Deep Venous Insufficiency Flashcards
Causes of DVI
Either by DVT or valvular insufficiency
Results due to failure of the venous system.
Together with varicose veins in the superficial system it is part of chronic venous insufficiency
Characterised by valvular reflux, venous HTN and obstruction
Primary causes of DVI
Underlying defect to the vein wall or valvular component
Includes congenital defects and connective tissue disorders
Secondary causes
Post-thrombotic disease
Post-phlebitic disease
Venous outflow obstruction
Trauma
Risk factors
Increasing age
Female gender
Pregnancy
Previous DVTs
Phlebitis
Obesity
Smoking
Jobs with long periods of standing
Clinical features
Chronically swollen lower limbs that can be aching, pruritic and painful
Venous claudication with bursting pain and tightness on walking
Examination findings
Varicose eczema
Thrombophlebitis
Haemosiderin skin staining
Lipodermatosclerosis
Atrophie blanche
What might patients who had a prior DVT present with?
Post Thrombotic syndrome
Features of Post Thrombotic syndrome
Heaviness
Cramps
Pain
Pruritus
Paraesthesia
Signs of pretibial oedema
Skin induration
Hyperpigmentation
Venous ectasia
Redness
Ulceration
What is used to monitor the degree of post-thrombotic syndrome
Villalta scale
Dx
Renal
Hepatic
Cardiac
disease
Lab tests
Routine bloods with FBC, U&Es and LFTs
ECHO might be done
Investigations
Doppler USS to assess the extent of venous reflux
MR venogram might be done as well.
Documentation of foot pulses and ABPI should be recorded as well
Conservative mangement
Compression stockings + suitable analgesic control
If the patient has a venous ulcer they should be started in full compression treatment with 4 layer bandage.
If symptoms remain elevating feet above the level of the heart can reduce symptoms and disease progression.
Surgical management
Less successful and poor level of evidence of any benefit.
Indications of venous stenting
Severe post thrombotic syndrome with an occluded iliac vein.
Puncturing the popliteal or femoral vein and crossing the occluded segment of vein with a wire up into the IVC
A balloon is then used to dilate the iliac vein prior to placement of a venous stent.
