Peripheral Venous Disorders Flashcards
What are the peripheral venous disorders?
- Varicose veins
- Superficial venous thrombophlebitis
- Chronic venous insufficiency (CVI)
- DVT
Describe varicose veins
- Dilated, tortuous superficial veins in lower extremities
- MC great saphenous vein
Risk factors for varicose veins
- Genetic
- Prolonged standing, heavy lifting
- Pregnancy
- Congenital or acquired AV fistulas or venous malformations
What are primary varicose veins?
- Originate in superficial system
- MC females
- 50% pts have fam hx
What are secondary varicose veins?
Originate in deep system (occlusions) and perforating veins (incompetent)
What is the test of choice to plan for varicose vein treatment?
U/S
What are potential complications of varicose veins?
- Superficial venous thrombosis (rare)
- Bleeding (secondary to trauma, MC in older pts)
What is the non-surgical treatment of varicose veins?
- Avoid prolonged standing
- Compression stockings when standing
- Leg elevation when possible
What is the surgical treatment of varicose veins?
- Endovenous ablation
- Great saphenous vein stripping
- Phlebectomy
- Compression sclerotherapy
When to refer varicose veins to vascular surgeon?
- Bleeding from varicose vein
- Superficial venous thrombosis
- Pain
- Cosmetic concerns
What is superficial venous thrombosis?
- Pain localized to site of a superficial thrombus
- Indurated, warm, red, tender cord extending along a superficial vein
- Do NOT result in PE
What is the MC cause of superficial venous thrombosis?
Short term IV
PICC lines
What are the risk factors for superficial venous thrombosis?
- Pregnancy/postpartum
- Varicose veins
- Buerger’s disease
- Trauma
- Systemic hypercoagulability
What is the treatment of superficial venous thrombosis?
- 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)
What is chronic venous insufficiency (CVI)?
- Venous wall and/or valves in leg veins not working effectively
- Causes blood to pool or collect (stasis)
What populations are affected by CVI?
- 50+ yo
- Females
What are causes of CVI?
- Post thrombotic syndrome
- Hx leg trauma
- A/w varicose veins, pelvic tumor, vascular malformations
How does CVI present?
Progressive pitting edema of the leg
What is the treatment of CVI?
Compression stockings!
What is used to treat ulcers/edema in CVI?
Unaboot!
What is DVT?
Blood clot that develops in deep venous system
What are potential complications of DVT?
- PE
- Post thrombotic syndrome (CVI)
- Phlegmasia alba dolens
- Phlegmasia cerulea dolens
What is phlegmasia alba dolens?
- 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
What is phlegmasia cerulea dolens?
- 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
What should be used for making the DVT diagnosis?
Wells criteria:
- 3 points high risk
- 1-2 points medium risk
- Less than 1 point low risk
What are the tests of choice to diagnose DVT?
- D-dimer
- Ultrasound
