Vascular disorders (venous) Flashcards
What is:
Dilated, tortuous superficial veins – severity NOT correlated w/ number/size
Dull, aching heaviness, fatigue (worse with standing), itching from eczema above ankle or overlying large varicosities
Chronic venous insufficiency (ankle edema, hyperpigmentation, chronic skin induration or fibrosis), restless legs
varicose veins
What are risk factors for varicose veins?
Prolonged standing or heavy lifting, pregnancy
>20% adults
What can help diagnose varicose veins?
duplex US
How can you treat varicose veins?
Compression stockings! Leg elevation, pain control
Sclerotherapy - permanent fibrous + obliteration of target veins
What’s more invasive treatment of varicose veins?
Surgical - vein stripping, endovenous treatments (thermal devices, cyanoacrylate glue injection, foam sclerosant injection)
What does this indicate:
Dull pain, induration, redness, hard, tenderness of vein, firm cord, edema UNCOMMON, proximal extension of induration + pain w/ chills and high fever
superficial venous thrombophlebitis
What can put someone at risk for superficial venous thrombophlebitis?
Pregnancy, postpartum, varicose veins, trauma, malignancy, hypercoagulability
What is the Troausseu sign?
superficial venous thrombophlebitis – could be an early sign of of systemic hypercoaguability second to to abdominal cancer
What causes superficial venous thrombophlebitis?
Inflammation of vein just below surface of the skin from blood clot – short term IV, long term PICC, or spontaneous
S. aureus
NOT a thrombus
How do you diagnose superficial venous thrombophlebitis?
US to rule out DVT
How do you treat superficial venous thrombophlebitis?
Focal/spontaneous - local heat + NSAIDS
5cm or longer of saphenous vein = prophylaxis w/ fondaparinux or rivaroxaban
When do you give full anticoagulation in superficial venous thrombophlebitis?
for rapidly progressing disease or concern for extension (active malignancy, Hx of venous thromboembolism, known thrombophilia)
What is treatment for extensive superficial venous thrombophlebitis?
Ligation and division of vein for extensive
If septic, consider intravascular abscess
Heparin or fondaparinux, remove catheter
Abx - vancomycin + ceftriaxone
Surgical excision
What could this indicate:
Progressive pitting edema
Secondary skin changes, itching, dull discomfort worse w/ standing, better if elevated, pain if ulceration is present, skin swelling, shiny, brownish, varicosities, cellulitis
chronic venous insufficiency
What can cause chronic venous insufficiency?
Severe venous HTN, prior DVT or
Leg trauma/surgery, obesity, progressive superficial venous reflux, congenital or neoplastic obstruction of pelvic veins, congenital or acquired arteriovenous fistula
What can help diagnosis chronic venous insufficiency?
US
ulcers, medially
NO redness disappears upon raising
How can you prevent chronic venous insufficiency?
early + aggressive anticoag of acute DVT
How do you treat chronic venous insufficiency?
Compression stockings, avoid prolonged standing/sitting, intermittent elevations of leg, exercise, sleep with legs above heart
How do you treat complications of chronic venous insufficiency?
Cellulitis treatment (cephalexin, clindamycin)
Ulcer treatment (debridement)
Vein treatment (reflux or obstruction)
What are these symptoms associated w/:
Legs – asymptomatic or pain, swelling, warmth, redness of lower extremity unilaterally
Areas of: Distal, proximal (majority), iliofemoral ass w/ most severe symptoms
deep vein thrombosis
What are the risk factors for deep vein thrombosis?
Virchow’s triad
What does this cause:
Blood clot obstructing blood flow in deep venous system from
Can be from recent surgery or trauma, hospitalization w/ prolonged bed rest, use of birth control
OR idiopathic, inherited or acquired hypercoagulable states like cancer or pregnancy
deep vein thrombosis
How long should you treat a deep vein thrombosis if provoked by major transient risk factor?
3-6 months if major event + bleeding risk allows
How long should you treat a deep vein thrombosis if unprovoked?
at least 3 months or indefinitely if allows
How long should you treat a deep vein thrombosis if recurrent unprovoked?
indefinite
How long should you treat a deep vein thrombosis if cancer related?
> 3-6 months as long as cancer is active, whichever is longer
How long should you treat a deep vein thrombosis if underlying significant thrombophilia?
indefinite
What is your first step in DVT?
D dimer
If the d dimer is +, what do you do in DVT?
US
If the d dimer is -, what do you do in DVT?
nothing. DVT unlikely.
What are other Dx techniques for DVT?
contrast venography and CT+MRI venography
What criteria is best for DVT and PE?
Wells
What’s key in DVT management?
Prevent reoccurence or development of complications
How do you treat non-severe isolated distal DVT (unlikely to reoccur)?
serial imaging of deep veins x2 weeks
How do you treat severe isolated distal DVT (unlikely to reoccur)?
consider anticoagulation x 3 months
How do you treat proximal DVT?
Anticoagulation for 3+ months
Dabigatran, rivaroxaban, apixaban, edoxaban
How do you treat iliofemoral DVT?
Anticoagulation for 3+ months
No resolution = catheter directed thrombectomy
What does this indicate:
Neurological symptoms if in brain/spinal cord (seizures, headaches, neurological deficits, vision changes, weakness, difficulty speaking, speech)
Bleeding or hemorrhage (severe headache, N/V, dizziness, loss of consciousness
Pain and swelling (visible bulging of veins)
arteriovenous malformation
What cause arteriovenous malformation?
Abnormal tangle of blood vessels that connect arteries to veins
MC in brain, spinal cord, lungs
High pressure → low pressure
AVMS = congenital, genetic conditions, vascular disorders or trauma
What does this indicate:
Neurological deficits, signs of hemorrhage (increased ICP), tortuous blood vessels
PE: assess motor, sensory, cognitive impairments, auscultation (bruit), palpation (thrill or pulsations)
DX: MRI/CT scan, angiography, EEG if seizures are present
arteriovenous malformation
What’s gold standard for ateriovenous malformation?
angiography
How do you treat arteriovenous malformation?
Observation
Surgical resection (if symptoms such as bleeding or neuro deficits)
Endovascular embolization
Radiosurgery
Medical management
