Varicose veins & SUPERFICIAL & DEEP VEINS OF BODY Flashcards
Superficial Veins of Upper Extremity
🧠⚡CBC ⚡
Cephalic Vein
Basilic Vein
Cubital Vein (Median Cubital Vein)
Deep Veins of Upper Extremity
🧠⚡BUR⚡
- Brachial Vein
- Ulnar Vein
- Radial Vein
Superficial Veins of Lower Extremity
- Greater Saphenous Vein
- Small Saphenous Vein
Deep Veins of Lower Extremity
🧠⚡IF PTP⚡
- Iliac vein
- Femoral vein
- Popliteal vein
- Tibial vein
- Peroneal Vein
GREAT SAPHENOUS VEIN
🧠⚡GmF ⚡
Medial aspect of LEG
⬇️
drains into Femoral Vein
Great SAPHENOUS vein lies close to
SAPHENOUS Nerve
SHORT SAPHENOUS VEIN
🧠⚡SLP ⚡
Lateral aspect of Leg
⬇️
Popliteal Vein
SHORT SAPHENOUS VEIN lies close to
🧠⚡Short is SO Short, that it cannot accompany SAPHENOUS NERVE ⚡
SURAL Nerve
ANTERIOR SAPHENOUS VEIN
Drains into LATERAL ASPECT of KNEE
⬇️
Drains tti GSV
Vein of Giacomini
Posterior extension of SHORT SAPHENOUS VEIN to GREATER SAPHENOUS VEIN
PERFORATORS of LOWER LIMB
🧠⚡My CBD Has Smooth Feathers ⚡
- May / Kustner Perforator @ HEEL
- Cockette Perforators x3 @ ANKLE
✨ 5cm above MEDIAL MALLEOLUS
✨ 10cm above MEDIAL MALLEOLUS
✨ 15cm above MEDIAL MALLEOLUS - Boyd Perforator @ KNEE (BELOW KNEE)
- Dodd Perforator @ MID-THIGH (ABOVE KNEE)
- Hunterian Perforator @ THIGH
- Spheno-femoral junction Perforator
SUPERFICIAL & DEEP VENOUS SYSTEM are connected by
PERFORATORS
What % of BLOOD flows through:
⭐ SUPERFICIAL VENOUS SYSTEM
⭐ DEEP VENOUS SYSTEM
⭐ SUPERFICIAL VENOUS SYSTEM
🎯 20%
⭐ DEEP VENOUS SYSTEM
🎯 80%
Location of SAPHENOFEMORAL JUNCTION
4cm BELOW & LATERAL to PUBIC TUBERCLE
For CORONARY ARTERY BYPASS, which vein graft is used
Great SAPHENOUS VEIN
Why SHORT SAPHENOUS VEIN cannot be STRIPPED?
Closely associated with SURAL NERVE, all along its course
TOTAL NUMBER OF PERFORATORS in LEGS
100-150 Perforators
VARICOSE VEINS
Dilated Tortuous VEINS with defective Valve
Cause of MOVEMENT OF BLOOD in ANTIGRAVITY DIRECTION
- Compression of MUSCLE around the Vein
- NEGATIVE INTRA-THORACIC PRESSURE DURING INSPIRATION
PERIPHERAL HEART
SOLEUS muscle
Theory for VARICOSE VEIN development
AMBULATORY VENOUS HYPERTENSION THEORY
During Exercise, MOST of the BLOOD goes through
Pressure in the SUPERFICIAL Venous system ⬇️
⬇️
Blood goes through DEEP VENOUS System
1° VARICOSE VEINS
CONGENITAL Defect
CONGENITAL Absence
2° VARICOSE VEINS
Causes
🧠⚡PDTA ⚡
- Proximal Venous Obstruction (Pregnancy, Pelvic Tumour)
- AV Fistula
- DVT
- Trauma
VARICOSITIES usually DO NOT EXTEND ABOVE the INGUINAL LIGAMENT, except
VARICOSE VEINS 2° TO PREGNANCY or PELVIC TUMOURS
⚡⚡ MOST COMMON CLINICAL FEATURE OF VARICOSE VEINS
Dilated Veins in Leg
🧑🏻⚕️ Clinical Features of VARICOSE VEINS
🧠⚡AEIOU ⚡
Aching (Dull Aching Pain)
Eczema
Itching
Oedema
Ulcerations
Pigmentation in VARICOSE VEINS is DUE TO
Hemosidrin deposition
Classification of DILATED VEINS
🧠⚡VRT ⚡
> 3mm ➡️ Varicose veins
1-3mm ➡️ Reticular Veins
< 1 mm ➡️ Thread Veins / Dermal Flare
Identify
CORONA PHLEBECTATICA (OR) MALLEOLAR FLARE
✨ < 1mm
✨ Fan shaped pattern of Telengectasia
EARLY SIGN OF ADVANCED VENOUS DISEASE
✨ CORONA PHLEBECTATICA
✨ ATROPHIE BLANCHE
✨ LIPODERMATOSCLEROSIS
ATROPHIE BLANCHE
INVERTED CHAMPAGNE BOTTLE APPEARANCE SEEN IN
Lipodermatosclerosis
✨ Obliteration of FAT resulting in WOODY Feel of Leg & Contracture of Tendoachilles
CEAP classification & Reporting system used for
VARICOSE VEINS
✨ CLINICAL MANIFESTATIONS
✨ ETIOLOGY
✨ ANATOMIC DISTRIBUTION
✨ PATHOPHYSIOLOGY
CEAP Classification
🧠⚡C TV, ESHA ⚡
🧠⚡ Always Consider HIGHER VALUE if Multiple findings given⚡
EAP in CEAP Classification
🧠⚡Etiology: CPSN ⚡
🧠⚡Anatomical: SPDN⚡
🧠⚡Pathophysiology: RO ⚡
Clinical Signs in VARICOSE VEINS
🧠⚡ MS orders PFT⚡
- MORRISEY’S COUGH IMPULSE TEST
- SCHWARTZ TEST
- PERTHES (MODIFIED) TEST
- FEGAN’S METHOD & MULTIPLE TORNIQUET TEST
- TRENDELENBURG Test
MORRISEY’S COUGH IMPULSE TEST
When the patient Coughs
⬇️
THRILL is felt at SAPHENO-FEMORAL JUNCTION
⬇️
INCOMPETENT SFJ
SCHWARTZ TEST
If thrill is felt on TAPPING OVER THE Vein
⬇️
SFJ INCOMPETENCE
PERTHES (MODIFIED) TEST
🧠⚡To R/O DVT ⚡
FEGAN’S METHOD & MULTIPLE TORNIQUET TEST
TRENDELENBURG Test
🩺 IOC FOR VARICOSE VEINS
DUPLEX SCAN
Doppler with B MODE USG