Module 5 : Chronic Venous Pathology Flashcards
chronic venous disease - underlying causes
- dysfunctional valves
- chronic outflow obstruction
dysfunctional valves
- primary = congenital \+ absence of valves \+ structure of valves mess d up - secondary \+ previous DVT \+ post thrombotic syndrome
chronic outflow obstruction
- iliofemoral veins post DVT
- recanalized vein or collaterals
+ decreased venous return
+ increase venous pressures - limb swelling and pain
symptoms of chronic venous insufficiency
- swelling and edema
- heaviness/ache
- discolouration/hyperpigmentation/brawny discolouration - gaiter sone
- varicosities
- venous claudication = intense burning
- stasis dermatitis/dry flaky skin
- telangiectasia
skin changes specific to chronic insufficiency
- edema
- brawny discoloration
- ulceration
- redness/rubor
edema
- fluid accumulation in tissue due to increase venous pressure
brawny discoloration
- browns color in gaiter zone
- result of leakage of RBC into surrounding tissue
ulceration
- tissue breakdown
- usually near medial malleolus
- typically occurs with deep vein GSV SSV incompetence
redness/rubor
- inflammation
- cellulitis
reflux
- retrograde flow in the veins
- caused by absent or incompetent valves
- results in venous hypertension due to
+ failed valves
+ calf muscle pump is ineffective
+ failure of perforating vein
venous hypertension - failed valves
- allows full gravitational/hydrostatic pressure exerted on the vein walls
venous hypertension - calf muscle pump is ineffective
- decreases ejection of blood that results in increased residual venous volume
venous hypertension - failure of perforating veins
- allows flow to reverse from deep to superficial veins
- high pressure in deep system is transferred to the weaker superficial system
- causes symptoms of heaviness and aching
varicose veins
- palpable
- distended greater than 4mm in diameter
- primary and secondary
varicose veins - primary
- dilated tortuous
- restricted to the superficial system
+ increased intraluminal pressure due to pregnancy obesity and prolonged standing - treatment : surgical ligation (vein stripping)
varicose veins - secondary
- due to obstructive conditions such as a previous DVT
- treatment
+ do not benefit from vein stripping
+ support stockings
+ surgical ligation of perforators
intraluminal pressure and perforators
- INCREASED DEEP VEIN INTRALUMINAL PRESSURE MAY CAUSE PERFORATORS TO DILATE AND BECOME INCOMPETENT
lower extremity venous insufficiency duplex exam - position
- patient standing or with the bed in an extreme reverse trendelenberg
- supine position ineffective for reflux assessment
- standing
+ uses stool or platform with handrail
+ holds handrail
+ rotate leg outward
+ transfers weight to opposite leg - calf veins examined
+ sitting or legs over bed
lower extremity venous insufficiency duplex exam - provocative maneuvers - valsalva
- assess PROXIMAL VENOUS VALVES FOR COMPETENCY
- inhale deeply hold their breath and contract the abdomen
- ask patient to release breath and relax abdomen after 1-2 seconds
lower extremity venous insufficiency duplex exam - provocative maneuvers - augmentation
- used to determine reflux below the knee
protocol
- rule out DVT in deep system
+ compression - assess deep venous system for phasicity and reflux
+ color and spectral waveform
+ use valsalva and distal leg augmentation
protocol - assessing the superficial system - gsv
- gsv
+ measure diameter
- transverse plane prod mid distal
+ color and spectral
- valsalva and augmentation for reflux
- SFJ (superficial femoral junction)
- look for accessory veins, duplication, varicosity
protocol - assessing superficial system - ssv
- measure diameter
+ transverse plane
+ start at ankle and work superior to SPJ
+ if less than 2mm mot likely competent - color and spectral
+ saphenopopliteal junction SPJ
protocol - assessing superficial system - assess perforators
- normally difficult to see
- seated
- medial calf to cocketts
- transverse plane tibiomedial condyle
- check for flow
+ should be towards the deep veins and < 3mm - best assessed with color