Peripheral venous disease

Question 1

What is the Lower limb venous system comprised of?

Answer 1

1. Deep venous system

2. Superficial venous system

Question 2

What is the deep venous system comprised of?

Answer 2

1. Popliteal vein
2. Femoral vein
3. Anterior and posterior tibial veins

Question 3

What is the superficial venous system comprised of?

Answer 3

1. Greater saphenous vein

2. Lesser saphenous vein

Question 4

What is the course of the greater saphenous vein?

Answer 4

1. Starts at the venous dorsal arch of the foot
2. Travels anteriorly to the medial malleolus
3. Travels posteriorly to pass the medial aspect of the knee
4. Travels anteriorly and laterally the thigh
5. Joins the femoral vein at the saphenousfemoral junction

Question 5

What is the course of the smaller saphenous vein?

Answer 5

1. starts at the lateral aspect of the dorsal venous arch of the foot
2. travels posterior to the lateral mallelous
3. Middle of the calf
4. All the way to the popliteal vein

Question 6

What are the veins that connect the Superficial and deep veins?

Answer 6

-the communicating veins that have one way valves that only allow movement from superficial to deep veins

Question 7

Where are some of the communicating veins located?

Answer 7

1. Saphenofemoral junction
2. Mid high- hunterian perforator
3. Distal thigh- Dodd’s perforator
4. Knee- Boyd’s perforator
5. Calf perforator- 5, 10, 15 cm from the medial malleolus

Question 8

What is the mechanism through which blood moves in the veins?

Answer 8

-the contraction of the calf muscles pushes and compresses large venous sinuses and squeezes the blood into the popliteal vein and back to the heart

Question 9

What happens when the calf muscles relax?

Answer 9

-the intramuscular veins open and suck the blood from the superficial veins into the deep veins

Question 10

What is chronic venous insufficiency?

Answer 10

-increased blood pressure that cause skin changes and vein changes

Question 11

What are varicose veins?

Answer 11

-when superficial veins become dilated and tortuous with the diameterof more than 3mm

Question 12

At what age does chronic venous insufficiency usually occur?

Answer 12

-around 50 years old

Question 13

What are the risk factors for chronic venous insufficiency?

Answer 13

• female and increasing age
• family history
• obesity
• smoking
• pregnancy
• sedentary lifestyle
• prior thrombosis
• increased abdominal pressure-constipation/coughing

Question 14

What is the pathophysiology of varicose veins?

Answer 14

-increased venous pressure that leads to dysfunctional valves that allow pooling to occur into the superficial veins as a result of increased pressure. This elevated pressure the leads to varicose veins

Question 15

What is the pathophysiology of chronic venous insufficency?

Answer 15

• varicose veins leads to the leakage of proteins and leucocytes
• this releases free radicals that damages the capillary basement membrane
• the plasma protein leaks out and causes oedema
• which leads to tissue hypoxia and hypoperfusion and ulcer formation

Question 16

How do we diagnose varicose veins?

Answer 16

-on history and clinical information

Question 17

How do we diagnose chronic venous insufficiency?

Answer 17

• with duplex ultrasonography
• tests for venous reflux
• examines the patency of the deep vein
• examines the sufficiency of the superficial and perforating veins

Question 18

What are the conservative Rx for CVI?

Answer 18

• compression socks(change them once a week if there are no ulcers, change them twice a week if here are ulcers)
• elevation of legs

Question 19

What are the definitive treatment for CVI?

Answer 19

-VENOUS ABLATION THERAPIES

Question 20

What is a complication of CVI?

Answer 20

-venous ulcers

Question 21

Where do venous ulcers usually present?

Answer 21

-just above the ankle(gaiter region)

Question 22

How do the ulcers present?

Answer 22

• shallow with irregular borders
• mild pain
• above ankle

Question 23

What are the differential diagnoses for venous ulcers?

Answer 23

• arterial ulcers

- malum performans ( associated with diabetic foot)

Question 24

What are the clinical features of varicose veins/chronic venous insufficiency?

Answer 24

• generlized or localised pain, lower extremity swelling and discomfort. Made worse by standing made better by walking and elevating legs
• pruritis, tingling and numbess

Question 25

What are the skin changes we should expect?

Answer 25

• telangiectasia
• dema that starts in the ankle and moves to the calf
• red brown or yellow brown pigmentation changes on the medial side of the ankle
• paraplantar varicose veins
• atrophie blanche-white plaques that are either coin sized or palm sized

Question 26

What is a definitive treatment for venous ulcers?

Answer 26

• make sure you take biopsy to rule out malignancy

- split skin graft

Question 27

What are the 3 tests that we can do for varicose veins?

Answer 27

1. tourniquet test
2. trendelenberg test
3. perthes test(tests the deep veins)

Question 28

Where is the saphenofemoral junction located?

Answer 28

2,5 cm below and lateral to the pubic tubercle

Question 29

Why do we need to check and palpate for peripheral pulses before we start compression socks?

Answer 29

-to check for ischaemia because the compression socks will occlude the arteries further

Question 30

What is the marjlolins ulcer?

Answer 30

-squamous cell carcinoma that develops when the ulcer enlarges, gets painful, the edge becomes thickened and raised and