Venous & Lymphatic Disease

Question 1

RECAP- in terms of anatomy, what is the difference between an artery and a vein?

Answer 1

Artery is thicker and has a smaller lumen compared to the total vessel size.
Vein is thinner and have a larger lumen compared to total vessel size.

Question 2

Which vein is used with the calve pump to push venous blood back to the heart?

Answer 2

Popliteal vein

Question 3

Where does the dorsal aspect of the foot drain into?

Answer 3

Great saphenous vein

Question 4

What are perforating veins?

Answer 4

Veins which transports blood from the superficial venous system to the deep venous system

Question 5

What is the sole of the foot drained by?

Answer 5

Short saphenous vein

Question 6

Which veins make up the deep venous system?

Answer 6

Tibial vein, the popliteal vein and the femoral vein.

Question 7

What are the two main problems that occur in the venous system?

Answer 7

Chronic venous insufficiency and varicose veins.

Question 8

What are venous veins caused by?

Answer 8

Damage of the valves of the venous system

Question 9

What are some of the causes for varicose veins?

Answer 9

Recent DVT
Pregnancy
Trauma
Tumours

Question 10

How can pregnancy cause varicose veins?

Answer 10

Due to hormone changes and the uterus sitting on the deep iliac veins, creating pressure

Question 11

What are some of the risk factors forvaricose veins?

Answer 11

Increasing age
Female>male
Previous DVT or trauma
Prolonged standing

Question 12

What is chronic venous insufficiency?

Answer 12

Prolonged damage to the venous system
Combination of superficial and deep disease

Question 13

Describe the pathophysiology for venous insufficiency.

Answer 13

Venous hypertension-> damages veins and causes endothelial leak -> oedema -> increased perfusion distance -> Impaired healing -> inflammation -> tissue damage

Question 14

What are the symptoms for systematic venous disease?

Answer 14

Pain, infection, ulcers, swelling, bleeding, itchiness, burning

Question 15

When doing a venous examination of the legs, what are some things to look out for?

Answer 15

Oedema, any discolouration, any signs of venous eczema.

Question 16

If you palpate the veins, what are you feeling for?

Answer 16

See if it is thrombosed
If it’s hard/tender
If its compressible i.e. you can move blood out of it

Question 17

What does a full vascular examination involve?

Answer 17

-Femoral, popliteal, dorsalis pedis and posterior tibial pulses.
-Ankle brachial pressure index to measure the pressure gradient between the arm and the ankle

Question 18

Which investigation is the best for venous disease?

Answer 18

Venous duplex ultrasound scanning

Question 19

Which classification guide is used to help in vasuclar disease?

Answer 19

CEAP

C-clinical causes
E- aetiology
A- anatomical distribution
P- pathophysiology

Question 20

Which part of the CEAP is most important for us rn?

Answer 20

Clinical (C0-C6)

Question 21

What does calf pump failure cause?

Answer 21

Oedema

Question 22

How is deep venous insufficiency usually treated/managed?

Answer 22

Compression- as long as there is no arterial compromise

Question 23

When may surgery be carried out in venous disease?

Answer 23

For superficial varicose veins

Question 24

What is the surgery for superficial varicose veins?

Answer 24

Endovenous treatment

Or, less commonly but still an option, foam sclerotherapy

Question 25

What does endovenous treatment do to the vein?

Answer 25

Heats it up

Question 26

What is used to combat the heat in endovenous surgery?

Answer 26

Combo of local anaesthetic and fluid to absorb the heat

Question 27

What is foam sclerotherapy?

Answer 27

Foam created by sclerosing agent and air
Injected into vein causing an irritant effect and the vein closes in on itself