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CV <3 > Lecture 18: PVD > Flashcards

Lecture 18: PVD Flashcards

1
Q

What are the essentials of diagnosis of varicose veins?

A
  • Dilated, tortuous, superficial veins in the leg
  • Asymptomatic or aching discomfort/pain
  • Often hereditary
  • Increased frequency post pregnancy
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2
Q

What are the main contributing factors to varicose veins?

A
  • Postpartum women (MC)
  • Prolonged standing
  • Heavy lifting
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3
Q

What are the two underlying mechanisms that contribute to varicose veins?

A
  • Poor venous reflux (valves causing backflow)
  • Venous Hypertension
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4
Q

What vein is MC affected as a varicose vein?

A

Great saphenous vein (medial leg)

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5
Q

What are some possible causes of secondary varicosities?

A
  • Thrombophlebitis
  • Proximal venous occlusion (rare)
  • Congential/AV malformations
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6
Q

What is the MC complaint for varicose veins?

A

Dull, aching heaviness after periods of standing.

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7
Q

What secondary symptom may occur over varicose veins?

A

Itching due to venous eczema

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8
Q

Does the # or size of varicosities correlate with symptoms?

A

NO

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9
Q

What is the chronic condition that may result with long-standing varicose veins?

A

Chronic venous insufficiency

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10
Q

What characterizes chronic venous insufficiency?

A
  • Ankle edema
  • Brownish skin pigmentation
  • Chronic skin induration or fibrosis
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11
Q

How are varicose veins diagnosed?

A

Clinically, but duplex sonography can be ordered as the imaging of choice for planning surgery

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12
Q

What is the nonsurgical tx for varicose veins?

A
  • Compression stockings (20-30 mm Hg)
  • Leg elevation

You only wear stockings during waking hours

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13
Q

What is sclerotherapy?

A

Direct injection of a sclerosing agent to cause permanent fibrosis.

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14
Q

What is endovenous laser therapy?

A

EVLA requires local anesthesia and a laser to destroy the small vein.

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15
Q

When is endovenous radiofrequency ablation a preferred procedure?

A

For significant varicose veins with signs of venous insufficiency or long varicosities

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16
Q

When is vein stripping used?

A

Removing part of the vein that is tortuous

LAST RESORT

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17
Q

What are the essentials of diagnosis of chronic venous insufficiency?

A
  • History of DVT or leg injury
  • Edema, brawny skin pigmentation, or subcutaneous lipodermatosclerosis in lower legs
  • Ulcerations at or above medial ankle
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18
Q

What is the MC etiology of chronic venous insufficiency?

A

Prior deep venous thrombophlebitis

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19
Q

What is a major complicating factor for patients with chronic venous insufficiency?

A

Obesity

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20
Q

What exactly does venous insufficiency lead to in the vein itself?

A

Failure of the valve leaflets to close due to scarring and thickening

Ultimately leads to edema

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21
Q

If a muscle biopsy were taken of someone with chronic venous insufficiency, what might be seen?

A
  • Interstitial space changes
  • Enlargement and fibrosis (elevated fibrinogen and fibrin)
  • Edema and inflammation

Leads to more capillaries

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22
Q

What is peri-capillary fibrosis?

A

Subcutaneous thickening and induration

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23
Q

What results from erythrocyte lysis in chronic venous insufficiency?

A

Hemosiderin deposits => brownish skin

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24
Q

What is the primary symptom of someone with chronic venous insufficiency?

A

Progressive, pitting edema of the lower leg.

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25
Q

What are the secondary conditions that may occur in chronic venous insufficiency?

A
  • Stasis dermatitis
  • Lymphedema
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26
Q

What does chronic venous insufficiency look like?

A
  • Taut, shiny skin at the ankle
  • Hemosiderin staining => brownish skin pigmentation
  • Loss of skin integrity => secondary cellulitis
27
Q

What is lipodermatosclerosis?

A
  • Panniculitis subtype
  • Inverted champagne bottle/bowling pin appearance
28
Q

What is atrophie blanche?

A

Star-shaped, ivory white atropic plaque

29
Q

What is corona phlebectatia?

A

Abnormally dilated veins around the ankles

30
Q

How is chronic venous insufficiency diagnosed?

A

Clinically

31
Q

What is the imaging test of choice for planning therapy in regards to chronic venous insufficiency?

A

Duplex ultrasonography

32
Q

What is the backup imaging for chronic venous insufficiency?

A

MDCT venography or MR venography, but requires dye

Only used if doppler was nondiagnostic

33
Q

What are the mainstays of treating chronic venous insufficiency?

A
  • Compression stockings
  • Avoid sitting a long time
  • Pneumatic compression for refractory cases
34
Q

What is an unna boot and what is it for?

A

Paste gauze compression dressing used for both compression and topical therapy

Weekly changed

35
Q

If a patient develops an ulcer in chronic venous insufficiency, what do they need?

A

A wound care team

36
Q

What are the essentials of diagnosing superficial venous thrombophlebitis?

A
  • Red, painful induration along a superficial vein
  • Commonly occurs at the site of a recent IV line
  • Marked swelling of extremity may occur
37
Q

What is the MCC of superficial venous thrombophlebitis?

A

Recent catheter placement

Caused by staph

38
Q

Where does superficial venous thrombophlebitis typically occur?

A

Lower extremities

MCC: Great saphenous vein

39
Q

What is the lingering thing that may occur with superficial venous thrombophlebitis?

A

Palpable cord

40
Q

What is the main complication of superficial venous thrombophlebitis?

A

Suppurative thrombophlebitis

41
Q

How is superficial venous thrombophlebitis diagnosed?

A

Clinically.

42
Q

What are the 3 complications of suppurative thrombophlebitis?

A
  • Metastatic abscess formation
  • Septicemia
  • Septic emboli
43
Q

When is venous doppler ultrasound indicated for superficial venous thrombophlebitis?

A

ONLY if involves proximal lower extremity or mixed picture

44
Q

How do we manage superficial venous thrombophlebitis?

A
  1. NSAIDs & compression stockings with no limitations on daily activities.
  2. Larger/more painful ones may require hot, wet compresses and leg elevation as well.
45
Q

What would indicate us to use anticoagulants for superficial venous thrombophlebitis? And what are the 3 anticoagulants?

A

If it is 5cm or longer.
Use: arixtra/fondaparinux, LMWH, or xarelto for 45days

Full-dose if it is rapidly progressing

46
Q

If the patient ends up septic from superficial venous thrombophlebitis, what is the goto ABX combo?

A

Rocephin + Vanco + (LWMH or fondaparinux)

The goto

47
Q

What are the essentials of diagnosing lymphangitis?

A
  • Red streaking from wound or cellulitis towards regional lymph nodes, which are typically enlarged and tender.
  • Chills, fever, malaise may be present.

Ang = channels

Extends proximally!

48
Q

What is the MCC of lymphangitis and the 2 main causative organisms?

A

Cutaneous inoculation of hemolytic strep or Staph

49
Q

What is lymphatic filariasis?

A

Lymphedema caused by a mosquito (Wuchereria bancrofti).
MC cause of acute lymphangitis worldwide previously

50
Q

What is nodular lymphangitis?

A

Painful or painless nodular subcutaneous swelling along lymphatic channel.

Always consider malignancy!

51
Q

What is the MC malignancy that causes lymphangitis?

A

Breast cancer

52
Q

How does lymphangitis typically present in the clinic?

A

Trauma/abrasion DISTALLY to infection site

53
Q

How do we diagnose lymphangitis?

A
  • CBC w/diff and blood cultures are a MUST.
  • Wound culture and I&D
  • Imaging for anatomic abnormalities
54
Q

What imaging may be indicated for lymphangitis?

A

Lymphangiography and lymphoscintigraphy

55
Q

What is the empiric ABX therapy for lymphangitis?

A

GABHS coverage: Dicloxacillin, keflex, ancef, rocephin, bactrim, etc

56
Q

Who can undergo oral abx therapy outpatient for lymphangitis?

A
  • Non-toxic
  • Non-febrile
  • Not immunocompromised
57
Q

What kind of compresses help lymphangitis?

A

Hot

58
Q

What kind of lymphangitis usually needs surgical intervention?

A

Nodular lymphangitis

59
Q

What are the essentials of lymphedema?

A
  • Painless, persistent edema of one or both legs, usually young women.
  • Pitting edema w/o ulceration, varicosities, or stasis pigmentation.
  • Lymphangitis and cellulitis could also develop
60
Q

What is the primary form of lymphedema?

A

Congenital hypo/hyperplastic lymphatics.

Worsening condition: pelvic or lumbar involvement.

61
Q

What is the secondary form of lymphedema?

A

Inflammatory or mechanical lymphatic obstruction from trauma, regional lymph node resection/irradiation, or malignancy, often following surgical removal of the lymph nodes in the groin or axilla.

62
Q

What can happen in both forms of lymphedema?

A

Secondary dilation of the lymphatics

63
Q

How is lymphedema diagnosed?

A

Clinically. MRI only for identifying masses.

64
Q

How is lymphedema managed?

A
  1. Intermittent leg elevation
  2. Compression stockings
  3. Massage toward the trunk
  4. Wound care
  5. Good hygiene
  6. Amputation for lymphangiosarcoma

CV <3 (25 decks)

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