Lower Limb Veins

Question 1

Symptoms of DVT

Answer 1

Hot, red and swollen calf

Question 2

Is it advisable to stent the iliac for DVT?

Answer 2

Yes

Question 3

What is May thurner syndrome

Answer 3

Right common Iliad compresses the left common Iliac causing DVT

Question 4

Factors that contribute to the risk of developing venous thrombo-embolic (VTE) disease?

Answer 4

Bed rest
Pregnancy
Central venous catheters
Long distance driving

Question 5

Will superficial thrombophlebitis always progress to DVT?

Answer 5

No

Question 6

Symptoms and features of varicose veins?

Answer 6

Venous excess
Leg aching when standing
Tortuous veins
Aching heavy legs

Question 7

What proportion of DVTs are iliofemoral?

Answer 7

1/3

Question 8

Superficial veins in leg

Answer 8

Great saphenous
Short saphenous
Superficial to femoral junction (SFJ)

Question 9

Deep veins in the leg (in order)

Answer 9

IVC

Common Iliac

Internal iliac / external iliac (branch off)

Femoral vein

Popliteal (knee level)

Anterior tib veins

Posterior tib veins

Peroneal (ankle/foot)

Question 10

Thrombus definition?

Answer 10

Blood clot in vessel

Question 11

Embolus definition?

Answer 11

Detached mass that can travel in the vessel (solid, liquid or gas)

Question 12

Embolism?

Answer 12

Lodging of an embolus

Question 13

Thrombo-embolism

Answer 13

Blockage by a thrombus that has travelled

Question 14

What does VTE Stand for

Answer 14

Venous thrombus-embolic disease

Question 15

Examples of VTE

Answer 15

DVT
PE

Question 16

Virchows Triad

Answer 16

Used to assess clotting risk includes:

Blood stasis

Change in vessel wall injury/damage

Thrombogenic changes in blood - hypercoaguability e.g pregnancy

Question 17

Signs and symptoms of DVT

Answer 17

Pain
Tender
Red
Swollen
Heavy ache
Hot

Question 18

Risk factors for VTE

Answer 18

Surgery
Immobility
Age
Malignancy
Pregnancy
Varicose veins
Thrombophelias

Question 19

Major risk factors for VTE

Answer 19

Major trauma
Congestive HF
Prev history
Central venous catheters
Hormone therapy

Question 20

Why are DVTs clinically important

Answer 20

1/3rd iliofemoral

50% develop PTS by 2 years

Long term chronic venous disease, ulceration and persistent impact to QoL

Affects working pop.

Long term effects on pt

Question 21

Management for DVT?

Answer 21

Previous management which is still an option in some cases (mainly distal disease)

Elevation
Stockings
Anti coagulation

Question 22

Invasive intervention for DVT?

Answer 22

If proximal (iliofemoral) invasive treatment needed.

Mechanical thrombectomy
Catheter directed lysis
Angiojet/mechanical assisted lysis EKOS (endovenous ultrasound assisted)

Question 23

Aim of iliofemoral invasive intervention

Answer 23

Remove clot and restore anatomical venous outflow for the limb

Reduce thrombus burden
Reduce PTS severity
Improve symptoms

Question 24

Use of imaging following vascular intervention for DVT

Answer 24

Duplex US 1 day, 14 days

Question 25

What to look for when scanning DVT?

Answer 25

Extension of DVT into iliac vein (PE risk)

Question 26

What is PTS

Answer 26

Post thrombotic syndrome

Question 27

Cause of PTS

Answer 27

Following DVT May Thurner syndrome

Question 28

PTS symptoms

Answer 28

Chronic pain Tight woody leg Inflammation Venous congestion Oedema Ulcers

Question 29

Treatment for PTS

Answer 29

Compression Wound care Elevation

Question 30

Varicose veins presentation

Answer 30

Enlarged turtuous veins Aching leg - heavy leg Failure of valves Venous incompetency

Question 31

What causes failure of venous valves

Answer 31

Viscous cycle of inflammation genetics and risk factors

Question 32

Risk factors for varicose veins

Answer 32

Gender, genetics. Age, weight, occupation (time standing), pregnant

Question 33

What is hydrostatic pressure

Answer 33

Higher pressure at bottom of body due to gravity from blood in veins

Question 34

Treatment options for varicose veins

Answer 34

Endogenous ablation (Destroy vein so collaterals are used) Foam sclerotherapy (Inject foam into affected veins that destroys the non-stick lining of the vein) Surgery / stab avulsions (Removal of veins)

Question 35

Venous ulceration symptoms

Answer 35

Tissue hardening Hyperpigmentation Non painful Wet / weeping Often on ankle

Question 36

Chronic venous incompetence symptoms

Answer 36

Pigmentation Ulceration Woody leg Varicose eczema - leaking - inflamed “Inverted champagne bottle” Swelling

Question 37

Talengiectasia what is and causes

Answer 37

Small visible red blood vessels (broken capillaries) Sun damage Post radiation Venous hypertension Chronic flushing

Question 38

What is superficial thrombophlebitis

Answer 38

Inflammation of vein from clotting Very painful in inflamed area Feels hard and lumpy under skin Does not usually progress to DVT

Question 39

Kippel-Trenauny-Weber Syndrome

Answer 39

Vascular malformation Rare congenital condition Varicose veins

Question 40

Presentation of kippel-Trenauny-Weber syndrome

Answer 40

Port wine stains Varicose veins Underdeveloped lymph system

Question 41

Which leg is more common for DVT

Answer 41

Left due to May-Thurner syndrome

Question 42

Areas for proximal DVT

Answer 42

Iliofemoral Femero-popliteal

Question 43

Area for distal DVT

Answer 43

Calf vein

Question 44

Treatment for distal DVT

Answer 44

Stocking Anticoag (DOAC) Elevation