Peripheral Venous Disease Flashcards
When does chronic venous insufficiency occur?
When blood does not efficiently drain from the legs back to the heart
Often due to damage of valves inside the veins
Where is the gaiter area?
Between the top of the foot + the bottom of the calf muscle
Skin changes in chronic venous insufficient
- haemosiderin staining
- venous or varicose eczema
- lipodermatosclerosis > inverted champagne bottle appearance
- Atrophie Blanche
What is haemosiderin staining?
Red/brown discolouration caused by haemoglobin leaking into skin
What is venous/varicose eczema?
Dry, itchy, flaky red cracked skin
Due to chronic inflammatory response in skin
What is lipdermatosclerosis?
- Hardening + tightening of the skin + SC
- fibrotic SC tissue
- panniculitis: inflammation of SC fat
- causes narrowing of lower legs > inverted champagne bottle
What is atrophie Blanche?
Patches of smooth porcelain white scar tissue on skin
Often surrounded by hyperpigmentation
Aside from skin changes, what can chronic venous insufficiency lead to?
- cellulitis
- poor wound healing
- pain
- skin ulcers
Key points of management of chronic venous insufficient
- keeping skin healthy
- improving venous drainage of legs
- managing complications
Management of chronic venous insufficiency regarding keeping the skin healthy
- monitor skin health + avoid skin damage
- regular emollient use e.g. Cetraban, doublebase
- topical steroids to treat venous eczema flares e.g. hydrocortisone, betnovate
- potent topical steroids to treat lipodermatosclerosis e.g. dermovate
Management of chronic venous insufficiency regarding improving venous drainage
- weight loss
- keeping active
- keep legs elevated when resting
- compression stockings (exclude arterial disease fist with ABPI)
What is deep venous insufficiency?
- Chronic disease that is caused by DVT or valvular insufficiency together with varicose veins
- part of chronic venous insufficiency
Causes of deep venous insufficiency
- primary: underlying defect to vein wall or valves e.g. congenital or connective tissue disorders
- secondary: secondary to damage e.g. trauma, post-thrombotic disease
Risk factors of deep venous insufficiency
- increase age
- female
- pregnancy
- previous DVT or phlebitis
- obesity
- smoking
- jobs with long standing periods
Features of post-thrombotic syndrome
- post DVT
- heaviness, cramps, pain, puritis + Paraesthesia
- pretibilal oedema
- hyperpigmentation
- ulceration
Investigations of deep venous insufficiency
Doppler USS
Foot pulses
Ankle brachial pressure index
What must be done prior to compression management?
Ankle brachial pressure index
To exclude arterial issues
What are varicose veins
Tortuous distended segments of superficial veins with associated valvular incompetence
>3mm
What are reticular veins?
Dilated blood vessels in the skin 1-3mm diameter
What are telangiectasia?
Dilated blood vessels in skin <1mm
Spider veins or thread veins
Risk factors of varicose veins
- prolonged standing
- obesity
- pregnancy
- family history
- DVT
Development of varicose veins
- mostly idiopathic
- secondary causes: DVT, pelvic masses e.g pregnancy, uterine mass, AV malformations
- arise from incompetent valves that allow blood flow from deep venous system to superficial system via perforating veins > venous hypertension + dilation of superficial veins
Where does blood most commonly from between deep to superficial veins in varicose veins?
Site of perforating veins
Sapheno-femroal junction
Sapheno-popliteal junction
Presentation of varicose veins
- visible dilated superficial leg veins
- mainly asymptomatic otherwise
- aching
- itchy
- features of venous insufficiency - ulceration, skin changes
