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VASCULAR SYSTEM > Varicose veins & SUPERFICIAL & DEEP VEINS OF BODY > Flashcards

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
Q

VARICOSITIES usually DO NOT EXTEND ABOVE the INGUINAL LIGAMENT, except

A

VARICOSE VEINS 2° TO PREGNANCY or PELVIC TUMOURS

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26
Q

⚡⚡ MOST COMMON CLINICAL FEATURE OF VARICOSE VEINS

A

Dilated Veins in Leg

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27
Q

🧑🏻‍⚕️ Clinical Features of VARICOSE VEINS
🧠⚡AEIOU ⚡

A

Aching (Dull Aching Pain)
Eczema
Itching
Oedema
Ulcerations

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28
Q

Pigmentation in VARICOSE VEINS is DUE TO

A

Hemosidrin deposition

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29
Q

Classification of DILATED VEINS
🧠⚡VRT ⚡

A

> 3mm ➡️ Varicose veins
1-3mm ➡️ Reticular Veins
< 1 mm ➡️ Thread Veins / Dermal Flare

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30
Q

Identify

A

CORONA PHLEBECTATICA (OR) MALLEOLAR FLARE

✨ < 1mm
✨ Fan shaped pattern of Telengectasia

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31
Q

EARLY SIGN OF ADVANCED VENOUS DISEASE

A

✨ CORONA PHLEBECTATICA
✨ ATROPHIE BLANCHE
✨ LIPODERMATOSCLEROSIS

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32
Q
A

ATROPHIE BLANCHE

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33
Q

INVERTED CHAMPAGNE BOTTLE APPEARANCE SEEN IN

A

Lipodermatosclerosis
✨ Obliteration of FAT resulting in WOODY Feel of Leg & Contracture of Tendoachilles

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34
Q

CEAP classification & Reporting system used for

A

VARICOSE VEINS

✨ CLINICAL MANIFESTATIONS
✨ ETIOLOGY
✨ ANATOMIC DISTRIBUTION
✨ PATHOPHYSIOLOGY

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35
Q

CEAP Classification
🧠⚡C TV, ESHA ⚡
🧠⚡ Always Consider HIGHER VALUE if Multiple findings given⚡

A
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36
Q

EAP in CEAP Classification
🧠⚡Etiology: CPSN ⚡
🧠⚡Anatomical: SPDN⚡
🧠⚡Pathophysiology: RO ⚡

A
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37
Q

Clinical Signs in VARICOSE VEINS

🧠⚡ MS orders PFT⚡

A
  1. MORRISEY’S COUGH IMPULSE TEST
  2. SCHWARTZ TEST
  3. PERTHES (MODIFIED) TEST
  4. FEGAN’S METHOD & MULTIPLE TORNIQUET TEST
  5. TRENDELENBURG Test
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38
Q

MORRISEY’S COUGH IMPULSE TEST

A

When the patient Coughs
⬇️
THRILL is felt at SAPHENO-FEMORAL JUNCTION
⬇️
INCOMPETENT SFJ

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39
Q

SCHWARTZ TEST

A

If thrill is felt on TAPPING OVER THE Vein
⬇️
SFJ INCOMPETENCE

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40
Q

PERTHES (MODIFIED) TEST
🧠⚡To R/O DVT ⚡

A
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41
Q

FEGAN’S METHOD & MULTIPLE TORNIQUET TEST

A
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42
Q

TRENDELENBURG Test

A
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43
Q

🩺 IOC FOR VARICOSE VEINS

A

DUPLEX SCAN
Doppler with B MODE USG

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44
Q

Doppler scan gives information about

A
  1. Flow of Blood
  2. Direction of flow
  3. Reflux
45
Q

Why before doing VARICOSE VEIN SURGERY, we should always RULE OUT DVT?

A

In VARICOSE VEIN Surgery ➡️ we remove Superficial Vein
➕
If Deep Vein are thrombosed
⬇️
Significant EDEMA of Lower Limb
(As no lymphatic drainage)

46
Q

TRENDELENBURG in MEDICINE

A

✨ Trendelenburg test: For Trendelenburg Gait (Activity of Abductors of Thigh: Gluteus medius & minimus)

✨ Trendelenburg test for VARICOSE VEINS

47
Q

In DOPPLER, what colour denotes

⭐ Blood moving AWAY from Heart
⭐ Blood moving TOWARDS the Heart

A

⭐ Blood moving AWAY from Heart
🎯 RED

⭐ Blood moving TOWARDS the Heart
🎯 BLUE

48
Q

Reflux in DOPPLER
Definition
How to check?

A

Retrograde flow lasting 0.5s or MORE

How to check?
⭐ Squeeze the CALF

49
Q

MICKEY MOUSE SIGN

A

⭐ SAPHENOFEMORAL VARICOSE VEIN
⭐ NORMAL person: Common Femoral Vein, Common Femoral Artery & Great Saphenous Vein
⭐ PORTA HEPATIS

50
Q

Adjunctive Management in VARICOSE VEINS

A
  1. Compression: Pneumatic compression
51
Q

Compression Garments (OR) STOCKINGS
⭐ CLASSES

A

Class 1 : 14-17 mmHg
Class 2 : 18-24 mmHg
Class 3 : 25-35 mmHg
Class 4: >35 mmHg

52
Q

⚡⚡ MOST COMMON COMPRESSION GARMENTS USED FOR VARICOSE VEINS

A

Class 3 COMPRESSION GARMENTS

53
Q

Higher Pressure GARMENTS is used in
(Class 4)

A

Lymphedema

54
Q

In patients with LOW ABPI (Arterial disease) ➕ Varicose veins, then COMPRESSION GARMENTS

A

Should be avoided

55
Q

⭐ Surgery for GSV & SFJ INCOMPETENCE

🧠⚡RET⚡

A
  1. Radio frequency ablation
  2. Endovascular Laser Therapy (EVLT) : 1470 nm
  3. Trendelenburg procedure: Flush Ligation of SFJ
56
Q

Endothermal Ablation

A

Gold standard management for GSV & SFJ incompetence

⭐ RFA ➕ EVLT

57
Q

Trendelenburg Procedure

A

Ligation of the SAPHENOFEMORAL JUNCTION (as close to FEMORAL VEIN)
➕
Ligation of TRIBUTARIES
➕
Additional: Stripping of GSV

58
Q

Why Ligation of SFJ as close to Femoral Vein as Possible?

A

If not
⬇️
SAPHENA VARIX

59
Q

Identify

A

Saphena Varix
Dilated proximal portion of the GSV or SSV may be visible or palpable

60
Q

Tributaries that needs to be LIGATED in TRENDELENBURG Procedure

A

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
Q

What if tributaries are NOT LIGATED in TRENDELENBURG Procedure?

A

High recurrence rates

62
Q

Stripping of Vein
Meaning

A

Putting a STRIPPER INTO THE VEIN
⬇️
PULLS OUT THE ENTIRE VEIN out of the leg

63
Q

Stripping in TRENDELENBURG PROCEDURE is done till

A

KNEE JOINT

⭐ NOT BELOW THE LEVEL OF KNEE JOINT
⬇️
SAPHENOUS NERVE CAN BE INJURED

64
Q

EVLT: MODE OF ACTION

A

Put a LASER catheter into the VEIN
⬇️
KEEPS FIRING
⬇️
⭐ HEAT PRODUCES COLLAPSING OF THE VEIN ⭐
⬇️
Catheter pulled back ➡️ Vein collapses along its path

65
Q

Types of EVLT probe

A

⭐ FORWARD FIRING
⭐ LATERAL FIRING

66
Q

Which EVLT PROBE is preferred?

A

LATERAL FIRING
✨ MORE UNIFORM DISTRIBUTION
✨ LESS RISK OF PERFORATION

67
Q

Identify

68
Q

Which procedure can be used for VARICOSITIES of any vein

69
Q

Advantage of RFA

A

✨ Continuous PULL BACK NOT REQUIRED
✨ EASIER

70
Q

Identify

A

RFA
✨ TEMPERATURE 120°
✨ 20 seconds CYCLE

71
Q

💊💉 MANAGEMENT of SSV & SPJ Incompetence

A
  1. Flush LIGATION
  2. RFA
  3. EVLT
72
Q

How Flush LIGATION of SPJ different from SFJ?

A

✨ No stripping is done

73
Q

Always mark SPJ before SURGERY?

A

Because SFJ has a VERY VARIABLE LOCATION

74
Q

💊💉 MANAGEMENT of PERFORATOR INCOMPETENCE

🧠⚡RED Surgery ⚡

A
  1. RFA
  2. EVLT
  3. DODD & COCKETT Procedure
  4. SEPS (Sub-fascial Endoscopic PERFORATOR Surgery)
75
Q

Dodd & Cockett procedure

A

Multiple Sub-fascial Ligation of Perforators
- Multiple skin incisions required
⬇️
Ligate the PERFORATOR above the Fascia & Below the FASCIA

76
Q

NEWER SURGERIES FOR VARICOSE VEINS

A
  1. Foam Sclerotherapy: For Veins < 3mm
  2. ENDOVENOUS GLUE THERAPY (Cyano-acrylate)
  3. TRIVEX
77
Q

TRIVEX

A

Trans-illuminated Powered Phlebectomy

78
Q

Sclerozing Agents in FOAM SCLEROTHERAPY

A
  1. Polidocanol
  2. Ethanolamine oleate
  3. Sodium Tetradecylsulfate
79
Q

Why FOAM is used in SCLEROTHERAPY in VARICOSE VEINS?

A

Sclerozing agent when comes in contact with blood ➡️ DOES NOT INDUCE INFLAMMATION & Fibrosis

Foam
⬇️
✨ Better Distributions & ACTION of Sclerozant

80
Q

How to produce FOAM for SCLEROTHERAPY

A

Tessari TECHNIQUE

81
Q

Identify

A

Tessari TECHNIQUE to produce Foam

82
Q

Ratio of Sclerozant and Air in Tessari TECHNIQUE

A

1:3 or 4 (Sclerozant:Air)

83
Q

Disadvantages of FOAM SCLEROTHERAPY

A
  1. More RECURRENCE
  2. MORE complications
84
Q

Complications of VARICOSE VEIN SURGERY
🧠⚡BIRD-Wound ⚡

A
  1. Bleeding
  2. Bruising
  3. Injury to Nerves, Femoral Artery, Femoral Vein
  4. Recurrance (SSV > GSV)
  5. Wound infection: ⚡⚡ MOST COMMON
85
Q

⚡⚡ MOST COMMON complication OF VARICOSE VEIN surgery

A

Wound Infection

86
Q

Complications of VARICOSE VEINS

A
  1. Bleeding
  2. SUPERFICIAL thrombophlebitis
  3. Calcification of veins
  4. Pigmentation
  5. Lipodermatosclerosis
  6. Ulceration
87
Q

How to stop bleeding of VARICOSE VEINS

A

Elevate the LIMB

88
Q

GAITER AREA OF LEG

A

Medial Malleolus

89
Q

Venous Ulcers

A

⭐ LOCATION:
✨ ⚡⚡ MOST COMMON: Medial Malleolus
✨ Lateral Malleolus

90
Q

Venous ulcer along the Lateral Malleolus is DUE TO

A

Short SAPHENOUS Vein pathology

91
Q

Characteristics of VENOUS ULCERS
🧠⚡ (SP)²⚡

A
  1. Shallow Ulcer
  2. Sloping Edges
  3. Pale Granulation Tissue on FLOOR
  4. Pigmented margins: DUE TO: Hemosidrin
92
Q

Characteristics of VENOUS ULCERS

A
  1. Shallow Ulcer
  2. Sloping Edges
  3. Pale Granulation Tissue on FLOOR
  4. Pigmented margins: DUE TO: Hemosidrin
93
Q

Identify

A

Venous ulcer

94
Q

BISGAARD REGIMEN is used for

A

💊💉 MANAGEMENT of VENOUS ULCER

95
Q

BISGAARD REGIME

A
  1. Elevation of LIMB
  2. EDUCATION
  3. Elastic Compression Stockings: 4 layers banding
  4. Dressing
  5. SURGERY
  6. PENTOXYPHYLLINE
96
Q

Only drug approved for VENOUS ULCERS

A

Pentoxyphylline

97
Q

4 Layer Bandaging in

A

Venous ulcers

  1. Wool
  2. Cotton Crape
  3. Elastic Bandage
  4. Cohesive Bandage

⭐ Pressure DUE TO: Bandaging: 35-40 mmHg

98
Q

Marjolin Ulcer develops in

A

LONG STANDING
⭐ Venous Ulcers
⭐ Burn Scars

99
Q

Marjolin Ulcer can develop which malignancy

A
  1. Squamous cell carcinoma
  2. Basal cell Carcinoma
100
Q

Characteristics APPEARANCE of MARJOLIN ULCER

A

Raised reverted CAULIFLOWER LIKE EDGES

101
Q

💊💉 MANAGEMENT of MARJOLIN ULCER

A

⭐ SURGICAL EXCISION

✨ NEVER DO RADIOTHERAPY

102
Q

KLIPPEL TRENAUNAY SYNDROME
Characteristic features

A

VARICOSE VEINS
➕
ABSENT DEEP VEINS
➕
VESTIGEAL VEINS

103
Q

Why VARICOSE VEINS in KLIPPEL TRENAUNAY SYNDROME managed conservatively?

A

No deep veins
➕
If VARICOSE VEIN surgery is done
⬇️
Significant edema of LEG

104
Q

Classical TDIAD of KLIPPEL TRENAUNAY SYNDROME

🧠⚡LVP: Louis Philipe⚡

A
  1. Limb Hypertrophy
  2. Varicose veins
  3. Port Wine Stain
105
Q

Multiple AV Fistula
➕
High Output CARDIAC FAILURE
➕
LIMB HYPERTROPHY

A

Parkes Weber SYNDROME

106
Q

Difference BETWEEN KLIPPEL TRENAUNAY SYNDROME & PARKES WEBER SYNDROME

107
Q

LEG ULCERS
🧠⚡VAIN PAIN ⚡

A

Venous
Arterial: Arterial Ischemic ulcers
Infection (e.g. syphilis)
Neuropathic: Diabetes

Pressure sores
Arthritis (e.g. RA, PAN)
Injury/ IDB
Neoplastic: Marjolin ulcer

108
Q

Heat generated by EVLT probe

VASCULAR SYSTEM (5 decks)

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