Chronic Venous Disease And DVT. Flashcards
What are varicose veins and what causes them?
Dilated, torturous, superficial veins due to transmission of deep vein pressure.
What is the epidemiology of varicose veins?
Around 30% of people age 18-64 but variable. Male female ratio varies. 80% have we bp and reticular veins. Age pregnancy and obesity are risk factors. Family history plays a part.
Why do we get varicose veins following a DVT?
What other conditions also do the same?
It increases deep vein pressure.
Deep vein obstruction and deep valve incompetence.
What are the complications of varicose veins?
Bleeding and bruising. Superficial thrombophlebitis. Chronic venous insufficiency haemosidering deposits, lipodermatosclerosis and ulceration.
What are haemosidering deposits?
Hyperpigmentation on the skin caused by iron deposits. Caused by red cell leakage or red cell breakdown.
What is Lipodermatosclerosis?
Inflammation of subcut fat causing fibrosis and hard skin that may be red or brown. Can be acute or chronic and is caused by white cells.
What are the first aid steps for bleeding varicose veins?
Elevation and pressure.
What is thromboplebitis?
Inflammation of a vein caused by a blood clot. They are quite painful.
What is chronic venous insufficency?
Irreversible skin damage as a result of sustained ambulatory venous hypertension.
What are some causes of venous hypertension?
Superficial reflux Deep reflux - first degree or secondary to DVT. Deep venous occlusion Mixed superficial and deep disease. Perforating vein reflux. Abnormal calf pump.
What is superficial reflux and what veins does it usually effect?
Valve not working properly in the vein causing reflux. Usually long or short saphenous veins.
What two systems can cause an abnormal calf pump?
Can be MSK or neurological causes.
What 2 main issues do duplex scans focus on?
State of the deep veins e.g. Occlusion or incompetence.
Look for saphenofemoral or saphenopoliteal incompetence.
What management do we use of varicose veins?
Non interventional e.g. Info and stockings.
Interventional either surgical or not.
What are graduated compression bandages and what are they used for?
4 layers of bandaging used for ulcers.
What are graduation compression stockings used for and how many classes are there?
Used for ulcer prevention and symptomatic relief. Come in 4 classes with the fourth being of the highest pressure.
What contraindications are there for graduated compression devices?
Low ABPI.
What interventional non surgical methods can we use to treat varicose veins?
Endovenous foam sclerotherapy. They inject foam to occlude the vessel.
Endovenous ablation mechanical, laser or thermal probe inserted causing thrombophlebitis.
What surgical interventions do we have?
High tie, stripping or foam. Multiple stab avulsions.
What are the complications of the interventions for varicose veins?
Thrombophlebitis, skin staying in, local ulceration, wound infection, nerve damage and recurrence.
What is duplex scanning?
A colour Doppler.
What are general risk factors for DVT?
Age, obesity, immobilisation for longer then three days. Pregnancy and the postpartum period. Major surgery in the last 4 weeks.
Long plane or car trips and varicose veins.
What are the medical risk factors for DVT?
Cancer, previous DVT, CVA, acute MI. CHF, sepsis, nephrotic syndrome and inflammatory bowel disease.
What is nephrotic syndrome?
Protein leakage from the kidneys.
What are traumatic reasons for DVT?
Multiple trauma, CNS or spinal cord damage, burns and lower extremity fractures.
What are the symptoms and signs of DVT?
Pain swelling, redness, heat, inflammation. Localised tenderness over deep veins.
What system do we use to assess risk of DVT?
Pre test probability score - PTP.
When is PTP scoring not valid?
If had previous DVT in the symptomatic leg and if pregnant.
What probabilities of getting a DVT does the PTP give us?
Low 3% chance
Moderate 17%
High 75 % chance.
What are a few examples of criteria on the PTP system?
Active malignancy
Calf swellings
Recently bedridden
IV drug use etc.
What investigations do we do for DVT?
D dimers and imaging.
What are D dimers?
Fibrin breakdown product. Not specific but can rule out damage.
What is venous plethysomography?
Strain gauge wire around the affected limb, venous emptying by compression. If there is a fast refill time there isn’t much emptying and therefore a clot.
What are the two DVT algorithms for diagnosis of DVT?
High PTP score, but neg D dimer and ultrasound = no DVT and we should consider another diagnosis.
High PTP score, pos d dimer, neg ultrasound = repeat assessment and repeat ultrasound later.
What is the treatment of DVT?
Anti coagulation with LMWH and warfarin.
Compression stocking for up to 6 weeks.
What can reduce the incidence of post phlebitic syndrome after treatment of DVT?
Grade 2 compression stocking for up to 5 years.
What is plegmasia dolens?
DVT causing obstruction of arterial inflow.not is a severed DVT with a background of peripheral arterial occlusive disease. It is an emergency causing threat to life and limb.
What is the treatment of phlegmasia dolens?
IVC filter, femoral arterial line, TPA intra arterially surgical review, decompression and amputation.
What two venous systems do we have in the lower limbs and what vessels do they comprise?
Deep system - tibial, popliteal and femoral.
Superficial system - saphenous and perforators.
What is the differential diagnosis of DVT?
Popliteal synovial rupture, superficial thrombophlebitis and calf cellulitis.
What is a bakers cyst?
Popliteal synovial rupture.
What are the different types of imaging we do for DVTs?
1st line ultrasound leg Doppler scan.
CT scan.
