Vascular Ulcers & Varicose veins

Question 1

MC of Venous ulcers

Answer 1

Incompetent venous valves that prevent efficient venous return from LE

Question 2

What SXS in pts would indicate possible venous ulcer?

Answer 2

Signs of venous insufficiency
- Varicose veins
- Venous stasis dermatitis
- Heaviness & pain in legs that gets better with elevation
- Edema

• Usually painless

Question 3

Venous Stasis Dermatitis

Answer 3

Deposition of hemosiderin –> Hyperpigmentation

Question 4

MC location of venous ulcers

Answer 4

Medial aspect of ankle & calf
- Can be anywhere between ankle & knee tho

Question 5

Best initial assessment of venous insufficiency w/ venous stasis ulcers

Answer 5

Doppler duplex scan/ Duplex ultrasound

Question 6

Tx of venous ulcers

Answer 6

• Elevation
• Compression stockings
• Unna’s boot - compression dressing w/ zinc oxide for healing

Question 7

MCC of Arterial ulcers

Answer 7

Occlusive arterial disease

Question 8

RFs/ Indications for Arterial Ulcers

Answer 8

• Smoking
• HTN
• Hypercholesterolemia -
• Diabetes

Question 9

When is symps of arterial ulcers worse?

Answer 9

Night- Dec perfusion
- Leg pain

Question 10

Best initial assessment of Arterial Ulcers

Answer 10

Ankle Brachial Index (ABI)

Question 11

MC location of Arterial ulcers

Answer 11

Dorsum of toes, feet & ankle
Sites of increased pressure

Question 12

Appearance of Arterial ulcers

Answer 12

“Punched-out”

Question 13

Wound base of Arterial ulcers

Answer 13

Necrotic tissue

Question 14

Appearance of Venous ulcers

Answer 14

Shallow w/ irregular margins

Question 15

Wound base of Venous ulcers

Answer 15

Granulation tissue

Question 16

MC form of venous disease in the LE

Answer 16

Varicose veins

Question 17

Varicose veins

Answer 17

Distention of the tortuous superficial veins d/t incompetent valves in the deep, superficial or perforator systems.

Question 18

MC site of incompetent valves (varicose vein)

Answer 18

• Saphenous veins & its tributaries
• Esophagus
• Anorectum
• Scrotum

Question 19

RFs for developing varicose veins

Answer 19

• Inc. age
• Female
• OCP use
• Pregnancy
• DVT

Question 20

Dx of Varicose veins

Answer 20

Based on clinical & physical findings
- Visible long, dilated & tortuous superficial veins along thigh & leg
- Evidence of venous stasis - ulceration, hyperpigmentation, and induration
- Heavy sensation in leg

Question 21

What test is pts. w/ varicose veins positive for?

Answer 21

Brodie- Trendelenburg test/ Valvular competence test

Question 22

Brodie- Trendelenburg test/ Valvular competence test

Answer 22

Pt. supine –> raise leg and compress saphenous vein @ thigh —> Pt. stand –> veins fill quickly from top down –> INCOMPETENT VALVES

Question 23

Best initial management of varicose veins

Answer 23

Conservative measures
- Leg elevation
- Compression stocking

Question 24

Other management for varicose veins

Answer 24

• Injection Sclerotherapy
• Laser ablation

Question 25

Superficial thrombophlebitis

Answer 25

Inflammation or thrombosis of superficial veins that causes pain

Question 26

CFs of Superficial Thrombophlebitis

Answer 26

- Palpable cord - Pain - Mild fever

Question 27

Associations of Superficial Thrombophlebitis

Answer 27

- Varicose vein in LE - Site of IV infusion in UE

Question 28

Tx of Uncomplicated Superficial Thromboplebitis

Answer 28

- Warm compression - Aspirin

Question 29

What should never be used for Tx of S. Thrombophlebitis?

Answer 29

ANTICOAGULATION

Question 30

Why is anticoagulation never used for Tx of S. Thrombophlebitis?

Answer 30

BC it is not a RF for PE or DVT