Vascular: Varicose veins and DVT Flashcards
what should you look for on inspection?
- varicosities
- ulcers
- haemosiderin staining (brown)
- muscle wasting and loss of skin elasticity
what does haemosiderin staining imply?
venous hypertension
what should you look for in palpation?
- temperature
- tenderness of the veins
- firm veins (thrombosis)
- junctions and their functionality
- pulses
what should you auscultate for?
bruits over the varicosity signifies AV malformation
how can you distinguish ulcers of different pathologies?
venous: around the medial malleolus
arterial: ulcers at pressure points
what is the tap test?
a transmitted percussion impulse from the lower limit of the varicose vein to the saphenofemoral junction demonstrates incompetence of superficial valves
what is the Tredelenburg’s test?
used to assess the competency of the saphenofemoral/saphenopopliteal valves
how should you complete the examination?
- abdominal examination
- pelvic exam in females
- external genitalia exam in men
how do venous ulcers come about?
result of sustained venous hypertension in the superficial veins from incompetent valves or previous DVT
management of venous ulcers
- high-compression bandaging
- leg elevation
- ulcer dressings
- if painful, give analgesia
- continue monitoring the situation using duplex ultrasound or plethysmography
signs of superficial vein disease
- enlarged, tortuous superficial veins
- pain
- oedema
- discolouration
- ulceration
- chronic inflammation: dry skin, flaky skin (venous eczema)
- lipodermatosclerosis
investigation for venous disease
venous duplex scanning
invasive treatment of varicose veins
- foam sclerotherapy
- laser ablation
- high saphenous ligation with vein stripping
- radiofrequency ablation
- venous glue
what does treatment aim to do?
eliminate the dysfunctional vein from the circulation; reduce the venous pressures in the leg, to heal up the venous ulcers
noninvasive treatment of varicose veins
- compression therapy (4-layer bandages, compression stockings)
cause of deep vein thrombosis
Virchow’s triad
- hypercoagulability
- endothelial damage
- haemodynamic changes
risk factors for DVT
- surgery (major like ortho)
- trauma
- malignancy
- HRT/OCP
- age
- thrombophilia
- genetics
- pregnancy
symptoms of DVT
- swellling
- calf pain
- redness
how do you stratify the risk?
Well’s score
what does the Wells score take into consideration?
- active cancer
- being bedridden
- calf swelling
- collateral superficial veins
- swelling of the leg
- localised tenderness along the deep venous system
- pitting oedema
- paralysis, paresis or recent plaster immobilisation of the leg
- previously documented DVT
investigating DVT
- D-dimer
- ultrasound (Doppler one, duplex study)
treating DVT
- heparin
- warfarin
- NOACs
what is the difference between unfractionated and low molecular weight heparin?
- UFH: IV (need to monitor the APTT)
- LMWH: SC (no need to monitor the function)
what is warfarin?
- oral administration
- monitored via INR
- Vitamin K antagonist (affects the production of coagulation factors II, VII, IX and X)
- has an initial prothrombotic effect
- need 3 days to adequately load the patient
what are NOACs?
- novel oral anticoagulants
- oral administration
- factor Xa inhibitor (diadaxaban)
- no need to monitor the INR with this
- no antidote if there is an overdose
treating deep venous reflux
- compression therapy
- deep venous stenting
