PVD Flashcards
(36 cards)
Types of Venous Disorders?
- Varicose Veins
- Superficial Venous Thrombophlebitis
- Chronic Venous Insufficiency
- Deep Vein Thrombosis
Varicose Veins?
– Dilated, tortuous superficial veins in the lower extremities
– MC greater saphenous vein and its tributaries
– Distention of the vein results in weakened/incompetent valves à dilation along the vein
Primary and Secondary Varicose Veins?
Primary:
– MC type superficial system (genetic)
– More common in females than males
– ½ of these patients have a FHx of varicose veins
Secondary:
– Originate from deep venous insufficiency and incompetent perforating veins or from deep venous occlusion that results in enlargement of superficial veins b/c they are acting as collaterals
Signs/symptoms of Varicose Veins?
– Asymptomatic or symptomatic
– Dull ache/heaviness or fatigue of the legs
– Venous stasis dermatitis may be present
– May be visible or only be palpable.
– Brownish pigmentation and thinning of the skin above the ankle may be present
what is the Imaging of chic for Varicose Veins?
– Duplex Ultrasound
Complications Varicose Veins?
– Superficial venous thrombosis (rare)
– Bleeding (secondary to trauma)
Non-Surgical & Surgical tx of Varicose Veins?
Non-surgical:
• Avoid prolonged standing
• Compression stockings (medium to heavy weight) when standing
• Leg elevation when possible
• Varicose Veins
Surgical:
• Endovenous ablation (radiofrequency or laser – collapsing vain)
• Greater saphenous vein stripping (works well)
• Phlebectomy w/ or w/o correction of reflux
• Compression Sclerotherapy
When to refer a pt w/ Varicose Veine to a vascular surgeon?
– Bleeding from varicose vein
– Superficial venous thrombosis
– Pain
– Cosmetic concerns
About Superficial Venous Thrombosis?
– Superficial thrombus
– Indurated, warm, red and tender cord extending along a superficial vein, (common along the saphenous vein)
– MC short term IV’s & PICC lines
– Do not result in pulmonary emboli
Tx for Superficial Venous Thrombosis?
Supportive:
• Elevation, warm compresses and NSAIDS
Anticoagulation:
•To prevent extension of the thrombus into the deep vein system
About Chronic Venous Insufficiency (CVI)?
– A condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. It causes blood to “pool” or collect in these veins (stasis).
What Causes CVI?
- History of leg trauma
- Superficial venous reflux
- Varicose veins
- Pelvic tumors obstructing the pelvic veins
- Vascular malformations
Physiology of VCI?
– Thickened Valves and scarred
– Results in an abnormally high hydrostatic force transmitted to the subcutaneous veins and tissues of the lower leg
• Results in edema
• Fibrosis of the subcutaneous tissue and skin
• Pigmentation of the skin (hemosiderin)
• Ulcerations that are slow to heal
• Varicosities may develop if d/t post-thrombotic event
Risk Factors of CVI?
– DVT – Varicose Veins – Obesity – Pregnancy – Inactivity – Smoking – Extended periods of standing or sitting – Female Sex – Age over 50
Signs/symptoms of CVI?
– Progressive pitting edema o
– Secondary Changes develop over time (progressive):
• Itching
• Dull ache in the leg that worsens w/ prolonged standing and resolves w/ leg elevation
• Skin at ankle is usually taut from swelling, shiny and a brownish pigmentation (hemosiderin)
• Thick and fibrous Subcutaneous
• Ulcerations may occur near the medial and lateral malleolus
• Cellulitis is common (blanching erythema)
• Varicosities may develop
Imaging for CVI?
Duplex U/S
Tx for CVI?
Generalized:
• Compression stockings - mainstay
• Avoid long periods of sitting/standing
• Intermittent elevations of legs/sleeping w/ legs elevated above the level of the heart
Ulcers
• Wet to dry dressings or occlusive hydrocolloid dressings
• Once ulcer has healed, compression stockings w/ graduated compression below the knee are used to prevent recurrent edema and ulceration
Surgery:
• Radiofrequency ablation or endovenous laser tx at the area of ulceration to promote healing
About DVT?
– A blood clot that develops in a deep vain.
– MC’ly in LE
Classic triad for DVT?
Virchow’s Triad
PANCE QUESTION
Virchow’s Triad ?
– Venous Stasis
– Injury to the vessel wall
– Hypercoagulable state
Causes of Venous Stasis?
Immobilization:
– Transient ( s/p Operation/surgery under general anaesthesia or Transcontinental flight)
– Extended: Confined hospitalization after pelvic, hip or spinal surgery; Due to stroke or Paraplegia
Reduced return blood flow to the heart:
– Increased blood viscosity: (Polycythemia vera, Severe dehydration)
– Increased Central Venous pressure (Rt. Heart failure, Pt. on Respirator with PEEP)
Reduced flow thru’ the leg veins:
– Abd. mass compressing Iliac Vein or IVC; Enlarged or Pregnant Uterus
Mechanical Injury to the Vein Wall of Venous Stasis?
• Obvious:
ex. Trauma, Surgery
• Obscure:
ex. Hip Arthroplasty with Femoral Vein manipulation, Old DVT with persistent endothelial vein damage.
Hypercoagulable State of Venous Stasis?
Primary -> genetic mutation:
Antithrombin III deficiency,
Antiphospholipid syndrome,
Protein C deficiency,
Protein S deficiency
Secondary:
Surgery,
Malignancy,
Pregnancy,
Oral Contraceptive Use
Complications of DVT?
– PE
– CVI
– Phlegmasia alba dolens → Common PANCE Questions
– Phlegmasia cerulea dolens → Common PANCE Questions
