Lower limb venous disease Flashcards
What is the CEAP classification of chronic venous disease?
Clinical signs
Aetiology
Anatomy
Pathophysiology
What is CEAP class 0?
No visible or palpable signs of venous disease
What is CEAP class 1?
Telangectasia, reticular veins, malleolar flare
What is CEAP class 2?
Varicose veins
What is CEAP class 3?
Oedema without skin changes
What is CEAP class 4?
Skin changes:
- Pigmentation
- Venous eczema
- Lipodermatosclerosis
What is CEAP class 5?
Skin changes with healed ulceration
What is CEAP class 6?
Skin changes with active ulceration
Which CEAP classes does the term “chronic venous disease” refer to?
All: C0-C6
Which CEAP classes does the term “chronic venous insufficiency” refer to?
C4-C6
What are risk factors for chronic venous disease?
Strong: age, pregnancy
Proposed: family history, obesity, prolonged standing, Caucasian, low fibre diet
What are the anatomical factors which assist in venous return to the heart?
- One-way venous valves
- Compression of veins/sinusoids by calf muscles
- Negative thoracic pressure on inspiration
Causes of venous hypertension?
Reflux (90%):
- Superficial
- Deep: post-DVT with recanalisation; primary valvular incompetence; congenital valvular atresia
Obstruction (10%):
- Iliofemoral vein area
- Superficial femoral vein area
- Varied locations
Causes of venous insufficiency?
- Venous pump overwhelmed by incompetent superficial vein valves
- DVT with: damage to pumping units; obstruction to deep veins; damage to valves; reflux from over-expanded veins acting as collaterals
- Deep veins obstructed by external pressure
- Inborn deficiency of valves or inherent weakness in vein walls
- Prolonged inactivity of muscles in dependant position
- Muscle dysfunction/paralysis
- Skeletal problems, arthritis, injury
What is primary venous insufficiency?
When no aetiologic mechanism can be identified: current theory is: inherently weak wall –> dilatation –> separation of valve cusps –> valvular incompetence
What is secondary venous insufficiency?
When there is an identifiable cause for the insufficiency e.g. DVT
Symptoms of venous insufficiency?
Aching, throbbing, itching, leg fatigue, heaviness, swelling
Usually worse at end of the day
Alleviated by elevation
Complications of varicosities?
- Thrombophlebitis: thrombosis in superficial varicosity followed by inflammation
- Pulmonary embolism if thrombophlebitis extends to sapheno-femoral junction
- Rupture/bleeding of varicosity - may be spontaneous or due to trauma
Complications of venous hypertension?
- Oedema
- Skin hyperpigmentation
- Itching
- Eczema
- Lipodermatosclerosis
- Breakdown of skin with ulceration
Definition of telangiectasia?
Dilated intradermal venules
Definition of reticular veins?
Dilated, non-palpable, subdermal veins
Definition of varicose veins?
Dilated, palpable subcutaneous veins >3mm
What is the anatomical distribution of the great saphenous vein?
Medial calf and thigh
What is the anatomical distribution of the short saphenous vein?
Posterolateral calf
