Acute Venous Pathology Flashcards
What is the learning outcome of the pathophysiology of acute venous disease?
Differentiate the pathophysiology of acute and chronic venous disease.
What are the objectives of studying acute venous disease?
- Describe the evolution of thrombus formation and propagation.
- Name the signs, symptoms and risk factors of acute deep venous thrombosis (DVT) and chronic venous insufficiency (CVI).
- Discuss the factors that lead to chronic venous insufficiency.
- Explain other pathologies that demonstrate symptoms of venous disease.
- Describe treatments for acute and chronic venous disease.
- List other medical tests that aid in diagnosis of venous disease.
What is the most common test for ruling out a DVT?
Ultrasound of the lower extremity.
What are the complications of untreated DVT? 2
- Pulmonary embolus (PE)
- Chronic venous insufficiency (CVI).
What are the components of Virchow’s Triad?
- Stasis
- Intimal injury
- Hypercoagulability
What factors contribute to venous stasis? 6
- Immobility due to illness, injury or surgery
- Congestive heart failure
- Chronic obstructive pulmonary disease (COPD)
- Obesity
- Pregnancy
- Previous DVT
What is hypercoagulability?
A state where blood is more likely to clot, influenced by conditions like cancer, pregnancy, and certain genetic factors.
What is the Well’s Score used for?
To assess the likelihood of DVT based on clinical history and signs.
What does a D-dimer assay indicate?
It detects the formation of acute thrombus and indicates the probability of a DVT.
Where does thrombus formation typically start in the lower extremity?
In the soleal sinus, calf veins, or at the valve cusps.
What is the appearance of an acute thrombus on ultrasound?
It appears as dilation of the vein with lack of compressibility, and can be anechoic or hypoechoic to surrounding tissue.
What is the difference between complete and partial thrombus?
Complete thrombus occludes the vein, while partial thrombus allows some blood to flow within the lumen.
What is May-Thurner Syndrome? Which demographic is more affected?
- Compression of the left common iliac vein between the right common iliac artery and spine
- More prevalent in females.
What is Paget-Schroetter Syndrome? What is often due to?
- The most common form of axillo-subclavian thrombosis in ambulatory, healthy people
- Often due to anatomical variations.
What is Phlegmasia Cerulea Dolens?
A condition where collateral veins become thrombosed, leading to massive obstruction of venous outflow and potential gangrene.
What are the categories of medical treatment for acute venous disease? 2
- Anticoagulation therapy
- Thrombolytic agents
What is the purpose of a caval filter?
To prevent thrombus from the lower limbs from propagating to the lungs, causing a pulmonary embolism.
What is superficial thrombophlebitis?
Acute thrombus in the superficial veins, diagnosed clinically as a ‘hard cord’ under the skin.
What is a thrombus?
A thrombus is a blood clot that can occur in the superficial veins of the extremities.
How is thrombus formation diagnosed clinically?
It is usually diagnosed clinically as a ‘hard cord’ palpated under the skin.
What imaging technique is used to delineate the extent of a thrombus?
Ultrasound is used to delineate the extent of the thrombus, particularly at major confluences into the deep system.
What is the clinical significance of superficial thrombus? 2
- Superficial thrombus has varied clinical significance
- Some treat it as a DVT while others prescribe a warm compress and anti-inflammatories.
What percentage of superficial thrombosis has a concurrent DVT or PE?
Approximately 25% of superficial thrombosis has a concurrent DVT or PE.
When is anticoagulation therapy indicated for a thrombus?
Anticoagulation therapy is indicated if the thrombus is 5 cm or more in length or is within 3 cm of the SFJ.
