31 - Venous Disease Flashcards
What is venous insufficiency?
Inadequate venous drainage of the lower extremities
What causes venous insufficiency?
- Clot
- Inherited abnormality of the veins
- Increased pressure in the venous system (mechanical or metabolic)
What is superficial venous insufficiency called?
Varicose veins
What is deep venous insufficiency called?
Chronic venous insufficiency
What is a thrombus?
Presence of a clot
What is phlebitis?
Inflammation within a vien
What is thrombophlebitis?
A broad term for inflammation of a view with or without the presence of a clot
What vein is most commonly involved in a superficial thrombophlebitis?
Great saphenous vein
This is more common than the lesser saphenous vein
How common is superficial thrombophlebitis?
3-11% of the general population
What are the risk factors associated with superficial thrombophlebitis?
Associated with conditions that increase the risk of thrombosis
- Coagulation abnormalities
- Endothelial dysfunction
- Venous therapy (following vein ablation)
- Malignancy and hypercoagulable states
What is the patient presentation of a superficial phlebitis?
- Tenderness, induration, pain and erythema along course of superficial vein, palpable cord***
What should you be thinking if a pateint presents like this?
High index of suspicion for DVT in patients with risk factors (such as a previous DVT)
How do you treat a superficial thrombophlebitis?
- Treatment is aimed at alleviating symptoms such as pain and swelling (NSAIDs, warm compression, elevation)
- Thrombus PREVENTION in deep veins
- Coagulation in patients with extensive involvement or high risk patients
What is one type of superficial venous insufficiency?
Varicose veins
Describe varicose veins
- Dilated, elongated tortuous
- Involves superficial veins 3 mm or greater is size
- Effects 10-30% of the population
- Seen more often in older patients
What is the pathology behind varicose veins?
- Inadequate muscle pump
- Incompetent valves leading to reflux
- Venous obstruction
What do the pathological aspects of varicose veins lead to?
Increased venous pressure - known also as “venous hypertension”
Note:
- Venous hypertension –> vein dilation –> skin changes —> skin ulceration
Describe the effect of incompetent valves
Valves become incompetent, veins are permeable the fluid in the blood leaks out and produces edema and fluid accumulation
How do you diagnose varicose veins?
- Diagnosis correlates with the degree of venous “reflux”
- It is identified by venous duplex ultrasound as retrograde (reversed) flow of greater than 0.5 seconds in duration
How do you manage varicose veins?
You treat according to the severity and etiology of the underlying reflux
- Conservative treatment includes elevaion, compression and exercise
- Invasive treatment is ablation therapy
What is chronic venous insufficiency again?
The presence of thrombophlebitis in a deep vein
- The chronic insufficiency is associated with structural and histological changes
What structural and histological changes occur in chronic venous insufficiency?
- Capillary microcirculatory disorders
- Fibrin deposition
- Inflammation