JC01 (Surgery) - Vein diseases Flashcards
Describe the course of the great saphenous vein
□ Arises from medial side of dorsal venous
arch of foot
□ Ascends immediately anterior to medial
malleolus together with saphenous n.
□ Runs up leg posteriorly to run posterior to
medial femoral condyle
□ Ascends obliquely up medial thigh
□ Empties at saphenofemoral junction (SFJ)
into femoral vein (deep venous system)
Define location of the saphenofemoral junction (SFJ)
→ 2.5cm below and lateral to pubic
tubercle
Describe the course of small saphenous vein
□ Arises from lateral side of dorsal venous arch of foot
□ Ascends posterior to lateral malleolus
□ Ascends along midline of posterior leg accompanied
by the sural nerve
□ Empties at saphenopopliteal junction (SPJ) into
popliteal vein (deep venous system)
Function and locations of perforating veins
Penetrate deep fascia to form communication between deep and superficial venous systems
→ SFJ and SPJ → Hunterian perforator at proximal thigh → Dodd’s perforator at distal thigh → Boyd’s perforator around knee level → Cockett’s perforators at 5, 10, 15cm from medial malleolus
Define chronic venous insufficiency
ambulatory venous hypertension
arises from congenital, primary or secondary causes (Etiology)
giving rise to reflux or obstruction or both (Pathophysiology)
in deep or superficial veins (Anatomy)
Risk factors of chronic venous insufficiency (7)
□ Gender: F>M
□ Age
□ Stature: ↑with BMI and height
□ Pregnancy: hormone-related weakness in venous wall
□ Occupation: long periods of standing
□ Family Hx: 50% if 1 parent, up to 80% risk if both parents
□ Causes of deep venous obstruction, eg. pelvic tumours
Symptoms of chronic venous insufficiency (5)
Symptoms:
□ Disfigurement
□ Pain: dull, in calf and lower leg (eg. nocturnal cramps)/ throughout day/ with prolonged standing
□ Pitting ankle oedema
□ Skin manifestations: hyperpigmentation, eczema, lipodermatosclerosis
□ Venous ulcer
Complications of varicose veins
→ Bleeding (due to thinning of skin)
→ Thrombosis (due to tortuosity of veins)
→ Superficial thrombophlebitis: red, painful tender lumps
→ Cellulitis
→ Other skin changes: eczema, lipodermatosclerosis, ulcerations
3 major etiologies of ambulatory venous hypertension
Primary (majority): inherent/ congenital weakness in venous walls
Secondary: Post-thrombotic
- Thrombosis obstruct deep veins
- WBC removal of thrombus cause valvular destruction and insufficiency
Postural/ Prolonged standing: increase venous pressure and dilatation
Explain regulation of venous pressure in lower limb
Normal venous pressure in foot ≈ 100mmHg
(column of blood from heart)
Muscle pump required to return venous
blood to heart → ambulatory venous BP ≈20-30mmHg
Flow of venous blood in lower limb during muscle contraction and relaxation?
1) Muscle contraction
→ deep veins compressed
→ blood ejected proximally
2) Muscle relaxation
→ ↓deep venous pressure
→ blood inflow from superficial veins via perforating veins
Explain pigmentation, edema and inflammatory changes in CVI
□ Pigmentation due to extravasation of RBC and hemoglobin
□ Pitting oedema due to extravasation of fluid and overloading of lymphatics
□ Inflammatory changes due to extravasation of WBC and plasma protein
→ Result: itchiness, skin thickening and ulcers
Varicose veins = chronic venous insufficiency. True or False? Why?
False
- VV is merely a reflection of the status of superficial veins
- Presence of VV often does NOT correlate with other
clinical manifestations of ambulatory venous HTN - VV should not be understood as the (sole) cause
or ‘precursor’ of more severe CVI manifestations
Causes of varicose veins
□ Primarily perforator incompetence → reflux of blood into superficial veins and dilatation
□ Primarily deep vein reflux/obstruction → perforators gradually become incompetent → reflux of blood into superficial veins → dilatation
□ Primarily superficial vein reflux/obstruction (uncommon)
Classification for clinical manifestations of CVI?
CAEP Classification: Clinical
C1 = Telangiectasia/ reticular veins C2 = Varicose veins C3 = Unilateral pitting Edema C4 = Pigmentation, eczema, dermatosclerosis C5 = Healed ulcer C6 = active ulcer
