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Surgery II > Vascular: Venous Disease > Flashcards

Vascular: Venous Disease Flashcards

1
Q

how should you examine a person with venous disease?

A

both standing up and sitting down, former to look for varicosities

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2
Q

where can you palpate the dorsalis pedis?

A

lateral to the extensor hallucis longus tendon; if not obvious, tell them to pull the hallux upwards

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3
Q

where can you palpate the posterior tibial pulse?

A

posterior and inferior to the medial malleolus

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4
Q

which type of waveform signifies more severe disease?

A

continuous monophasic

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5
Q

why should you exclude arterial disease before treating the venous disease?

A
  • compression on arterial disease will worsen the arterial disease
  • you have to examine pulses and ABPI before treating the patient
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6
Q

what should you ask the patient in the history?

A
  • occupation (people who work long hours standing are more prone to venous disease)
  • family history
  • pregnancy
  • race
  • previous episodes
  • smoking (mainly arterial disease)
  • obesity
  • history of DVT
  • history of trauma and major surgery and malignancy
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7
Q

clinical examination of venous disease

A
  • inspection: engorged veins, haemosiderin pigmentation, venous eczema
  • peripheral pulses
  • look at the gaitre area
  • to look for varicosities of the GSV, tell them to externally rotate the leg to visualise that part of the leg more
  • peripheral pulses
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8
Q

investigation of venous disease

A
  • doppler
  • ABPI
  • duplex scan
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9
Q

management of venous disease

A
  • 4-layer bandaging
  • Daflon
  • ECMS (stimulates the calf muscles, increases venous return and reduced swelling)
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10
Q

general advice for the patient

A
  • maintain compression
  • weight loss, change in diet and exercise
  • smoking cessation
  • monitor and control pulse, BP, glucose to maintain health
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11
Q

what do you do in a duplex scan?

A
  • check compressibility of the vein
  • look for coloured flow
  • check the pulse wave
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12
Q

how do you assessment the superficial veins?

A
  • check the junctions and their competencies
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13
Q

what is the Valsalva manoeuver?

A

moderately forceful attempted exhalation against a closed airway, usually done by closing one’s mouth, pinching one’s nose shut while expelling air out as if blowing up a balloon

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14
Q

treatment of venous disease

A
  • endovascular treatment
  • sclerotherapy
  • open surgery
  • radiofrequency ablation
  • 4-layer bandaging
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15
Q

what are the 4 layers in the 4 layer bandage?

A
  • non-adherent dressing
  • wadding
  • crepe
  • cohesive bandaging
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16
Q

what is the aim of compression therapy?

A
  • prevent venous insufficiency and reflux

- stop fluid build up at the ankle

17
Q

what is sclerotherapy?

A
  • an irritant chemiacl is mixed with air to make the foam
  • this is fed into the vein through a butterfly needle, guided by ultrasound
  • the leg is wrapped up, depending on the length of the vein being destroyed
  • this bandage is removed a week after
18
Q

how is traditional surgery done?

A
  • incision is made through the groin, find the vein and ligate it here
  • remove the vein by stripping
  • 2 types: pin and plastic disposable
  • the stripper is passed through the vein, vein is stitched through it and the vein is stripped
  • this risks pulling out the sural/saphenou nerve
19
Q

what is high energy ablation?

A
  • can either be done through laser or radiofrequency
  • the energy is passed through the vein which burns the vein to stop the venous reflux
  • in RFA, cold saline is injected into the surroundings of the vein to prevent burning the surroundings
20
Q

what is vein glue?

A
  • the glue is injected into the vein
  • the area is pressed so that the vein closes
  • no need for bandging or risk of burns here
  • only require local anaesthetic
21
Q

basic classification of veins

A
  • superficial (above the fascia)

- deep (below the fascia)

22
Q

list the deep veins of the leg

A
  • anterior tibial
  • posterior tibial
  • peroneal
  • popliteal
  • profunda femoris vein
  • common femoral vein
  • external iliac
  • common iliac
23
Q

list the superficial veins of the leg

A
  • great saphenous

- short saphenous

24
Q

describe the path of the great saphenous vein

A
  • starts at the dorsum of the foot
  • goes up to the groin following a posteromedial route
  • penetrates the fascia to meet the femoral vein at the saphenofemoral junction
25
Q

describe the path of the small saphenous vein

A
  • lateral aspect of the foot

- goes until the popliteal fossa to join the popliteal vein at the saphenopopliteal vein

26
Q

what other types of veins can cause varicosities?

A

perforator veins

27
Q

explain the physiology of veins and valves

A
  • there are multiple mechanisms that help blood move upwards:
    • valves
    • contraction of calf muscle
    • change in intrathoracic pressure
  • if you do not supply the heart with that blood, there is a drop in CO, a drop in blood going to the brain, causing syncope
28
Q

pathophysiology of venous disease

A
  • in venous HTN, the pressure in the veins is high, highest in the ankle region due to incompetent valves
29
Q

why are varicose veins important?

A

since a lot of blood is accumulated in the veins and they are under a high pressure, they can bleed torrentially if nicked

30
Q

what are venous telengiectasias?

A
  • spidery veins

- these are not treated, unless symptomatic

31
Q

how do you do the Tredelenburg test?

A
  • lie the patient flat to empty the veins
  • tighten the tourniquet above the defect
  • stand the patient up
  • if you have tightened above the defect, the varicosities should not refill
32
Q

what type of skin changes can you see in venous disease?

A
  • oedema
  • discolouration
  • dermatitis
  • venous eczema (mainly in the gaiter area - flaky and whitish)
  • ulceration
  • haemosiderin pigmentation
33
Q

symptoms of thrombophlebitis

A
  • pain
  • swelling
  • heat
  • difficult to move the limb
34
Q

management of thrombophlebitis

A
  • NSAIDs

- compression stockings

Surgery II (19 decks)

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