Venous and Lymphatic Disease Flashcards
What causes varicose veins?
Valvar dysfunction
Where are the common sites for varicose veins?
Long saphenous - 80-87%,
Short saphenous - 21-30%
(alone 13%, combined- 21%)
Which gender is most likely to get varicose veins?
What are the symptoms and signs of varicose veins?
Cosmesis
Localised or generalised discomfort in the leg
Nocturnal cramps
Swelling
Acute haemorrhage
Superficial thrombophlebitis (inflammation of the wall of a vein with associated thrombosis, often occurring in the legs during pregnancy.)
Pruritus - itching
Skin changes
What are the indications for surgery on varicose veins?
? Symptoms
Superficial thrombophlebitis
Signs of chronic venous insufficiency
Bleeding
Others: cosmetic
anxiety that disease may progress
What are the possible treatments for varicose veins?
Surgery
–High tie, stripping, multiple stab avulsions
Injection (sclerotherapy)
Minimally invasive procedures
Compression
Conservative (may include compression)
What are contraindications for surgical intervention of DVT?
Previous DVT (collaterals)
Arterial insufficiency
Patient co morbidity
Morbid obesity
What are the surgical treatments for varicose veins which are under GA?
Ligation of the sapheno-femoral or sapheno-popliteal junctions
Vein stripping and multiple stab avulsions
What is the surgical treatment of varicose veins?
Ligation and Stripping
Ligation is when you cut and seal the vein in two places.
The first cut is made near your groin at the top of the varicose vein. The second cut is made further down your leg, usually around your knee or ankle.
The section of the vein is then pulled out
Where is ligation usually taken place?
The sapheno - femoral or sapheno - popliteal junctions
What are the varicose vein surgery complications?
Common:
minor haemorrhage,
thrombophlebitis (inflammation of the wall of a vein with associated thrombosis, often occurring in the legs during pregnancy., haematoma (a solid swelling of clotted blood within the tissues.)
wound problems, severe pain
Less Common:
sural/saphenous nerves
Rare:
damage to deep veins, arteries, nerves, DVT
What are the minimally invasive treatments of main trunk varicosities?
Foam sclerotherapy
–chemical reaction with endothelium
Endovenous laser ablation (EVLA)
–thermal ablation
Radiofrequency ablation (VNUS)
–thermal ablation
All methods are used to seal the vein
What are the advantages of local anaesthetic?
Potential advantages
–reduce surgical trauma (bruising, scarring: no incisions) less pain
–reduce time off work
–do not require an operating theatre
–potential to increase patient throughput
When might scleropathy not be available?
When there is history of DVT
When is surgery recommended?
If endothermal ablation treatments and sclerotherapy are unsuitable for you
What are the stages of the Laser (EVLA) - technique?
Micro puncture needle is inserted into the incompetent long or short saphenous using ultrasound
Guidewire is moanouvered to saphenous junction with deep vein using ultrasound.
Catheter and laser fibre introduced over guidewire to 1cm below the junction
(Micro punture needle - guidewire - catheter and laser fibre)
What is VNUS?
Uses heat to close vein (85 degrees C)
How is foam scleropathy administered?
What are signs of chronic venous insufficiency?
Ankle oedema
Telangectasia - Dilation of capillaries causing them to appear as small red or purple clusters, spidery appearance
Venous eczema - lower legs
Haemosiderin pigmentation – yellowish brown pigment formed by the breakdown of haemoglobin
Hypopigmentation “atrophie blanche”
Lipodermatosclerosis
Venous ulceration
What is thepathophysiology of chronic venous insufficiency?
Venous hypertension – with right heart failure
Venous engorgement and stasis (distension of vein woth blood)
Imbalance of Starling forces and fluid exudate
What is AVP
Known as ambulatory venous pressure( AVP)
Active movements: pressure falls to 30mmHg
What does high AVP mean?
High AVP -failure of muscle pump, valves, or
outflow obstruction
Venous Hypertension
How can the calf muscle pump fail?
–Superficial venous reflux
–Deep venous reflux
–Venous obstruction
–Neuromuscular
–Obesity
–Inactivity
What is a leg ulceration?
–breach in the skin between knee and ankle joint, present for over 4 weeks
What is the differential dagnosis of leg ulceration?
–Almost 80% purely venous in origin
–Up to 20% have significant arterial disease
–diabetes, rheumatoid arthritis, vasculitis, CT disease
What is treatment for leg ulceration?
Compression therapy
Dressings (non-adherent)
Excersize
(Not systemic and topical therapy - not proven - most ulcers colonised rather than infected)
What are the primary causes of lymphoedema?
–Congenital
–Praecox (means it happens at an earlier stage of life)
–Tarda (happens after the age of 35)
What are the secondary causes of lymphoedema?
–Malignancy
–Surgery (Radical mastectomy; groin/axillary dissection)
–Radiotherapy
–Infection (Filariasis/tuberculosis/pyogenic)
What is treatment of lymphoedema?
Elevation and drainage
Compression
