins for use as a bypass conduits (arterial conduit)

venous mapping 2 types

CABG lower extremitiy grafts

what is the first choice for venous mapping

GSV

diameter of GSV

>2.5cm

US is used to prove ____ for venous mapping

patency of the vessel

CW can also be used to determine the ____ and _____ of reflux

presence origion

CW has no image so it can make it difficult to know of lack of flow is due to ____ or ____

DVT extrinsic compression

CW evaluates the ____ and ____. First in the _____ and compared to signal after _____

waveform auditory signals resting position provocative maneuver

Chronic Venous Pathophysiology Flashcards

(80 cards)