Venous Flashcards
What are the cutoff values in for duration of reflux in duplex of lower extremities?
1sec for Femoral and Popliteal veins
500ms for the other veins (Deep femoral, Saphenous, Tibial and perforator veins)
What is the most appropriate treatment for post thrombotic syndrome with venous leg ulcer?
Debriding the ulcer and Compression therapy of 40-50mmHg stockings
What are the CEAP classification?
classify the physical findings associated with chronic venous insufficiency.
Clinical 0 - No visible signs 1 - Telangiectasias or reticular veins 2 - Varicose veins 3 - Edema 4a - Pigmentation and/or eczema 4b - Lipodermatosclerosis and/or atrophy 5 - Healed venous ulcer 6 - Open venous ulcer A - Asymptomatic S - Symptomatic
Etiology
C - congenital
P - primary
S - secondary (post thrombotic)
Anatomy
S - superficial
P - Perforator
D - Deep
Pathophysiology R - reflux O - obstruction R,O - reflux and obstruction N - no venous pathophysiology identifiable
What is the risk factor most associated with progression of CEAP clinical class of patients with varicose veins and chronic venous insufficirncy?
Prior deep vein thrombosis
What are the typical swelling areas of the leg in venous insufficiency?
Swelling is limited to the foot and ankle.
What should be considered if all the leg is swollen?
Venous outflow obstruction and/or lymphedema.
What is the normal standing venous pressue?
90mmHg
What is the normal venous pressure after exercise?
30mmHg
how long does it take in a healhy person for the venous pressure (AVP test) to return to 90% of normal standing pressure after exercise?
30 seconds
What is Ambulatory Venous Pressure test?
Gold standard for messuring venous hemodynamics.
Butterfly needle is placed in a dorsal pedal vein.
Baseline venous pressure is messured in standing.
10 tiptoe manuvers.
Recording of time to returen to 90% of baseline pressue.
25% with venous ulcers have normal AVP!!!
What are optional resultes of AVP and their meaning?
Normal venous pressure - 90mmHg and fall to 30mmHg around exercise.
Pressure not fall normaly - Calf pump not working effectively.
Fast return to standing pressure - reflux of deep or superficial veins.
Pressure rise rather than fall - deep veins occlusion.
What is Plethysmography test?
Noninvasive method of estimating changes in volume in an extremity and outflow. There are few diffecent methods but all messuring outflow.
Patients with normal outflow exhibit rapid emptying of their lower extremity veins.
Inflation of thigh pump to occlude outflow and fast deflation while messuring the venous pressure.
In normal subject (non occluded) the pressure drops fast to base line.
What is the sensitevity of Plethysmography in detection DVT?
~90% above knee DVT and 66% and less below knee
What is the rate of exsiting anterior accessory GSV?
anterior accessory GSV is the most common, found in
up to 14%
How many vulves in the GSV and in the SSV?
Each of the veins have the same number of vulves which is 7-10.
What is the rate of connection of SSV to SPJ within 5cm if the popliteal skin crease?
2/3
1/3 as high as 7cm above the crease.
What is a reticular vein?
thin-walled venules (blue) lying in the superficial compartment with 1-3mm diameters.
May connect to the saphenous and create network called lateral subdermic venous system (LSVS) and may connect to telangietasias in 88% of patients.
What is a Telangiectasias vein?
dilated venules (blue), capillaries, or arterioles (red) 0.1 to 1.0 mm in diameter.
Reticular veins are frequently “feeder” veins to
telangiectasias
What is the Venous Clinical Severity Score (VCSS) and the Villalta scale?
Scoring systems that assess severity of disease and
quality-of-life issues.
What is the primery point of primery and reccurent reflux in majority of patients?
SFJ mainly (~70%) and SSV (~20%).
What are the most recommended treatments for saphenous reflux?
Both Radiofrequency ablation (RFA) and Endovenous laser ablation (EVLA) are safe and efficacious.
What is the advantage of RFA and EVLA over open surgery and foam sclerotherapy?
“Success” rates were: 84% for RFA 94% for EVLA 78% for surgery 77% for foam sclerotherapy.
RFA and EVLA have less convalesce time, and decreased post procedural pain and morbidity.
They have more efficacy and cost-effective over sclerotheraphy.
What are the complications of EVLA
DVTs, 0% to 5.7%
skin burns, less than 1%
nerve injury, 0% to 22%
superficial thrombophlebitis, 0% to 25%.
Rear complication (both EVLA and in RFA) is arteriovenous fistula, commonly occurring where the external pudendal artery crosses posterior to the GSV.
