Chapter 26 - Testing considerations for venous evaluation Flashcards
Wells criteria for DVT
1) Active cancer 6 months
2) Paralysis, paresis, plaster immobilization of LE
3) bedridden > 3 days; major surgery 4 weeks
4) Localized tenderness along deep vein
5) entire leg swollen
6) calf swelling > 3cm more than other leg
7) pitting edema
8) collateral superficial veins
9) alternative diagnosis (-2 points)
all 1 point
LOW 0 points
MODERATE 1-2 points
HIGH 3+ points
Differential diagnosis of DVT
1) muscle strain
2) direct injury to leg
3) muscle tear
4) Baker’s cyst
5) cellulitis
6) lymphangitis
7) heart failure
8) extrinsic compression
9) complication of chronic venous insufficiency
10) adventitial cystic disease
CEAP C class
0) no signs
1) telangiectasia/reticular veins
2) varicose
3) edema
4A) pigmentation/eczema
4B) lipodermatosclerosis/atrophie blanche
5) healed ulcer
6) active ulcer
Virchow’s triad
1) endothelial damage
2) venous stasis
3) hypercoagulability
Paget-Schroetter syndrome
Stress or effort thrombosis
Thrombosis of subclavian or axillary vein due to repetitive activity
May-Thurner syndrome
Left common iliac vein compression
Compression of LCIV by RCIA
Nutcracker syndrome
Compression of left renal vein by SMA
Post thrombotic syndrome
Post phlebitic syndrome
Combination of chronic swelling, brawny discoloration and ulcer to distal calf/ankle (Gaiter)
Klippel Trenaunay
Hypoplastic/absent deep veins
Varicosities of superficial system
Enlarged limb
Port wine stain
SVC syndrome causes
1) malignant lesion
2) catheter induced thrombosis
Symptoms of SVC syndrome
1) Dyspnea
2) facial swelling
3) extermity swelling
Most common cause of IVC tumour
Renal cell carcinoma
Primary vs secondary varicose veins
Primary: hereditary absence of valves
Secondary: obstruction of some sort
Phlegmasia alba dolens
Arterial spasm secondary to extensive acute iliofemoral vein thrombosis
Swollen, pale, painful
Phlegmasia cerulea dolens
Reduced arterial inflow leading to tissue hypoxia, venous gangrene
Swollen, dark, painful
