T13 - Doença Venosa Crónica

Question 1

Estadios mais avançados de Doença Venosa Crónica? Progressão?

Answer 1

Designados por Insuficiência Venosa Crónica (C3-C6) - 15-20%

DVC progrediu em 57.8% dos pacientes

Question 2

Veins are exposed to various biomechanical forces?

Answer 2

1. Flowing blood
2. Intra and extra-luminal pressure
3. Longitudinal tensile load

Question 3

Varicose veins - Cellular mechanisms?

Answer 3

Endothelium Dysfunction
Inflammatory mediators
Leukocyte adhesion, margination, diapedesis and transmigration
– Chronic Inflammation (specific and different from other chronic inflammation)
– Mechanical stimulus

Question 4

Activation of C Nocioceptors?

Answer 4

Inflammatory mediators
Nociceptors - C fibers
Non localized nociceptive message - Diffuse pain

Question 5

SYM Vein Consensus?

Answer 5

• • Description and definition of venous symptoms
• • Attributing leg symptoms to venous disorders
• • Pathophysiology of venous symptoms
• • Scoring of venous symptoms
• • Clinical examination and investigations

Question 6

CEAP Classification?

Answer 6

Clinical Classification
Etiologic Classification
Anatomic Classification
Pathophysiologic Classification

Question 7

Clinical Classification?

Answer 7

C0 - No visible or palpable signs of venous disease
C0s - C0 with minor symptoms
C1 - Telangiectasia or reticular veins
C2 - Varicose veins
C3 - Edema
C4a - Pigmentation and/or eczema
C4b - Lipodermatosclerosis and/or atrophie blanche
C5 - Healed venous ulcer
C6 - Active venous ulcer
S - Symptomatic including ache, pain, tightness, skin irritation, heaviness, and muscle cramps
A - Asymptomatic

Question 8

How to confirm diagnosis?

Answer 8

Duplex ultrasound is recommended as the primary diagnostic test of choice in suspected chronic venous disease, to reliably evaluate the specific venous anatomy and to identify the source and pattern of reflux

Question 9

Complicações agudas de Doença Venosa Crónica?

Answer 9

• • Varicoflebite
• • Varicorragia
• • Trombose Venosa Profunda (Embolia Pulmonar consequente)?

Question 10

Correção Cirúrgica?

Answer 10

Partir de C2

Question 11

QoL and CEAP?

Answer 11

QoL deteriorates with increasing CEAP class

Question 12

Average score by dimension?

Answer 12

Pain, Physic, Psychological, Social

Women over 50 years are more affected in every dimension

Question 13

Sistema Venoso?

Answer 13

Sistema Superficial (Compartimento Safeno)
Sistema Profundo
Veias Prefurantes

Question 14

DVC treatment?

Answer 14

Lifestyle Modifications
- Venoactive Drugs
- Elastic Compression
- Surgery
Prevent complications

Question 15

Indications for invasive treatment?

Answer 15

• • To relief symptoms and improve QoL
• • To prevent acute complications
• • To prevent the progression of the disease
• • To satisfy cosmetic reasons

Question 16

Techniques?

Answer 16

Various minimal invasive techniques

Question 17

Recomendações?

Answer 17

• • For the treatment of great saphenous vein reflux in patients with symptoms and signs of chronic venous disease, endovenous thermal ablation techniques are recommended in preference to surgery
• • For the treatment of small saphenous vein reflux in patients with symptoms and signs of chronic venous disease, endovenous thermal ablation techniques should be considered. Access to the small saphenous vein should be gained no lower than mid-calf.

Question 17

Recomendações?

Answer 17

• • For the treatment of great saphenous vein reflux in patients with symptoms and signs of chronic venous disease, endovenous thermal ablation techniques are recommended in preference to surgery
• • For the treatment of small saphenous vein reflux in patients with symptoms and signs of chronic venous disease, endovenous thermal ablation techniques should be considered. Access to the small saphenous vein should be gained no lower than mid-calf.