Vascular (2) (Common venous conditions) Flashcards
venous conditions
- Varicose veins
- Haemorrhage
- Thrombophlebitis
- Venous hypertension
- DVT
- Chronic venous insufficiency’s
Chronic venous insufficiency
When blood does not efficiently drain from the legs back to the heart. Usually, this is the result of damage to the valves inside the veins- resulting in venous hypertension
e.g. varicose veins
causes of chronic venous insufficiency
- age
- immobility
- obesity
- prolonged standing
- after a deep vein thrombosis.
- varicose veins.
venous hypertension
The valves are responsible for ensuring blood flows in one direction as the leg muscles contract and squeeze the veins. When the valves are damaged, the pumping effect of the leg muscles becomes less effective in draining blood towards the heart. Blood pools in the veins of the legs, causing venous hypertension.
- Chronic pooling of blood à skin changes à esp Gaiter area
presentation of chronic venous insufficiency
- haemosiderin staining
- venous eczema
- lipodermatosclerosis
- atrophie blance
- cellulitis
- poor healing
- skin ulcers
- pain
Haemosiderin staining
- is a red/brown discolouration caused by haemoglobin leaking into the skin
Venous eczema
- is dry, itchy, flaky, scaly, red, cracked skin. These eczema-like changes are caused by a chronic inflammatory response in the skin.
Lipodermatosclerosis
is hardening and tightening of the skin and tissue beneath the skin. Chronic inflammation causes the subcutaneous tissue to become fibrotic (turning to scar tissue). Inflammation of the subcutaneous fat is called panniculitis. The narrowing of the lower legs causes the typical “inverted champagne bottle” appearance
atrophie blanche
- refers to patches of smooth, porcelain-white scar tissue on the skin, often surrounded by hyperpigmentation.
management of chronic venous insufficiency
-
Keeping skin healthy
- Monitoring skin health and avoiding skin damage
- Regular use of emollients (e.g., diprobase, oilatum, cetraben and doublebase)
- Topical steroids to treat flares of venous eczema
- Very potent topical steroids to treat flares of lipodermatosclerosis
-
Improving venous drainage to the legs
- Weight loss if obese
- Keeping active
- Keeping the legs elevated when resting
- Compression stockings (exclude arterial disease first with an ankle-brachial pressure index)
-
Managing complications
- Antibiotics for infection
- Analgesia for pain
- Wound care for ulceration
Varicose veins
Are distended superficial veins measuring more than 3mm in diameter, usually affecting the legs.
varicose veins pathophysiology
- Veins contain valves that only allow blood to flow in one direction, towards the heart. In the legs, as the muscles contract, they squeeze blood upwards against gravity. The valves prevent gravity from pulling the blood back into the feet.
- When the valves become incompetent, the blood is drawn downwards by gravity and pools in the veins and feet.
- The deep and superficial veins are connected by vessels called the perforating veins (or perforators), which allow blood to flow from the superficial veins to the deep veins. When the valves are incompetent in these perforators, blood flows from the deep veins back into the superficial veins and overloads them.
- This leads to dilatation and engorgement of the superficial veins, forming varicose veins.
RF for varicose veins
Risk Factors
- Increasing age
- Family history
- Female
- Pregnancy
- Obesity
- Prolonged standing (e.g., occupations involving standing for long periods)
- Deep vein thrombosis (causing damage to the valves)
presentation of varicose veins
Varicose veins present with engorged and dilated superficial leg veins. They may be asymptomatic or have symptoms of:
- Heavy or dragging sensation in the legs
- Aching
- Itching
- Burning
- Oedema
- Muscle cramps
- Restless legs
special tests for varicose veins
tap tests
cough test
trendelenburg test
perthes test
duplex US
Tap tests
Saphenofemoral junction (SFJ) and tap the distal varicose vein, feeling for a thrill at the SFJ- thrill suggest incompetent valve between VV and SFJ
Cough test
- Apply pressure to SFJ and ask patient to cough- feel for thrills
- Thrill suggest dilated vein
Trendelenburg test
With the patient lying down, lift the affected leg to drain the veins completely. Then apply a tourniquet to the thigh and stand the patient up. The tourniquet should prevent the varicose veins from reappearing if it is placed distally to the incompetent valve. If the varicose veins appear, the incompetent valve is below the level of the tourniquet. Repeat the test with the tourniquet at different levels to assess the location of the incompetent valves.
Perthes test
apply a tourniquet to the thigh and ask the patient to pump their calf muscles by performing heel raises whilst standing. If the superficial veins disappear, the deep veins are functioning. Increased dilation of the superficial veins indicates a problem in the deep veins, such as deep vein thrombosis.
duplex US
- US that shows speed and volume of blood flow (assess the extent of varicose veins)