14. Venous disorders of the lower limbs Flashcards
Essential properties of lower limb veins ?
- The deep veins lie beneath the deep fascia.
- the superficial veins lie superficial to the deep fascia..
Superficial and perforating veins ?
- The long saphenous vein drains the inner leg to the groin.
- The short saphenous vein drains the back of the calf to the popliteal vein behind the knee.
Clinical tests of the superficial veins’ insufficiency ?
- The Trendelenburg test.
Assessment of VENOUS INSUFFICIENCY (especially varicose veins) has become much more precise with ?
the advent of hand-held Doppler probes and in complex cases, plethysmography and duplex scanning
Varicose veins ?
- Varicose veins are tortuous, dilated, prominent superficial veins in the lower limb, often in the anatomical distribution of the long and short saphenous veins.
Varicose veins’ aetiology ?
– primary or familial (most common type).
– secondary or post-thrombotic.
– congenital malformations of veins alone.
– varicosities deliberately created by
arteriovenous fistulae in patients with renal failure in order to facilitate repeated cannulation for haemodialysis
Primary or familiar varicose veins ?
- They usually appear early in life and more than
one family member is affected. - Progesterone, the principal hormone of pregnancy, causes passive dilatation of veins, facilitating the development of varicose veins.
Secondary varicose veins ?
Secondary varicose veins occur with the postphlebitic limb and are usually caused by perforator valve failure.
Symptoms of varicose vein ?
- Patient commonly reports: Heaviness, Discomfort, Extreme fatigue.
- Pain is dull, does not occur when patient lies.
- pain exacerbated afternoon, usualy doesn’t appear early in the morning.
- Cutaneous itching.
- Local congestion.
Treatment for varicose veins ?
- Surgery.
- Sclerotherapy.
- New forms of laser and light treatments.
What patients are better treated surgically ?
Patients with junctional incompetence, significant truncal reflux, and large varicosities.
What patient should be treated by compression sclerotherapy ?
Patients with isolated segments of varicosities.
What patient should be treated by microsclerotherapy ?
Patients with reticular varices and dermal flares.
Compression sclerotherapy ?
• The three essentials in compression sclerotherapy: – effective sclerosant – injection into an empty vein – maintained compression with exercise.
The aim of effective sclerotherapy is to produce ?
an endothelial disobliteration and not a thrombophlebitis.
What is used for injecting larger veins in Compression sclerotherapy ?
3% sodium tetradecyl sulphate.
Complications after varicose veins ligation ?
- Areas of altered sensation and numbness.
- Extensive bruising usually resolves within 2
to 6 weeks. - Recurrent varicose veins.
Indications for Varicose Vein Intervention ?
- Cosmetic.
- Symptoms refractory to conservative therapy.
- Bleeding from a varix.
- Superficial thrombophlebitis,
- Lipodermatosclerosis.
- Venous stasis ulcer.
Virchow’s triad ?
- Hypercoagulability.
- Hemodynamic changes (stasis, turbulence).
- Endothelial injury/dysfunction.
** factors that are thought to contribute to thrombosis.
Symptoms of DVT ?
- Odema.
- Tenderness on palpation.
- Pain.
- Discoloured skin.
- Feeling of warmth.
- Dilatation of superficial veins.
- Moses’ sign (Bancroft’s sign) , Humans’ sign.
- Symptoms of pulmonary embolism. (chest pain, shortness of breath, tachypnea, hemoptysis)
What score is used for DVT ?
Well’s score.
Treatment of DVT ?
- LMWH.
- Unfractionated heparin.
- Fondaparinks.
- VKA.
- New oral anticoagulants (rivaroxaban, apixaban, betrixaban).
- Dabigatran.
- Graduated compressive stockings.
- IVS filters.
- Thrombolysis.
- Thrombectomy.
