304 Vascular arterial, venous, and IR Flashcards by Malgorzata Szymaniak

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

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What are the different causes of venous insufficiency?

-Immobility
-Calf muscle pump failure
-Deep venous occlusion
-Superficial venous reflux
–Deep venous reflux
-Obesity
-Dependency

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What is the cause of venous hypertension?

Venous insufficiency

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What is Gaiter area?

The area below the knee and above the ankle where venous ulcers are most likely to happen

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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

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What is the definition of a varicose vein?

A vein that has permanently lost its vascular efficiency so remains continuously dilated under pressure

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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

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What is a varicocele?

Abnormally dilated veins in the scrotum

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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)

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What is the Aberdeen vein score?

Quantifies the effect of venous disease on the quality of life

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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

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What are some complications fo varicose veins?

Phlebitis 20%
Bleeding 3%
Skin changes 25%
Ulceration 5-10%

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What is Phlebitis?

AKA superficial thrombophlebitis

An inflammatory response to an embolus
No infected

Treated with LMW Heparin

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What is the SPJ/SFJ?

SPJ: saphenopopliteal junction
SPJ: Sapheno-femoral junction

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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

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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

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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