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2. Cardiovascular System > 41. Venous and Lymphatic Disease > Flashcards

41. Venous and Lymphatic Disease Flashcards

1
Q

What are varicose veins?

A
  • Swollen and enlarged veins on legs and feet usually
  • Often bulging, twisty and lumpy on appearance
  • Purple or dark blue in colour
  • tortuous dilated superficial veins
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2
Q

What veins are affected by varicose veins?

A

Superficial veins only (superficial limb disease)

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3
Q

What happens to valves in varicose veins?

A
  • valves become floppy and bend backwards which makes them leaky
  • this means blood is not held up and blood no longer can flow upwards normally
  • if valves don’t work ,leakage of blood backwards occurs (backflow) which causes swollen veins
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4
Q

What are main sites of varicose veins? (2)

A
  1. long saphenous (80-87%)
  2. short saphenous (21-30%)
    alone= 13%
    combined= 21%
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5
Q

What is the primary aetiolgoy of varicose veins?

A
  • multifactorial

- mainly due to valvular dysfunction

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6
Q

What is the prevalence of varicose veins in males and females?

A 
males= 10-15%
females= 20-25%
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7
Q

What parts of patient history are most important when diagnosing varicose veins?

A
  1. age when veins first appeared
  2. occupation (esp. if standing for long periods)
  3. pregnancies (twins, big babies)
  4. previous DVT/ major trauma (good reason for DVT which affects DEEP veins in contrast)
  5. family history
  6. signs and symptoms
  7. complications
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8
Q

What are common signs and symptoms for varicose veins? (9)

A
  1. cosmesis (surgical correction)
  2. localised or generalised discomfort in the leg
  3. nocturnal cramps
  4. swelling
  5. acute haemorrhage
  6. superficial thrombophlebitis (inflammation because of blood clot or vein wall damage)
  7. pruritus (itching)
  8. skin changes (eg. eczema, lipodermatosclerosis and ulcers)
  9. oedema
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9
Q

What are indications for intervention for varicose veins? (6)

A
  • when symptoms severe
  • superficial thrombophlebitis
  • signs of chronic venous insufficiency
  • bleeding
  • cosmetic wishes
  • anxiety that disease may progress
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10
Q

What is the treatment for varicose veins?

A
  1. surgery; superficial venous surgery (vein junction is tied; high tie, stripping, multiple stab avulsions)
  2. injection (sclerotherapy)
  3. minimally invasive procedures
  4. compression
  5. conservative
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11
Q

What do new NICE guidelines say about specialist referral for varicose veins? (5)

A

Only referred when:

  • bleeding
  • pain
  • ulceration
  • superficial thrombophlebitis
  • severe impact on quality of life
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12
Q

What are contra-indications for surgical approach for varicose veins? (4)

A
  1. previous DVT (collaterals)
  2. arterial insufficiency
  3. patient comorbidity
  4. morbid obesity
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13
Q

What happens during a surgery to treat varicose veins?

A
  • conventional surgery under general anaesthesia
  • ligation of the sapheno-femoral or sapheno-popliteal junctions (joining)
  • vein stripping and multiple stab avulsions ( PIN; perforate invaginate stripping)
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14
Q

What are common complications for varicose vein surgery? (7)

A
  1. minor haemorrhage
  2. thrombophlebitis
  3. haematoma
  4. wound problems
  5. severe pain
    less common:
  6. sural/ saphenous nerves can be damaged (sural supplies inner foot and saphenous supplies outer foot) which can affect function
  7. damage to deep veins, arteries, nerves, DVT
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15
Q

What are 4 minimally invasive treatments of main trunk varicosities?

A
  1. foam sclerotherapy (chemical reaction with endothelium)
  2. endovenous laser ablation (EVLA; thermal ablation)
  3. Radiofrequency ablation (VNUS; thermal ablation/)
  4. Compression
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16
Q

What is ablation?

A
  • surgical removal of body tissue
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17
Q

What anaesthetic is used for minimally invasive treatments?

A

local anaesthetic

18
Q

What are potential advantages of minimally invasive treatments with local anaesthetic? (5)

A
  1. reduce surgical trauma (bruising, scarring, no incisions, less pain)
  2. reduce time off work
  3. do not require operating theatre
  4. potential to increase patient throughput
  5. more clinical and cost effective compared to conventional surgery
19
Q

What is a laser (EVLA) technique to treat varicose veins?

A
  • less invasive treatment than surgery
  • micro puncture needle inserted into incompetent long or short saphenous vein using ultrasound
  • guidewire introduce and manoeuvred to saphenous junction with deep vein using ultrasound
  • catheter and laser fibre introduced over guidewire to 1cm below junction
20
Q

In EVLA treatment, is the vein removed?

A

No, instead veins are heated by laser. Heat kills walls of the veins and the body naturally absorbs the dead tissue and abnormal veins are destroyed. as they collapse and are sealed shut. Once vein is no longer functioning and damaged completely, body will restore blood flow to healthy veins and damaged vein will turn into scar tissue and become reabsorbed into the body

21
Q

What is the difference between EVLA and VNUS procedures?

A
  • have the same goal and outcomes and do the same thing except they have different technology involved.
  • EVLA uses laser as heat and VNUS uses radiofrequency to heat
22
Q

What is foam sclerotherapy?

A
  • needle inserted into the incompetent vains under ultrasound control
  • foam injected and prevented from entering deep venous system which makes varicose veins shrink
  • common for smaller varicose veins or spider veins
23
Q

What are symptoms of chronic venous insufficiency?

A
  • ankle oedema
  • telangectasia
  • venous eczema
  • haemosiderin pigmentation
  • hypopigmentation “atrophie blanche”
  • lipodermatosclerosis
  • venous ulceration
24
Q

What is chronic venous insufficiency?

A
  • Veins cannot pump enough blood back to the heart
  • typically affects legs
  • includes varicose veins
25
Q

What is the pathophysiology of chronic venous insufficiency? (3)

A
  1. venous hypertension
  2. venous engorgement and stasis
  3. imbalance of Starling forces and fluid exudate
    (can be due to phlebitis, thrombophilia, blood clots, arteriovenous fistula etc)
26
Q

What is ambulatory venous pressure? (AVP)

A
  • gold standard for calf musculovenous pump
  • standing motionless pressure in foot= ~90mmHg
  • active movements of leg pressure falls to 30mmHg
27
Q

What does a high AVP suggest?

A
  • failure of muscle pump, valves or outflow obstruction

- venous hypertension can arise

28
Q

What is the aetiology of chronic venous insufficiency? (6)

A

Failure of calf muscle pump:

  • superficial venous reflux
  • deep venous reflux
  • venous obstruction
  • neuromuscular
  • obesity
  • inactivity
29
Q

Define lef ulcer.

A

Breach in the skin between knee and ankle joint present for over 4 weeks

30
Q

What is the differential diagnosis for leg ulceration. (6)

A
  • 80% purely venous in origin
  • 20% have significant arterial disease
  • diabetes
  • rheumatoid arthritis
  • vasculitis
  • CT disease
31
Q

What is found on examination in leg ulceration? (4)

A
  • signs of chronic venous insufficiency
  • oedema
  • locomotor system
  • vascular
32
Q

What investigations should be done to diagnose leg ulceration? (2)

A
  1. ABPI; ankle-brachial pressure index (if low then possibly arterial disease)
  2. Duplex; ultrasound commonly used to visualise vessels
33
Q

What is the main difference between arterial and venous ulcers?

A

Location of where the ulcer is on the leg

34
Q

Where are venous ulcers often found? (2)

A
  • above medial malleoli (ankle)

- above lateral malleoli

35
Q

Where are arterial ulcers often found? (4)

A
  • over toe joints
  • anterior shin
  • under heel
  • over malleoli
36
Q

Where are neuropathic ulcers often found? (5)

A
  • over malleoli
  • inner side of first metatarsal head
  • over toe joints
  • under metatarsal head
  • under heel
37
Q

What is the treatment for severe skin changes as a result from varicose veins?

A
  1. multi-layer graduated, elastic, high-grade compression therapy
  2. exclude arterial disease 100%
  3. dressings: non- adherent dressings if painful; hydrocolloid/foam dressing
  4. systemic and topical therapy: not proven, most ulcers colonised rather than infected
  5. exercise: calf muscle pump used
38
Q

What needs to be measured before treatment is established for skin changes from varicose veins?

A

ABPI: ankle- brachial pressure index

39
Q

What are treatment options for chronic venous insufficiency? (3)

A
  1. improving blood flow (compression stockings, exercise, elevation)
  2. medication: diuretics, anticoagulants
  3. surgery (if severe)
40
Q

What are 3 categories of primary lyphoedema? (3)

A
  1. congenital
  2. preacox/early (before 30)
  3. tarda/leter (after age of 30)
41
Q

What is the cause for secondary lymphoedema? (4)

A
  1. malignancy
  2. surgery (radical mastectomy, groin/axillary dissection)
  3. radiotherapy
  4. infection (filariasis/TB/pyogenic0
42
Q

What is the treatment for lymphoedema? (3)

A
  1. elevation and mannual draiange
  2. compression
  3. taking care of diet, exercise and lifestyle choices
    No definitive cure

2. Cardiovascular System (42 decks)

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