PVD Flashcards
What is chronic venous insufficiency?
valvular incompetence w/secondary venous HTN in LEs
May c/o fatigue, heaviness or achiness in legs, may have varicose veins
Risk factors for CVI
prolonged standing increased body weights failed muscle pump function trauma hx leg ulcer claudication pregnancy genetics NOT risk factors: DM, HTN, smoking (these are arterial)
What to look for/inspect on exam of CVI
Inspection: varicosities, pigmentation irregularities, stasis dermatitis, edema, healed/active ulcers, dilated saphenous veins
What to palpate for on exam of CVI
calf - tenderness or firmness, muscle tension, saphenous system for cords and tenderness, LE pulses
How to test for incompetent saphenous veins
Manual Compression Test
bottom fingers palpate dilated vein then compress top fingertips about 20cm above. If pulse noted to distal fingers, saphenous valves in that portion of vein incompetent
Characteristics of venous ulcers
irregular border, shallow fibrous wound bed, rarely eschar, underlying structures not typically visible, +pulses
often in ankle area or lower leg above medial malleolus, slow developing
Characteristics of arterial ulcers
regular margins, base of yellow fibrous material or necrotic eschar, granulation tissue scant or absent, exposure of underlying structures more common, decreased pulses
How to distinguish between cellulite and VI
cellulitic areas blanch then rapidly return to bright red (venous takes a few seconds for bluish hue to return)
Characteristics of lymphedema
soft edema that becomes hard and non pitting, marked thickening of skin, rarely ulcerates - can be d/t surgery, radiation, presence of tumor near lymph nodes
What is superficial thrombophlebitis?
thrombosis and inflammation of one or more superficial veins (25% have concurrent DVT)
How to manage superficial thrombophlebitis?
if has not extended to deep veins, negligible risk for PE and often can be effectively managed w/ice, elevation, NSAIDs. Can also use LMWH
How to Dx DVT
Compression venous ultrasonography w/or w/o doppler imaging (non-compressible is diagnostic)
Contrast venography is still gold standard, but not really used unless symptomatic and other methods have not been confirmatory
Tx of DVT
LMWH - weight based dosing
start warfarin on day 1 at 5mg, adjust subsequent daily dose per INR
Stop heparin after at least 4/5 days of combined therapy w/INR >2
Continue warfarin at least 3 mo w/INR 2-3
Clinical manifestations of superficial thrombophlebitis
pain, swelling, redness, tenderness of superficial veins
