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Vascular > Module 5 : Chronic Venous Pathology > Flashcards

Module 5 : Chronic Venous Pathology Flashcards

1
Q

chronic venous disease - underlying causes

A
  • dysfunctional valves

- chronic outflow obstruction

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2
Q

dysfunctional valves

A 
- primary = congenital
   \+ absence of valves
   \+ structure of valves mess d up
- secondary
    \+ previous DVT
    \+ post thrombotic syndrome
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3
Q

chronic outflow obstruction

A
  • iliofemoral veins post DVT
  • recanalized vein or collaterals
    + decreased venous return
    + increase venous pressures
  • limb swelling and pain
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4
Q

symptoms of chronic venous insufficiency

A
  • swelling and edema
  • heaviness/ache
  • discolouration/hyperpigmentation/brawny discolouration - gaiter sone
  • varicosities
  • venous claudication = intense burning
  • stasis dermatitis/dry flaky skin
  • telangiectasia
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5
Q

skin changes specific to chronic insufficiency

A
  • edema
  • brawny discoloration
  • ulceration
  • redness/rubor
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6
Q

edema

A
  • fluid accumulation in tissue due to increase venous pressure
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7
Q

brawny discoloration

A
  • browns color in gaiter zone

- result of leakage of RBC into surrounding tissue

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8
Q

ulceration

A
  • tissue breakdown
  • usually near medial malleolus
  • typically occurs with deep vein GSV SSV incompetence
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9
Q

redness/rubor

A
  • inflammation

- cellulitis

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10
Q

reflux

A
  • retrograde flow in the veins
  • caused by absent or incompetent valves
  • results in venous hypertension due to
    + failed valves
    + calf muscle pump is ineffective
    + failure of perforating vein
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11
Q

venous hypertension - failed valves

A
  • allows full gravitational/hydrostatic pressure exerted on the vein walls
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12
Q

venous hypertension - calf muscle pump is ineffective

A
  • decreases ejection of blood that results in increased residual venous volume
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13
Q

venous hypertension - failure of perforating veins

A
  • allows flow to reverse from deep to superficial veins
  • high pressure in deep system is transferred to the weaker superficial system
  • causes symptoms of heaviness and aching
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14
Q

varicose veins

A
  • palpable
  • distended greater than 4mm in diameter
  • primary and secondary
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15
Q

varicose veins - primary

A
  • dilated tortuous
  • restricted to the superficial system
    + increased intraluminal pressure due to pregnancy obesity and prolonged standing
  • treatment : surgical ligation (vein stripping)
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16
Q

varicose veins - secondary

A
  • due to obstructive conditions such as a previous DVT
  • treatment
    + do not benefit from vein stripping
    + support stockings
    + surgical ligation of perforators
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17
Q

intraluminal pressure and perforators

A
  • INCREASED DEEP VEIN INTRALUMINAL PRESSURE MAY CAUSE PERFORATORS TO DILATE AND BECOME INCOMPETENT
18
Q

lower extremity venous insufficiency duplex exam - position

A
  • patient standing or with the bed in an extreme reverse trendelenberg
  • supine position ineffective for reflux assessment
  • standing
    + uses stool or platform with handrail
    + holds handrail
    + rotate leg outward
    + transfers weight to opposite leg
  • calf veins examined
    + sitting or legs over bed
19
Q

lower extremity venous insufficiency duplex exam - provocative maneuvers - valsalva

A
  • assess PROXIMAL VENOUS VALVES FOR COMPETENCY
  • inhale deeply hold their breath and contract the abdomen
  • ask patient to release breath and relax abdomen after 1-2 seconds
20
Q

lower extremity venous insufficiency duplex exam - provocative maneuvers - augmentation

A
  • used to determine reflux below the knee
21
Q

protocol

A
  • rule out DVT in deep system
    + compression
  • assess deep venous system for phasicity and reflux
    + color and spectral waveform
    + use valsalva and distal leg augmentation
22
Q

protocol - assessing the superficial system - gsv

A
  • gsv
    + measure diameter
    - transverse plane prod mid distal
    + color and spectral
    - valsalva and augmentation for reflux
    - SFJ (superficial femoral junction)
    - look for accessory veins, duplication, varicosity
23
Q

protocol - assessing superficial system - ssv

A
  • measure diameter
    + transverse plane
    + start at ankle and work superior to SPJ
    + if less than 2mm mot likely competent
  • color and spectral
    + saphenopopliteal junction SPJ
24
Q

protocol - assessing superficial system - assess perforators

A
  • normally difficult to see
  • seated
  • medial calf to cocketts
  • transverse plane tibiomedial condyle
  • check for flow
    + should be towards the deep veins and < 3mm
  • best assessed with color
25
Q

normal valve closure time

A
  • within 0.5 seconds
26
Q

abnormal perforators looks

A
  • have bidirectional flow and lumen of > 4mm
    + endoscopic perforator surgery has become popular in recent years and location and size of these connecting veins essential
  • limitation of exam ar obesity, pitting edema, bony structures, cat and bandages
27
Q

abnormal reflux time

A
  • deep : >/= 1 sec
  • superficial : >/= o.5 sec
  • perforator : >/= o.35 sec
28
Q

size of GSV at SFJ

A
  • > 9mm
29
Q

size of GSV at mid thigh

A
  • > 7mm
30
Q

size of GSV at mid calf

A
  • > 5mm
31
Q

continuous wave doppler assessment

A
  • effective to determine the presence and origin of reflux
  • GSV and SSV as well as calf perforators
  • acute disease and chronic
  • no image
  • based on evaluation of auditory signals n the resting position and comparison to signal received
  • need good knowledge of anatomy
32
Q

treatment - medical - injection sclerotherapy

A
  • for small varicose vein
  • injecting sodium tetradecyl sulphate into the varied
  • which causes fibrosis and eventual obliteration of lumen
33
Q

treatment - medical - controlling risk factors

A
  • limit long periods of inactivity
  • promote venous drainage
    + support stockings
    + elevate legs
    + unna boots (medicated compression dressings)
34
Q

treatment - surgical - ligation

A
  • incompetent superficial veins

- rarely valvular reconstruction or valve transplant

35
Q

treatment - surgical - vein stripping

A
  • varicose vein therapy involves stepping entire saphenous vein or local excision of varicosities
36
Q

treatment - surgical - Venous ablation

A
  • inject chemical into GSV to occlude it
37
Q

treatment - surgical - traditional phlebotomy

A
  • multiple incision then hook and pull out
  • vein tied off
  • wire threaded up through leg
38
Q

endovascular treatment

A
  • radio frequency ablation
  • transilluminated power phlebotomy
    + minimally invasive
    + illuminating device into vein
    + vein sucked out
  • laserthermal ablation
39
Q

preoperative venous mapping

A
  • duplex ultrasound used to determine availability of superficial veins for use as bypass conduits
  • most common use if for CABG (coronary artery bypass graft) and lower extremity grafts
  • autologous (native) veins remain the conduit of choice due to long term latency and greater durability
40
Q

preoperative venous mapping method

A
  • first choice GSV (excellent length )
  • preoperative marking of vein along with written report as to size length and branching is essential
    + marking allows surgeon to cut directly to vein
  • evaluate GSV
    + standing and reverse trendelenbeg
  • keep warm to keep veins dilated
  • prove latency
  • asses for anatomic variation and structural abnormalities
  • obtain diameter along vein
    + 2.5mm in trans
  • vein marked on skin to identify location

Vascular (7 decks)

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