Venous and Lymphatic disease Flashcards
What are varicose veins?
Dilated, tortuous, superficial vein most common in lower limb
Describe the course of the long saphenous vein
Dorsal arch drains into lesser saphenous passes anterior to medial malleolus and up medial aspect of the leg
Describe the spahenofemoral junction
Located 2.5cm below and lateral to pubic tubercle
Long Saphenous perforates crubiform fascia, empties into femoral vein
Describe the course of the short saphenous vein
Plantar venous arch drains into the short saphenous vein travelling posterior to lateral malleolus and draining into popliteal vein
What structures assist against gravity to ensure venous return?
Valves and calf muscle pumps
Causes of venous valve failure
Surgery Trauma DVT Hormonal changes eg pregnancy Tumour
Describe how valve failure leads to venous incompetence
One failure increases pressure causing dilatation of distal vein leading to incompetence
Risk factors for venous incompetence
Female Age Pregnancy DVT Occupation Family history
Symptoms of varicose veins
Burning Itching Heaviness Tightness Swelling Discolouration - pink ulcers Phlebitis Bleeding Disfiguration Eczema Ulceration
What test can be performed to demonstrate venous incompetence?
Tap test
Tap saphenofemoral junction
Transmitted impulse at knee indicates incompetence of valves between 2 hands
Trendelenburg
Raise leg and drain superficial veins
Apply pressure over junction and ask patient to stand
Veins will not dilate but refill once pressure removed - incompetent saphenofemoral valve
What investigations are used in venous incompetence?
Doppler
US
What classification system is used for venous insufficiency?
CEAP
Describe CEAP stages of classifying venous insufficiency
C0 - no visible, palpable signs C1 - teleangiectasis or reticular veins C2- varicose C3- oedema C4 a - pigmentation/eczema C4 b - lipodermatosclerosis C5- healed venous ulcer C6 - active venous ulcer
Management of venous insufficiency
Endovenous treatment
US guided foam sclerotherapy
Open surgery
Adverse effects/complications of endovenous treatment
Burns
Paraesthesia
Phlebitis
DVT
Adverse effects of US Guided foam sclerotherapy
thrombophlebitis
skin pigmentation
Stroke, TIA, MI if foam migrates
Complications of open surgery
Anaesthetic risk
Wound infection
Damage saphenous and sural nerves
Bleeding
Causes of chronic venous insufficiency
Failure of calf muscle pump
Superficial venous reflux
Deep reflux (Surgery, DVT, congenital)
Venous obstruction (HF, portal HT, obesity)
Signs of chronic venous insufficiency
Oedema Telangiectasia Eczema Haemosiderin pigmentation Hypopigmentation Lipodermatosclerosis Ulceration
Investigations for venous ulcers
History, Exam, ABPI
Bloods - FBC, u&Es, LFTs
ECHO - exclude cardiac disease
Treatment of venous ulcers
Wound care
Elevation
Compression bandaging
Shock wave therapy
Causes of secondary lymphoedema
Sugery
Malignancy
Radiotherapy
Infection
Treatment of lymphoedema
Elevation
Drainage
Differential diagnoses in leg swelling
Renal disease
Hepatic disease
Cardiac disease
Complications of deep venous insufficiency
Swelling
Recurrent cellulitis
Chronic pain
Ulceration
DVT
Secondary lymphoedema
Varicose veins
