Peripheral Venous Disorders

Question 1

What are the peripheral venous disorders?

Answer 1

• Varicose veins
• Superficial venous thrombophlebitis
• Chronic venous insufficiency (CVI)
• DVT

Question 2

Describe varicose veins

Answer 2

• Dilated, tortuous superficial veins in lower extremities

- MC great saphenous vein

Question 3

Risk factors for varicose veins

Answer 3

• Genetic
• Prolonged standing, heavy lifting
• Pregnancy
• Congenital or acquired AV fistulas or venous malformations

Question 4

What are primary varicose veins?

Answer 4

• Originate in superficial system
• MC females
• 50% pts have fam hx

Question 5

What are secondary varicose veins?

Answer 5

Originate in deep system (occlusions) and perforating veins (incompetent)

Question 6

What is the test of choice to plan for varicose vein treatment?

Answer 6

U/S

Question 7

What are potential complications of varicose veins?

Answer 7

• Superficial venous thrombosis (rare)

- Bleeding (secondary to trauma, MC in older pts)

Question 8

What is the non-surgical treatment of varicose veins?

Answer 8

• Avoid prolonged standing
• Compression stockings when standing
• Leg elevation when possible

Question 9

What is the surgical treatment of varicose veins?

Answer 9

• Endovenous ablation
• Great saphenous vein stripping
• Phlebectomy
• Compression sclerotherapy

Question 10

When to refer varicose veins to vascular surgeon?

Answer 10

• Bleeding from varicose vein
• Superficial venous thrombosis
• Pain
• Cosmetic concerns

Question 11

What is superficial venous thrombosis?

Answer 11

• Pain localized to site of a superficial thrombus
• Indurated, warm, red, tender cord extending along a superficial vein
• Do NOT result in PE

Question 12

What is the MC cause of superficial venous thrombosis?

Answer 12

Short term IV

PICC lines

Question 13

What are the risk factors for superficial venous thrombosis?

Answer 13

• Pregnancy/postpartum
• Varicose veins
• Buerger’s disease
• Trauma
• Systemic hypercoagulability

Question 14

What is the treatment of superficial venous thrombosis?

Answer 14

• Supportive (elevation, warm compress, NSAIDs)
• Anticoag (only indicated if a thrombus is in thigh or arm and extending toward junctions that may take it into deep vein system)

Question 15

What is chronic venous insufficiency (CVI)?

Answer 15

• Venous wall and/or valves in leg veins not working effectively
• Causes blood to pool or collect (stasis)

Question 16

What populations are affected by CVI?

Answer 16

• 50+ yo

- Females

Question 17

What are causes of CVI?

Answer 17

• Post thrombotic syndrome
• Hx leg trauma
• A/w varicose veins, pelvic tumor, vascular malformations

Question 18

How does CVI present?

Answer 18

Progressive pitting edema of the leg

Question 19

What is the treatment of CVI?

Answer 19

Compression stockings!

Question 20

What is used to treat ulcers/edema in CVI?

Answer 20

Unaboot!

Question 21

What is DVT?

Answer 21

Blood clot that develops in deep venous system

Question 22

What are potential complications of DVT?

Answer 22

• PE
• Post thrombotic syndrome (CVI)
• Phlegmasia alba dolens
• Phlegmasia cerulea dolens

Question 23

What is phlegmasia alba dolens?

Answer 23

• Complication of DVT
• White Leg
• Occurs when there is total occlusion of deep venous system
• Edema in leg develops and compromises arterial circulation = white leg

Question 24

What is phlegmasia cerulea dolens?

Answer 24

• Complication of DVT
• Venous gangrene
• Continuation of alba dolens (white leg)
• Complete occlusion of arterial blood supply
• Skin and toes become gangrenous
• Prognosis very poor

Question 25

What should be used for making the DVT diagnosis?

Answer 25

Wells criteria:

• 3 points high risk
• 1-2 points medium risk
• Less than 1 point low risk

Question 26

What are the tests of choice to diagnose DVT?

Answer 26

• D-dimer

- Ultrasound