Vascular disorders (venous) Flashcards
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)
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 and septic superficial venous thrombophlebitis?
Ligation and division of vein for extensive
Heparin or fondaparinux
remove catheter
If septic, consider intravascular abscess
Abx - vancomycin + ceftriaxone
Surgical excision
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)
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’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
How do you treat arteriovenous malformation?
Observation
Surgical resection (if symptoms such as bleeding or neuro deficits)
Endovascular embolization
Radiosurgery
Medical management
