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Clin Med-Cardiology Exam 1 > Peripheral Venous Disorders > Flashcards

Peripheral Venous Disorders Flashcards

1
Q

Varicose Veins most commonly found

A

greater saphenous vein and its branches

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2
Q

Varicose Veins pathophysiology

A

Distention of the vein results in weakened/incompetent valves  dilation along the vein
Dilation increased pressure and distention of the vein segment below that valve progressive failure of the next lower valve increased dilation
Perforating veins may become incompetent as well reflux of blood from the deep system into the superficial system which results in increasing venous pressure and distention

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3
Q

Varicose vein RF

A

Genetics
Prolonged standing or heavy lifting
Pregnancy
Congenital or acquired AV fistulas or venous malformations (young patients)

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4
Q

Varicose Vein S/S

A

Does not correlate to the # and size of varicosities
Asymptomatic or symptomatic
Dull ache/heaviness or fatigue of the legs after prolonged standing that is relieved w/ leg elevation
Venous stasis dermatitis may be present above the ankle or directly over a large varicosities
May be visible on exam when standing
May only be palpable in obese patients
If chronic, a brownish pigmentation and thinning of the skin above the ankle may be present

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5
Q

What imaging do you want to use for Varicose veins

A

Duplex Ultrasound

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6
Q

Varicose vein comlications

A

Superficial venous thrombosis (rare)

Bleeding

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7
Q

Varicose vein treatment non Sx

A

Avoid prolonged standing
compression stockings
Leg elevation when possible

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8
Q

Varicose Vein TX with Sx

A

Endovenous ablation (radiofrequency or laser)
Greater saphenous vein stripping
Phlebectomy w/ or w/o correction of reflux
Compression Sclerotherapy

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9
Q

When should you refer a pt with varicose veins to surgeon

A

Bleeding from varicose vein
Superficial venous thrombosis
Pain
Cosmetic concerns

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10
Q

What is Superficial venous thrombosis

A

Pain localized to the site of a superficial thrombus

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11
Q

Superficial venous thrombosis S/S

A

Indurated, warm, red and tender cord extending along a superficial vein, (common along the saphenous vein)
Most common cause: short term intravenous catheterization(IV’s) and PICC lines
Do not result in pulmonary emboli

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12
Q

Superficial venous thrombosis RF

A 
Pregnancy/postpartum
Varicose veins
Thromboangiitis obliterans
Trauma
Systemic hypercoagulability (protein s,c or phospholipid insufficiency)
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13
Q

Superficial venous thrombosis TX

A

Supportive:
Elevation, warm compresses and NSAIDS
Anticoagulation:
Only indicated if a thrombus has developed in the thigh or arm and it is extending toward the saphenofemoral junction (leg) or the cephalo-axillary junction (arm)

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14
Q

CVI definition

A

A condition that occurs when the venous wall and/or valves in the leg veins are not working effectively
It becomes difficult for blood to return to the heart from the legs
Causes blood to “pool” or collect in these veins

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15
Q

CVI causes

A

Changes secondary to acute DVT (post thrombotic syndrome)
History of leg trauma

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16
Q

Chronic Venous Insufficiency Pathophysiology

A

Valve leaflets either thickened and scarred (post thrombotic syndrome) or functionally inadequate (varicose/refluxed vein)

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17
Q

CVI RF

A 
DVT
Varicose Veins
Obesity
Pregnancy
Inactivity
smoking
Extended periods of sitting or standing
Female
Age over 50 years old
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18
Q

CVI S/S:

A

Progressive pitting edema of the leg is the primary presenting symptoms

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19
Q

CVI imaging

A

Duplex US

20
Q

CVI treatment

A

Compression stockings mainstay of Tx
can also
Avoid long periods of sitting/standing
Intermittent elevations of legs throughout the day, sleeping w/ legs elevated above the level of the heart

21
Q

CVI Ulcer TX

A

Ulcers (involve a wound care specialist):
Wet to dry dressings or occlusive hydrocolloid dressings (consist of paste w/ zinc oxide, calamine, glycerin and gelatin), ex. Unaboot

22
Q

CVI SX Tx

A

Radiofrequency ablation or endovenous laser tx to correct superficial reflux/incompetent perforator veins that feed the area of ulceration to promote healing

23
Q

DVT definition

A

A blood clot that develops in the deep venous system. The clot may partially or completely block blood flow through the vein.

24
Q

DVT (Virchow’s Triad):

A

Venous Stasis
Injury to the vessel wall
Hypercoagulable state

25
Q

EVT etiology

A

Mechanical Injury to the Vein Wall

Hypercoagulable state

26
Q

DVT complications

A

Pulmonary Embolism
Post thrombotic syndrome (chronic venous insufficiency)
Phlegmasia alba dolens
Phlegmasia cerulea dolens

27
Q

Phlegmasia Alba Dolens

A

White Leg
Occurs when there is massive deep thrombosis with total occlusion of the deep venous system.
The venous drainage falls on the superficial system which is unable to handle the load. Develop edema in the leg which compromises the arterial circulation  leg turns white

28
Q

Phlegmasia cerulea dolens

A

Venous gangrene
Continuation of alba dolens(white leg) where you develop complete occlusion of the arterial blood supply to the limb
Usually require amputation

29
Q

DVT RF

A 
Hypercoagulable states
Thrombophilia
Trauma
Obesity
Recent Surgery/invasive procedures
Immobilization
Recent Prolonged Travel
Cancer
Pregnancy/Post-partum
OCP’s/HRT 
Prior DVT
30
Q

DVT Signs/symptoms

A 
Leg swelling
Leg pain
Unilateral leg tenderness
 Unilateral pitting edema
Increased calf circumference (>2-3cm)
Calf Tenderness
Homan’s Sign (controversial)
31
Q

DVT diagnosis

A

D-dimer:
Sensitivity is >80%, not specific
Combination of low-risk assessment (<1 point on Wells) & negative D-dimer assay effectively rules out DVT
Positive d-Dimer test does not raise the likelihood of DVT
False +: MI, Sepsis, Cancer, Post-op state, Late Pregnancy

32
Q

DVT imaging

A

Ultra sounds most widely used

33
Q

DVT immediate TX

A

Mainstay of tx:
Immediate anti-coagulation with:
Parenteral unfractionated Heparin (UFH),
Low Molecular Weight Heparin (LMWH) or
fondaparinux
** all of above followed by conversion to oral Coumadin ( Warfarin) or Thrombolytics

34
Q

DVT long term anticoagulation

A

Warfarin which is started at the same time as parenteral agent
Takes 5-7 days to achieve therapeutic dosage of Coumadin (INR target of 2.5 w/ a range of 2.0-3.0)

35
Q

Immediate Anticoagulation

A

After 5-7 days of treatment, the residual thrombus will begin to endothelialize in the vein. The meds do not directly dissolve thrombus

36
Q

LMWH

A

Has a greater bioavailability, a more predictable dose response and a longer half life than UFH
No monitoring or dose adjustment is required unless the patient is markedly obese or has CKD (reduce dose)

37
Q

Fondaparinux (Arixtra )

A

Administered SQ once daily
No lab monitoring is required
Weight based dosage
Does not cause heparin induced thrombocytopenia

38
Q

Warfarin

A

Requires a minimum of 5 days to be therapeutic
Monitor INR (assesses the anticoagulant effect)
Typical starting dose is 5mg QD
Dose is titrated to achieve the target INR

39
Q

Role of Thromolytics in Acute DVT

A

Direct attack on the clot, unlike anti-coagulant therapy
Limited role currently
Only used in very select cases of Extensive DVT (Ileo-Femoral) of recent origin, in a pt. with low bleeding risks
Complications of bleeding high

40
Q

Inferior Vena Caval Filters (IVC) indications

A

Active bleeding that contraindicates anticoagulation
Recurrent venous thrombosis despite intensive anticoagulation
Prophylactically: Major trauma with multiple/complex pelvic fractures, Severe head injuries, patients with advanced malignancy

41
Q

DVT Typically treated as an outpatient if

A

patient/family can administer the parenteral anticoagulant,
The patient has a good support system,
Ths patient has a permanent residence, telephone service and no hearing/language impairment is present

42
Q

Provoked DVT in arm/calf (recent surgery, trauma, OCP/HRT, or indwelling catheter) Tx

A

3 months of tx

43
Q

Provoked proximal leg DVT

A

3-6 months

44
Q

Patients w/ cancer:

A

3-6 months of LMWH w/o warfarin and continue anticoagulation indefinitely unless patient becomes cancer-free

45
Q

Unprovoked DVT

A

consider indefinite tx d/t high rate of recurrence

Clin Med-Cardiology Exam 1 (8 decks)

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