Varicose veins, Lymphoedema Flashcards Preview

MS4 - Vascular > Varicose veins, Lymphoedema > Flashcards

Flashcards in Varicose veins, Lymphoedema Deck (48)
Loading flashcards...
1

Pathophysiology of varicose veins

One-way flow from supficial → deep normally maintained by valves

Valve failure → ↑ pressure in sup veins → varicosity

2

3 main sites for varicose veins

1. Saphenofemoral Junction: 3cm below and 3cm lateral to pubic tubercle

2. Saphenopopliteal Junction: popliteal fossa

3. Perforators: draining Great saphenous vein

3

Hunter's varicose vein

medial thigh perforator 

4

Cockett's varicose vein

3 medial calf perforators

5

primary causes of varicose veins

- Congenitally weak or absent valves

- Prolonged standing

- Pregnancy

- Obesity

6

Secondary causes of varicose veins

DVT

Constipation

Overactive pumps (e.g. cyclists)

 Klippel-Trenaunay

7

Klippel Trenaunay syndrome 

Port wine stain

Varicose veins

Limb hypertrophy (bone/soft tissue)

8

Symptoms of varicose veins

Pain

Tingling

Bleeding

Swelling

9

Skin changes of varicose veins

Venous stars

Haemosiderin deposition

Lipodermatosclerosis (panniculitis)

Atrophie blanche

 

10

Venous stars

From raised intravenous pressure

Cannot be obliterated by pressure

11

Panniculitis

inflammation of fat

12

Lipodermatosclerosis

A type panniculitis 

Induration (hardening) of the skin of lower legs in venous insufficiency 

13

Atrophie blanche

White scar on lower leg

sign of vascular inflammation

14

Thrombophlebitis

clot in vein, could be supreficial or deep

15

Varicose eczema aka

gravitational eczema

16

Investigations for varicose veins

1. Duplex ultrasonography

2. Bloods: FBC, U+E, clotting, G+S

3. CXR, ECG

17

When to refer a patient with varicose veins

Bleeding

Pain

Ulceration

Superficial thrombophlebitis

Severe impact on QoL

18

classification of chronic venous disease

CEAP classification

- Clinical signs (1-6 + sympto or asympto)

- Etiology

- Anatomy

- Pathophysiology

19

Conservative management of varicose veins

Lose weight

Relieve constipation

Education (Avoid prolonged standing, Regular walks)

Class II Graduated Compression (Stockings 18-24mmHg, symptomatic relief and slows progression)

Skin Care (Maintain hydration with emollients, Treat ulcers rapidly)

20

indications for minimally invasive therapies for varicose veins

small below knee varicosities not involving great saphenous vein or short saphenous vein

21

Endovascular techniques for varicose veins

- Injection sclerotherapy: 1% Na tetradecyl sulphate

- Endovenous laser or radiofrequency ablation

22

VNUS

Radiofrequency ablation

Catheter inserted and heated to 120 C

Closes the vein

23

EVLA

Endovenous laser ablation

24

Injection sclerotherapy

Sclerosant foam or liquid

Liquid for small veins below knee

25

Post-operative care following endovascular therapy for varicose veins

- Compression bandage for 24hrs

- Compression stockings for 1mo

26

Indications for surgical management of varicose veins

- Saphenofemoral Junction incompetence

- Major perforator incompetence

- Symptomatic: ulceration, skin changes, pain

27

Surgical procedures for varicose veins

Ligation (eg Trendelenberg)

Microphlebectomy

Subfascial endoscopic perforator surgery (SEPS)

28

Trendelenberg surgery

Saphenofemoral ligation

29

Microphlebectomy

Multiple avulsions (cuts) to skin to remove the vein, sutures may not be required 

30

Post-op care following surgery for varicose veins

Bandage tightly

Elevate for 24h

Discharged with compression stockings and to walk daily.

31

Complications of varicose vein surgery

Damage to cutaneous nerve (e.g. long saphenous)

Recurrence: may approach 50%

32

Bilateral causes of leg swellings

↑ Venous Pressure

↓ Oncotic Pressure

Lymphoedema

Myxoedema (Hyper- / hypo-thyroidism)

 

33

Causes of reduced oncotic pressure

Nephrotic syndrome

Hepatic failure

34

Drug causing raised venous pressure

nifedipine

35

unilateral causes of leg swellings

Raised venous pressure (Venous insufficiency, DVT)

 Infection or inflammation

Lymphoedema

36

What is lymphoedema?

Collection of interstitial fluid due to blockage or absence of lymphatics

37

Primary causes of lymphoedema

Congenital absence

Praecox

Tarda

 

38

Lymphoedema praecox

After birth but <35yrs

F>M

80% of primary lymphoedema 

 

39

Lymphoedema tarda

 >35yrs

10 % of cases

40

Milroy's syndrome genetics

Autosomal dominant 

F>M

 

41

Milroy's syndrome sx

Bilateral swelling/lymphoedema of lower extremities 

+/- hydrocele

42

Secondary causes of lymphoedema

FIIT

- Fibrosis: e.g. post-radiotherapy

- Infiltration

- Infection: TB, Filariasis

- Trauma: block dissection of lymphatics

43

Infiltration causes of lymphoedema

Cancer of prostate, lymphoma

 

44

Filariasis 

Parasitic disease caused by round worms

Main worm: Wuchereria bancrofti

45

Investigations for lymphoedema

Doppler US

Lymphoscintigraphy

CT / MRI

46

Lymphoscintigraphy

Radioactive radiotracer injected into skin

Travels up the lymphatics

Device on the outside identifies the sentinele node

47

Conservative management of lymphoedema

 Skin care

Compression stocking

Physio

Treat or prevent comorbid infections

48

Surgical mx of lymphoedema 

 Debulking operation:

- liposuction to reduce the volume of the limb (fat hypertrophy secondary to lymphoedema) 

- radical debulking (removing all the skin and fat and do skin graft)