304 Vascular arterial, venous, and IR Flashcards
What are the 2 venous muscles pumps int he body?
Muscles in the calf and diaphragm
They contract and create a pressure that pushes venous blood around the body
What are the different causes of venous insufficiency?
-Immobility
-Calf muscle pump failure
-Deep venous occlusion
-Superficial venous reflux
–Deep venous reflux
-Obesity
-Dependency
What is the cause of venous hypertension?
Venous insufficiency
What is Gaiter area?
The area below the knee and above the ankle where venous ulcers are most likely to happen
What are spider veins?
AKA Telangiectasia varicose veins
Small clusters of blue or red veins that sometimes appear on your face or legs; they’re harmless and, unlike trunk varicose veins, do not bulge underneath the surface of the skin
What is the definition of a varicose vein?
A vein that has permanently lost its vascular efficiency so remains continuously dilated under pressure
What is ovarian vein incompetence?
Otherwise unexplained pelvic pain in pre-menopausal women
Affects back, pelvis and upper thigh
Equivalent to a varicocele in men
What is a varicocele?
Abnormally dilated veins in the scrotum
What is the CEAP classification used for?
Classification of Varicose veins
C = Clinical
* C0 – no visible venous disease
* C1 - reticular veins and thread veins
* C2 - varicose veins
* C3 – oedema
* C4 – skin changes
* C5 - healed ulceration
* C6 - active ulceration
E = Etiology (primary vs secondary)
A = Anatomy (location eg. Deep)
P = Pathophysiology (reflux, obstruction)
What is the Aberdeen vein score?
Quantifies the effect of venous disease on the quality of life
What are the symptoms of varicose veins?
Heaviness or tension
Feeling of swelling
Aching
Restless legs
Cramps
Itching
Tingling
Women experience more of these symptoms compared to men
What are some complications fo varicose veins?
Phlebitis 20%
Bleeding 3%
Skin changes 25%
Ulceration 5-10%
What is Phlebitis?
AKA superficial thrombophlebitis
An inflammatory response to an embolus
No infected
Treated with LMW Heparin
What is the SPJ/SFJ?
SPJ: saphenopopliteal junction
SPJ: Sapheno-femoral junction
How does the SPJ/SFJ relate to varicose veins?
Varicose veins have been linked to great saphenous vein reflux and in particular, with reflux at the saphenofemoral junction (SFJ)
It can be checked by asking the patient to sit down and then lie down to see is the veins are visible
Why would there be a bruit over the SFJ in varicose vein disease?
A bruit indicates turbulent blood flow which may suggest an underlying arteriovenous malformation
What is the treatment for varicose veins?
Conservative measures
Or Invasive treatments
– Surgery
– Catheter (heat based) therapy
– Sclerotherapy
- Conventional sclerotherapy
- US guided foam sclerotherapy
» Cyanoacrylate glue
What are some conservative treatments for varicose veins?
Leg elevation
Exercise
Weight loss
Compression stockings
What are TED stockings?
Thrombo-embolus deterrent stockings
What is the maximum dose of lignocaine?
7mgs/kg
What is a phlebectomy?
Removal of veins
What is sclerotherapy?
The treatment of varicose blood vessels by the injection of an irritant which causes inflammation, coagulation of blood, and narrowing of the blood vessel wall.
What is the aetiology of DVT?
Virchow’s triad
- Changes to flow
Eg. immobility, paralysis, extrinsic vessel compression - Changes to blood coagulation
Eg. Thrombophilia, severe dehydration, malignancy, sepsis, drugs like COCP, COVID - Changes to blood vessel wall
Eg. deep vessel injection, trauma
How is a DVT diagnosed?
-Clinical features
* History
* Clinical features
* Wells score
-D-dimer testing
-Duplex US scanning
How does COVID-19 contribute to vascular disease?
- Significantly increased risk of thrombosis
– Likely due to direct endothelial cell infection - Platelet aggregation and activation
- Increased arterial and venous thrombosis
– Increased risk of Stroke, critical limb and mesenteric
ischaemia
– Patients are prothrombotic.
– Benefit in continuing statin therapy.
– Digital manifestations of mild or asymptomatic - Covid fingers or covid toes (chilblains)
What are chilblains?
Small, itchy swellings on the skin that occur as a reaction to cold temperatures
Occur mostly on fingers and toes
What is the management of DVT?
Manage the DVT itself
– Anticoagulation
* Heparin/LMWH
* DOAC eg Rivaroxaban/ Apixiban.
* Warfarin (monitoring required)
– Compression hosiery
* 2 weeks minimum.
* Longer if still symptomatic.
* Ensure sufficient arterial supply and healthy enough skin
What is post-thrombotic syndrome?
A combination of patient reported
symptoms and objective findings
such a swelling and skin changes in
patients following DVT of the upper
or lower extremity.
- 20 -50% of patients after
symptomatic DVT . - 5 -10% will suffer severe PTS with
features of advanced chronic venous insufficiency
*Impact on QoL can be devastating.
– Severe pain and ulceration in
young patients
What is the pathophysiology of post-thrombotic syndrome?
Obstruction at key points
* Reflux: loss of valvular integrity.
* Ambulatory venous hypertension.
* Triggering of inflammation: PAIN.
* Reduced calf perfusion with tissue
hypoxia.
* Increased tissue permeability:
Oedema
* Progressive pump dysfunction
The quicker the clot resolution, the
less collateral damage
What is a venous infarction?
A medical emergency that occurs due to obstruction of the venous system by thrombus or external compression
Pulses palpable initially because blood is pumped in but had nowhere to go causing:
Swelling (often severe), Tenderness (compartment syndrome), and discoloration/ cyanosis
What is Phlegmasia alba dolens and Phlegmasia caerulea dolens?
Uncommon conditions that result from acute, massive venous thromboembolism
Associated with DVT of the lower extremity and have high associated morbidity and mortality
What are the Pulmonary complications of DVT?
Pulmonary embolism
Chronic pulmonary hypertension
What are the symptoms of DVT?
Shortness of breath
Pleuritic chest pain
Collapse
Sudden death
What is the definition of relative ischaeima?
Insufficient perfusion to permit full function but is okay at rest
What is Claudication?
The equivalent of leg angina
Absolute: critical ischaemia with gangrene and pain at rest
What are the 6 P’s of limb ischaemia?
Pale
Painful
Pulseless
Perishingly cold ‘Poikilothermic’
Paraesthetic
Paralysed
Lower 2 are neurological an develop in late stage
What are some causes of acute limb ischaemia?
Embolic
-AF, endocarditis, proximal aneurysm
Thrombotic
-Rupture of an atherosclerotic plaque
Aneurysm
-Eg Popliteal thrombosis
Trauma
-Fracture / Dislocation
-Knife, Gunshot wound
-IV drug use
-Iatrogenic
What is the treatment for acute limb ischaemia?
Heparin 5000 iu IV
LMWH (Fragmin) s/c
Analgesia
Foot down
What does TLC stand for?
Tender loving care
What is the Seldinger technique?
A procedure to obtain safe access to blood vessels
It allows for insertion of a catheter
Used in angioplasty
