Venous Dx

Question 1

Q/ What’s varicose vein’s, & it’s common in male or female?

Answer 1

it is dilated, usually tortuous, subcutaneous veins 3 mm in diameter measured in the upright position with demonstrable reflux.
More common in females

Question 2

Give 3 risk factors for venous dysfunction?

Answer 2

● Heredity
● Female sex,
● Hormonal Influence

Question 3

What are the indications to treat Varicose Veins?

Answer 3

1•Symptomatic (aching, heaviness, and cramps)
2•Complicated pigmentation, dermatitis, induration, superficial ulceration, and thrombosis of varicosities
3•Large varicosities subject to trauma
4•Cosmetic concern

Question 4

What are the treatment options for varicose veins ?

Answer 4

1- non surgical Tx : compression stockings, elevation of lower limbs, exercise of leg muscles
2- Minimal invasive techniques: thermal oblation, non thermal cyanoacrylate ,sclerotherapy,
3- Surgery: proximal ligation, stab avulsion

Question 5

What’s the etiology behind VTE ?

Answer 5

1- stasis of blood flow.
2- endothelial damage.
3- the hypercoagulable state.

Question 6

What is DIAGNOSTIC EVALUATION OF VENOUS DYSFUNCTION?

Answer 6

•Perthes test
•Brodie-Trendelenburg test
•Plethysmography
•Duplex Doppler Ultrasonography

Question 7

What is VENOUS THROMBOSIS?

Answer 7

is the formation of a semi-solid
coagulum within the venous system and may occur in the superficial system (usually described as
superficial thrombophlebitis) or the deep system (deep venous thrombosis or DVT).

Question 8

1ry or spontaneous DVT caused by ?

Answer 8

Hypercoagulanle state

Question 9

2ry DVT caused by?

Answer 9

occur after immobilization, surgical procedures, and trauma.

Question 10

How Hypercoagulable State happened?

Answer 10

■ Factor V Leiden mutation
■ Prothrombin gene mutation
■ Protein C deficiency
■ Protein S deficiency
■ Antithrombin III deficiency
■ Antiphospholipid syndrome

Question 11

Sequence of Pathology

Answer 11

Propagation to involve more proximal segments of the deep
venous system
• Pulmonary embolism
• The late consequence of DVT, particularly of the iliofemoral
veins, can be CVI and ultimately post-thrombotic syndrome,
as a result of valvular dysfunction in the presence of luminal
obstruction.
• Recanalization

Question 12

Give 3 risk factors for DVT ?

Answer 12

• Past history DVT.PE
• Increase age
• Immobility
• Malignancy
• Surgery or trauma
• Cardiac failure , stroke and MI
• Oral contraceptive
• Thrombophilia

Question 13

What are the complications of DVT ?

Answer 13

PE, CVI, paradoxical emboli, phlegmasia caerulea doles

Question 14

Approach to patient with suspected DVT ?

Answer 14

1• History pain,swelling,distended vein,skin discolation,ulceration,risk factors

2• Clinical: high index of suspicion, +ve Homans’ sign , Calf tenderness is frequently present, swelling of the foot and calf, phlegmasia alba dolens, phlegmasia cerulea dolens, venous gangrene

3• Investigations: Venography, Impedance Plethysmography, Fibrin, Fibrinogen Assays And Magnetic Resonance Venography

Question 15

What are the prophylactic measures for DVT ?

Answer 15

1- mechanical: leg elevation, early mobility, intermittent pneumatic compression and graduated compression stockings.

2- Pharmacological: low dose UFH, LMWH, synthetic pentasaccharides, dextran 70 and vitamin K antagonists (warfarin)

Question 16

Give the treatment options for DVT ?

Answer 16

1- pharmacological (Antithrombotic therapy like UFH, LMWH, Warfarin, apixaban & rivaroxaban
2- non pharmacological :
* Temporary or permeant IVC Filter
* Systemic or direct catheter thrombolytic therapy
* Operative thromboectomy

Question 17

What is the Surgical Treatment of Chronic Venous Insufficiency?

Answer 17

• Perforator Vein Ligation
• Venous Reconstruction
• Valvoplasty, or valve repair

Question 18

Chronic Venous Insufficiency
• leg fatigue, discomfort, and heaviness.

Answer 18

• leg fatigue, discomfort, and heaviness.
• varicose veins, edema.
• hyperpigmentation, lipodermatosclerosis.
• venous ulceration.
• Chronic venous insufficiency or the postthrombotic
syndrome develops in approximately 50 percent of the
patients with deep venous thrombosis.

Question 19

Treatment of Chronic Venous
Insufficiency

Answer 19

Non operative Treatment of Chronic Venous
Insufficiency
Compression Therapy:
•Graduated elastic compression stockings
•Unna’s boot
•Multilayered dressings

Surgical Treatment of Chronic Venous Insufficiency
•Perforator Vein Ligation
•Venous Reconstruction

Question 20

What is the differences between venous, arterial & diabetic ulcers, regarding their cause, location amd associated signs & symptoms?

Answer 20

1- Venous ulcer:
Cause: venous hypertension 2ry to DVT or varicose veins
Location: medial side of leg, above ankle
Associated signs & symptoms: it’s shallow with sloping edges, bleeds easily after minor trauma & surrounded by pigmentation associated dermatoliposclerosis.

2- Arterial ulcer
Cause: Occlusive arterial disease
Location: lateral ankle, heel, metatarsal heads, tips of the toes
Associated signs & symptoms: painful ulcers, do not bleed, nonhealing, with associated features of ischemia, e.g. claudication, absent pulses, pallor.

3- Diabetic ulcer
Cause: ischemia or neuropathic
Location: plantar aspect of foot or toes
Associated signs & symptoms: it’s deep, painless ulcers associated with cellulitis, deep tissue abscesses, warm foot, pulses may be present.

Question 21

LMWH advantage over UH:

Answer 21

1- more potent
2- longer duration if action
3- less frequent dosing
4- lower risk of heparin-induced thrombocytopenia