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Varicose veins & SUPERFICIAL & DEEP VEINS OF BODY Flashcards

1
Q

Superficial Veins of Upper Extremity
🧠⚡CBC ⚡

A

Cephalic Vein
Basilic Vein
Cubital Vein (Median Cubital Vein)

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2
Q

Deep Veins of Upper Extremity

🧠⚡BUR⚡

A
  1. Brachial Vein
  2. Ulnar Vein
  3. Radial Vein
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3
Q

Superficial Veins of Lower Extremity

A
  1. Greater Saphenous Vein
  2. Small Saphenous Vein
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4
Q

Deep Veins of Lower Extremity

🧠⚡IF PTP⚡

A
  1. Iliac vein
  2. Femoral vein
  3. Popliteal vein
  4. Tibial vein
  5. Peroneal Vein
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5
Q

GREAT SAPHENOUS VEIN
🧠⚡GmF ⚡

A

Medial aspect of LEG
⬇️
drains into Femoral Vein

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6
Q

Great SAPHENOUS vein lies close to

A

SAPHENOUS Nerve

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7
Q

SHORT SAPHENOUS VEIN
🧠⚡SLP ⚡

A

Lateral aspect of Leg
⬇️
Popliteal Vein

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8
Q

SHORT SAPHENOUS VEIN lies close to

🧠⚡Short is SO Short, that it cannot accompany SAPHENOUS NERVE ⚡

A

SURAL Nerve

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9
Q

ANTERIOR SAPHENOUS VEIN

A

Drains into LATERAL ASPECT of KNEE
⬇️
Drains tti GSV

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10
Q

Vein of Giacomini

A

Posterior extension of SHORT SAPHENOUS VEIN to GREATER SAPHENOUS VEIN

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11
Q

PERFORATORS of LOWER LIMB

🧠⚡My CBD Has Smooth Feathers ⚡

A
  1. May / Kustner Perforator @ HEEL
  2. Cockette Perforators x3 @ ANKLE
    ✨ 5cm above MEDIAL MALLEOLUS
    ✨ 10cm above MEDIAL MALLEOLUS
    ✨ 15cm above MEDIAL MALLEOLUS
  3. Boyd Perforator @ KNEE (BELOW KNEE)
  4. Dodd Perforator @ MID-THIGH (ABOVE KNEE)
  5. Hunterian Perforator @ THIGH
  6. Spheno-femoral junction Perforator
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12
Q

SUPERFICIAL & DEEP VENOUS SYSTEM are connected by

A

PERFORATORS

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13
Q

What % of BLOOD flows through:
⭐ SUPERFICIAL VENOUS SYSTEM
⭐ DEEP VENOUS SYSTEM

A

⭐ SUPERFICIAL VENOUS SYSTEM
🎯 20%

⭐ DEEP VENOUS SYSTEM
🎯 80%

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14
Q

Location of SAPHENOFEMORAL JUNCTION

A

4cm BELOW & LATERAL to PUBIC TUBERCLE

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15
Q

For CORONARY ARTERY BYPASS, which vein graft is used

A

Great SAPHENOUS VEIN

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16
Q

Why SHORT SAPHENOUS VEIN cannot be STRIPPED?

A

Closely associated with SURAL NERVE, all along its course

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17
Q

TOTAL NUMBER OF PERFORATORS in LEGS

A

100-150 Perforators

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18
Q

VARICOSE VEINS

A

Dilated Tortuous VEINS with defective Valve

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19
Q

Cause of MOVEMENT OF BLOOD in ANTIGRAVITY DIRECTION

A
  1. Compression of MUSCLE around the Vein
  2. NEGATIVE INTRA-THORACIC PRESSURE DURING INSPIRATION
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20
Q

PERIPHERAL HEART

A

SOLEUS muscle

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21
Q

Theory for VARICOSE VEIN development

A

AMBULATORY VENOUS HYPERTENSION THEORY

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22
Q

During Exercise, MOST of the BLOOD goes through

A

Pressure in the SUPERFICIAL Venous system ⬇️
⬇️
Blood goes through DEEP VENOUS System

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23
Q

1° VARICOSE VEINS

A

CONGENITAL Defect
CONGENITAL Absence

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24
Q

2° VARICOSE VEINS
Causes

🧠⚡PDTA ⚡

A
  1. Proximal Venous Obstruction (Pregnancy, Pelvic Tumour)
  2. AV Fistula
  3. DVT
  4. Trauma
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25
VARICOSITIES usually DO NOT EXTEND ABOVE the INGUINAL LIGAMENT, except
VARICOSE VEINS 2° TO PREGNANCY or PELVIC TUMOURS
26
⚡⚡ MOST COMMON CLINICAL FEATURE OF VARICOSE VEINS
Dilated Veins in Leg
27
🧑🏻‍⚕️ Clinical Features of VARICOSE VEINS 🧠⚡AEIOU ⚡
Aching (Dull Aching Pain) Eczema Itching Oedema Ulcerations
28
Pigmentation in VARICOSE VEINS is DUE TO
Hemosidrin deposition
29
Classification of DILATED VEINS 🧠⚡VRT ⚡
> 3mm ➡️ Varicose veins 1-3mm ➡️ Reticular Veins < 1 mm ➡️ Thread Veins / Dermal Flare
30
Identify
CORONA PHLEBECTATICA (OR) MALLEOLAR FLARE ✨ < 1mm ✨ Fan shaped pattern of Telengectasia
31
EARLY SIGN OF ADVANCED VENOUS DISEASE
✨ CORONA PHLEBECTATICA ✨ ATROPHIE BLANCHE ✨ LIPODERMATOSCLEROSIS
32
ATROPHIE BLANCHE
33
INVERTED CHAMPAGNE BOTTLE APPEARANCE SEEN IN
Lipodermatosclerosis ✨ Obliteration of FAT resulting in WOODY Feel of Leg & Contracture of Tendoachilles
34
CEAP classification & Reporting system used for
VARICOSE VEINS ✨ CLINICAL MANIFESTATIONS ✨ ETIOLOGY ✨ ANATOMIC DISTRIBUTION ✨ PATHOPHYSIOLOGY
35
CEAP Classification 🧠⚡C TV, ESHA ⚡ 🧠⚡ Always Consider HIGHER VALUE if Multiple findings given⚡
36
EAP in CEAP Classification 🧠⚡Etiology: CPSN ⚡ 🧠⚡Anatomical: SPDN⚡ 🧠⚡Pathophysiology: RO ⚡
37
Clinical Signs in VARICOSE VEINS 🧠⚡ MS orders PFT⚡
1. MORRISEY'S COUGH IMPULSE TEST 2. SCHWARTZ TEST 3. PERTHES (MODIFIED) TEST 4. FEGAN'S METHOD & MULTIPLE TORNIQUET TEST 5. TRENDELENBURG Test
38
MORRISEY'S COUGH IMPULSE TEST
When the patient Coughs ⬇️ THRILL is felt at SAPHENO-FEMORAL JUNCTION ⬇️ INCOMPETENT SFJ
39
SCHWARTZ TEST
If thrill is felt on TAPPING OVER THE Vein ⬇️ SFJ INCOMPETENCE
40
PERTHES (MODIFIED) TEST 🧠⚡To R/O DVT ⚡
41
FEGAN'S METHOD & MULTIPLE TORNIQUET TEST
42
TRENDELENBURG Test
43
🩺 IOC FOR VARICOSE VEINS
DUPLEX SCAN Doppler with B MODE USG
44
Doppler scan gives information about
1. Flow of Blood 2. Direction of flow 3. Reflux
45
Why before doing VARICOSE VEIN SURGERY, we should always RULE OUT DVT?
In VARICOSE VEIN Surgery ➡️ we remove Superficial Vein ➕ If Deep Vein are thrombosed ⬇️ Significant EDEMA of Lower Limb (As no lymphatic drainage)
46
TRENDELENBURG in MEDICINE
✨ Trendelenburg test: For Trendelenburg Gait (Activity of Abductors of Thigh: Gluteus medius & minimus) ✨ Trendelenburg test for VARICOSE VEINS
47
In DOPPLER, what colour denotes ⭐ Blood moving AWAY from Heart ⭐ Blood moving TOWARDS the Heart
⭐ Blood moving AWAY from Heart 🎯 RED ⭐ Blood moving TOWARDS the Heart 🎯 BLUE
48
Reflux in DOPPLER Definition How to check?
Retrograde flow lasting 0.5s or MORE How to check? ⭐ Squeeze the CALF
49
MICKEY MOUSE SIGN
⭐ SAPHENOFEMORAL VARICOSE VEIN ⭐ NORMAL person: Common Femoral Vein, Common Femoral Artery & Great Saphenous Vein ⭐ PORTA HEPATIS
50
Adjunctive Management in VARICOSE VEINS
1. Compression: Pneumatic compression
51
Compression Garments (OR) STOCKINGS ⭐ CLASSES
Class 1 : 14-17 mmHg Class 2 : 18-24 mmHg Class 3 : 25-35 mmHg Class 4: >35 mmHg
52
⚡⚡ MOST COMMON COMPRESSION GARMENTS USED FOR VARICOSE VEINS
Class 3 COMPRESSION GARMENTS
53
Higher Pressure GARMENTS is used in (Class 4)
Lymphedema
54
In patients with LOW ABPI (Arterial disease) ➕ Varicose veins, then COMPRESSION GARMENTS
Should be avoided
55
⭐ Surgery for GSV & SFJ INCOMPETENCE 🧠⚡RET⚡
1. Radio frequency ablation 2. Endovascular Laser Therapy (EVLT) : 1470 nm 3. Trendelenburg procedure: Flush Ligation of SFJ
56
Endothermal Ablation
Gold standard management for GSV & SFJ incompetence ⭐ RFA ➕ EVLT
57
Trendelenburg Procedure
Ligation of the SAPHENOFEMORAL JUNCTION (as close to FEMORAL VEIN) ➕ Ligation of TRIBUTARIES ➕ Additional: Stripping of GSV
58
Why Ligation of SFJ as close to Femoral Vein as Possible?
If not ⬇️ SAPHENA VARIX
59
Identify
Saphena Varix Dilated proximal portion of the GSV or SSV may be visible or palpable
60
Tributaries that needs to be LIGATED in TRENDELENBURG Procedure
Medial: 1. Superficial EXTERNAL PUDENDAL 2. Distal EXTERNAL PUDENDAL DISTALLY: 1. ACCESSORY ANTERIOR SAPHENOUS VEIN 2. POSTERIOR MEDIAL THIGH VEIN LATERALLY: 1. SUPERFICIAL EPIGASTRIC VEIN 2. SUPERFICIAL CIRCUMFLEX ILIAC VEIN
61
What if tributaries are NOT LIGATED in TRENDELENBURG Procedure?
High recurrence rates
62
Stripping of Vein Meaning
Putting a STRIPPER INTO THE VEIN ⬇️ PULLS OUT THE ENTIRE VEIN out of the leg
63
Stripping in TRENDELENBURG PROCEDURE is done till
KNEE JOINT ⭐ NOT BELOW THE LEVEL OF KNEE JOINT ⬇️ SAPHENOUS NERVE CAN BE INJURED
64
EVLT: MODE OF ACTION
Put a LASER catheter into the VEIN ⬇️ KEEPS FIRING ⬇️ ⭐ HEAT PRODUCES COLLAPSING OF THE VEIN ⭐ ⬇️ Catheter pulled back ➡️ Vein collapses along its path
65
Types of EVLT probe
⭐ FORWARD FIRING ⭐ LATERAL FIRING
66
Which EVLT PROBE is preferred?
LATERAL FIRING ✨ MORE UNIFORM DISTRIBUTION ✨ LESS RISK OF PERFORATION
67
Identify
EVLT
68
Which procedure can be used for VARICOSITIES of any vein
EVLT
69
Advantage of RFA
✨ Continuous PULL BACK NOT REQUIRED ✨ EASIER
70
Identify
RFA ✨ TEMPERATURE 120° ✨ 20 seconds CYCLE
71
💊💉 MANAGEMENT of SSV & SPJ Incompetence
1. Flush LIGATION 2. RFA 3. EVLT
72
How Flush LIGATION of SPJ different from SFJ?
✨ No stripping is done
73
Always mark SPJ before SURGERY?
Because SFJ has a VERY VARIABLE LOCATION
74
💊💉 MANAGEMENT of PERFORATOR INCOMPETENCE 🧠⚡RED Surgery ⚡
1. RFA 2. EVLT 3. DODD & COCKETT Procedure 4. SEPS (Sub-fascial Endoscopic PERFORATOR Surgery)
75
Dodd & Cockett procedure
Multiple Sub-fascial Ligation of Perforators - Multiple skin incisions required ⬇️ Ligate the PERFORATOR above the Fascia & Below the FASCIA
76
NEWER SURGERIES FOR VARICOSE VEINS
1. Foam Sclerotherapy: For Veins < 3mm 2. ENDOVENOUS GLUE THERAPY (Cyano-acrylate) 3. TRIVEX
77
TRIVEX
Trans-illuminated Powered Phlebectomy
78
Sclerozing Agents in FOAM SCLEROTHERAPY
1. Polidocanol 2. Ethanolamine oleate 3. Sodium Tetradecylsulfate
79
Why FOAM is used in SCLEROTHERAPY in VARICOSE VEINS?
Sclerozing agent when comes in contact with blood ➡️ DOES NOT INDUCE INFLAMMATION & Fibrosis Foam ⬇️ ✨ Better Distributions & ACTION of Sclerozant
80
How to produce FOAM for SCLEROTHERAPY
Tessari TECHNIQUE
81
Identify
Tessari TECHNIQUE to produce Foam
82
Ratio of Sclerozant and Air in Tessari TECHNIQUE
1:3 or 4 (Sclerozant:Air)
83
Disadvantages of FOAM SCLEROTHERAPY
1. More RECURRENCE 2. MORE complications
84
Complications of VARICOSE VEIN SURGERY 🧠⚡BIRD-Wound ⚡
1. Bleeding 2. Bruising 3. Injury to Nerves, Femoral Artery, Femoral Vein 3. Recurrance (SSV > GSV) 4. Wound infection: ⚡⚡ MOST COMMON
85
⚡⚡ MOST COMMON complication OF VARICOSE VEIN surgery
Wound Infection
86
Complications of VARICOSE VEINS
1. Bleeding 2. SUPERFICIAL thrombophlebitis 3. Calcification of veins 4. Pigmentation 5. Lipodermatosclerosis 6. Ulceration
87
How to stop bleeding of VARICOSE VEINS
Elevate the LIMB
88
GAITER AREA OF LEG
Medial Malleolus
89
Venous Ulcers
⭐ LOCATION: ✨ ⚡⚡ MOST COMMON: Medial Malleolus ✨ Lateral Malleolus
90
Venous ulcer along the Lateral Malleolus is DUE TO
Short SAPHENOUS Vein pathology
91
Characteristics of VENOUS ULCERS 🧠⚡ (SP)²⚡
1. Shallow Ulcer 2. Sloping Edges 3. Pale Granulation Tissue on FLOOR 4. Pigmented margins: DUE TO: Hemosidrin
92
Characteristics of VENOUS ULCERS
1. Shallow Ulcer 2. Sloping Edges 3. Pale Granulation Tissue on FLOOR 4. Pigmented margins: DUE TO: Hemosidrin
93
Identify
Venous ulcer
94
BISGAARD REGIMEN is used for
💊💉 MANAGEMENT of VENOUS ULCER
95
BISGAARD REGIME
1. Elevation of LIMB 2. EDUCATION 3. Elastic Compression Stockings: 4 layers banding 4. Dressing 5. SURGERY 6. PENTOXYPHYLLINE
96
Only drug approved for VENOUS ULCERS
Pentoxyphylline
97
4 Layer Bandaging in
Venous ulcers 1. Wool 2. Cotton Crape 3. Elastic Bandage 4. Cohesive Bandage ⭐ Pressure DUE TO: Bandaging: 35-40 mmHg
98
Marjolin Ulcer develops in
LONG STANDING ⭐ Venous Ulcers ⭐ Burn Scars
99
Marjolin Ulcer can develop which malignancy
1. Squamous cell carcinoma 2. Basal cell Carcinoma
100
Characteristics APPEARANCE of MARJOLIN ULCER
Raised reverted CAULIFLOWER LIKE EDGES
101
💊💉 MANAGEMENT of MARJOLIN ULCER
⭐ SURGICAL EXCISION ✨ NEVER DO RADIOTHERAPY
102
KLIPPEL TRENAUNAY SYNDROME Characteristic features
VARICOSE VEINS ➕ ABSENT DEEP VEINS ➕ VESTIGEAL VEINS
103
Why VARICOSE VEINS in KLIPPEL TRENAUNAY SYNDROME managed conservatively?
No deep veins ➕ If VARICOSE VEIN surgery is done ⬇️ Significant edema of LEG
104
Classical TDIAD of KLIPPEL TRENAUNAY SYNDROME 🧠⚡LVP: Louis Philipe⚡
1. Limb Hypertrophy 2. Varicose veins 3. Port Wine Stain
105
Multiple AV Fistula ➕ High Output CARDIAC FAILURE ➕ LIMB HYPERTROPHY
Parkes Weber SYNDROME
106
Difference BETWEEN KLIPPEL TRENAUNAY SYNDROME & PARKES WEBER SYNDROME
107
LEG ULCERS 🧠⚡VAIN PAIN ⚡
Venous Arterial: Arterial Ischemic ulcers Infection (e.g. syphilis) Neuropathic: Diabetes Pressure sores Arthritis (e.g. RA, PAN) Injury/ IDB Neoplastic: Marjolin ulcer
108
Heat generated by EVLT probe
60 J/cm

VASCULAR SYSTEM (5 decks)

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