Chronic Venous Pathophysiology

Question 1

What is the learning outcome for chronic venous disease?

Answer 1

Differentiate the pathophysiology of acute and chronic venous disease.

Question 2

What are the objectives related to chronic venous insufficiency?

Answer 2

Describe sonographic techniques to evaluate for chronic venous insufficiency and venous mapping.

Question 3

What are the signs and symptoms of chronic venous insufficiency (CVI)? 8

Answer 3

1. Swelling/edema
2. Heaviness/ache
3. Hyperpigmentation
4. Ulcers
5. Varicosities
6. Venous claudication
7. Stasis dermatitis
8. Increased venous pressure.

Question 4

What are the underlying causes of chronic venous insufficiency? What are the two types?

Answer 4

Dysfunctional valves which can be primary (congenital) or secondary (damaged from previous DVT or chronic outflow obstruction).

Question 5

What is post-thrombotic syndrome? What does this cause? 2

Answer 5

1. Damage to the vein post DVT
2. Leading to fibrous strands that increase the risk of recurring DVT.

Question 6

What is reflux in the context of venous disease?

Answer 6

Retrograde flow of blood in the veins of the lower extremity, resulting in venous hypertension.

Question 7

What are the types of varicose veins? 3

Answer 7

1. Spider veins
2. Reticular veins
3. Varicose veins.

Question 8

What is the role of ultrasound in assessing chronic venous insufficiency? 3

Answer 8

1. To rule out DVT
2. Assess the deep system
3. Superficial system, and perforators.

Question 9

What are the normal reflux times in the deep system? 2

Answer 9

1. Less than 1 second is normal
2. Greater than 1 second is clinically significant.

Question 10

What are the preventative treatments for chronic venous insufficiency? 7

Answer 10

1. Limit inactivity
2. Exercise
3. Lose weight
4. Elevate legs
5. Wear compression stockings
6. Practice good skin hygiene
7. Take antibiotics for skin infections.

Question 11

What are the main medical treatments for chronic venous insufficiency?

Answer 11

Injection sclerotherapy and endovenous thermal ablation.

Question 12

What are common surgical treatments for chronic venous insufficiency?

Answer 12

Ligation and stripping of incompetent veins and vein bypass.

Question 13

What is venous mapping?

Answer 13

Using duplex ultrasound to determine the availability of superficial veins for bypass conduits.

Question 14

What is the first choice vein for bypass procedures?

Answer 14

The great saphenous vein (GSV) must have a diameter greater than 2.5mm.