What are some risk factors for varicose veins?
What is thrombophlebitis?
Inflammation of a vessel wall associated with thrombosis
What are mechanisms of venous hypertension?
- Reflux of blood from deep to superficial veins due to valvular failure
- Calf pump failure
What are some clinical features of venous ulcers?
Hx of venous insufficiency
Hx of previous surgery
- Shallow, large, irregular edge
- Moist granulating base
- Over gaiter area
- Surrounding inflammation
What causes lipodermatosclerosis?
Denatured subcutaneous fat and excess fibrin deposition
How are venous ulcers treated?
Elevation and compression
Debridement and split skin graph
Treat underlying pathology
What is the difference between primary and secondary varicose veins?
Primary occur in the absence of valvular incompetence in the superficial or perforating veins
Secondary are associated with deep venous incompetence secondary to recanalisation of DVT
What are the history/examination characteristics of ischaemic ulcers?
History of claudication/vascular disease
Cardiovascular risk factors
Distal periphery or pretibial
Punched out, no inflammatory - surrounding is white
Little bleeding when debrided
Pale and sloughy base
What are the two theories proposed to explain why venous ulcers form?
White cell trapping hypothesis
Venous hypertension > Perfusion pressure is reduced > WBC (that are larger and less deformable than RBC) clog capillary and cause RBC back up > WBC activation > Proteolytic enzyme release and local inflammation
Fibrin cuff hypothesis
Venous hypertension causes capillary elongation and increased permeability > large molecules like fibrin extrude from vessels > Fibrin deposits in skin forming a barrier to oxygenation > ischaemia
What are some clinical features of a neuropathic ulcer?
- Hx of diabetes
- On pressure areas
- Plantar surface of MTP joint, MM/LM, dorsal IP joints
- Distorted foot architecture
- Granulating base
What are some symptoms of DVTs?
How does varicose veins be treated?
Endovenous laser therapy
What are some signs of arterial insufficiency?
Venous guttering (delayed refilling after beurger's test)
+ beurger's test (lift the foot to 45 degrees and look for pallor)
Slow cap refill
What are some three main types of ulcers?