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Cardiovascular (Joyce) > Chronic Venous Insufficiency + Varicose Veins > Flashcards

Chronic Venous Insufficiency + Varicose Veins Flashcards

1
Q

Define varicose veins (primary + secondary)

A

Dilated tortuous veins (≥3mm when standing)

  • Primary = superficial/perforator veins (w/o DV incompetence)
  • Secondary = deep veins (from inadequate DVT recanalisation / obstruction)
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2
Q

Define varicose veins (primary + secondary)

A

Dilated tortuous veins (≥3mm when standing)

  • Primary = superficial/perforator veins (w/o DV incompetence)
  • Secondary = deep veins (from inadequate DVT recanalisation / obstruction)
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3
Q

Appropriate venous return requires adequate fx of:

A
  • muscle pump

* venous valves

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4
Q

Pathophysiology of VV

A

Valve incompetence (rarely muscle pump failure) –> reflux / venous blood stasis –> venous HTN –> venous distention (varicose veins)

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5
Q

Histology of VV

A
  • marked increased collagen matrix
  • disorganised SMCs
  • decreased elastin
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6
Q

Define chronic venous insufficiency

A

Impaired venous fx secondary to chronically raised venous pressure

(usually oedema, skin chances, ulcers)

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7
Q

Normal venous pressure when walking in normal vs. CVI

A
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8
Q

Risk factors for VV / CVI

A
  • age
  • FHx (most sig. factor – esp. VV)
  • smoking
  • DVT
  • obesity
  • female, OCP, parity
  • orthostatic occupation
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9
Q

What % of people w. DVT go onto suffer from VV / CVI?

A

up to 50%

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10
Q

What % of people w. DVT go onto suffer from VV / CVI?

A

up to 50%

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11
Q

Clinical Px of CVI / VV

A 
VENOUS CHANGES 
• corona phlebectatica 
• telangectasias 
• reticular veins 
• varicose veins 
SKIN CHANGES 
• dry scaly skin 
• hyperpigmentation (hemosiderin) 
• lipodermatosclerosis 
• eczema 
• atrophie blanche 
• venous ulcers

LEG SYX
• oedema
• leg “heaviness” (at the end of the day)
• leg ache / fatigue (at the end of the day / after long periods of standing – relieved by elevation)
• leg cramps

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12
Q

Pathophysiology of VV

A

Valve incompetence (rarely muscle pump failure) –> reflux / venous blood stasis –> venous HTN –> venous distention (varicose veins)

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13
Q

Histology of VV

A
  • marked increased collagen matrix
  • disorganised SMCs
  • decreased elastin
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14
Q

Cx of CVI / VV

A
  • Hemorrhage (erosion of veins)
  • Ulcers
  • Infx (uncommon if compliant w. Rx/stockings)
  • Saphenectomy / endovenous-related DVT (1-3%)
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15
Q

Normal venous pressure when walking in normal vs. CVI

A
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16
Q

Aetiology of CVI

A
  • REFLUX
  • obstruction (e.g. poor DVT recanalisation)
  • both
  • other (e.g. AVM, venous malformation, connective tissue disorder…)
17
Q

Risk factors for VV / CVI

A
  • age
  • FHx (most sig. factor – esp. VV)
  • smoking
  • DVT
  • obesity
  • female, OCP, parity
  • orthostatic occupation
18
Q

What % of people w. DVT go onto suffer from VV / CVI?

A

up to 50%

19
Q

Classification of venous disease (clinical)

A
  • C0 = no visible venous disease
  • C1 = telangectasies
  • C2 = varicose veins
  • C3 = oedema
  • C4a = pigmentation (hemosiderin +/- eczema due to irritation by blood products)
  • C4b = lipodermatosclerosis (+/- calcification + atrophie blanche)
  • C5 = healed venous ulcers
  • C6 = active venous ulcers
20
Q

Clinical Px of CVI / VV

A 
VENOUS CHANGES 
• corona phlebectatica 
• telangectasias 
• reticular veins 
• varicose veins 
SKIN CHANGES 
• dry scaly skin 
• hyperpigmentation (hemosiderin) 
• lipodermatosclerosis 
• eczema 
• atrophie blanche 
• venous ulcers

LEG SYX
• oedema
• leg “heaviness” (at the end of the day)
• leg ache / fatigue (at the end of the day / after long periods of standing – relieved by elevation)
• leg cramps

21
Q

Ix of CVI / VV

A

Doppler U/S
• localise obstruction
• retrograde flow / reflux
• valve closure time >0.5 seconds

Consider:
• ambulatory venous pressure (gold standard)
• Photoplethysmography

22
Q

Rx of CVI / VV

A

CONSERVATIVE
• graded pressure stockings
• elevation, avoid long periods of standing
• weight loss
• moisturizer
• ULCERS = wrap in zinc-oxide, split thickness grafts, ABX, debridement, phentoxyphillline

SURGICAL
• Valve incompetence –> valve repair
• Reflux –> excision of damaged vein, ligation, ablation, sclerotherapy (injection of NaCl/STD)
• Obstruction –> percutaneous iliac angioplasty + stent

23
Q

Cx of CVI / VV

A
  • Hemorrhage (erosion of veins)
  • Ulcers
  • Infx (uncommon if compliant w. Rx/stockings)
  • Saphenectomy / endovenous-related DVT (1-3%)
24
Q

Appearance of venous ulcers

A

LOCATION =
• ankle
• anterior to medial malleolus
• pretibial area

APPEARANCE
• shallow irregular borders
• ruddy granulation tissue (no dead tissue)
• leg shows evidence of venous insufficiency (leg warm, hair, pulses present)

PAIN = absent / mild (relieved w. elevation)

25
Q

Rx of venous ulcers

A

Heal w. elevation + compression

May also add: 
• zinc oxide dressing 
• partial  thickness graft 
• debridement 
• ABX
• phentoxyphilline

Cardiovascular (Joyce) (5 decks)

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