Venous and Lymphatic Disease Flashcards
What is the deep venous system?
Carries the blood deep within the muscles of the thigh, and drains into the IVC.
The calf muscles compress the popliteal vein and increase VR.
How does the great saphenous vein join the deep venous system?
It joins the deep venous system at the saphenofemoral junction, at the femoral triangle. Perforating veins go into the GSV and transport blood into the deep venous system.
How does the small saphenous vein join the popliteal vein?
From the sole of the foot, it runs up the posterior calf and drains into the popliteal vein via perforations.
What is chronic venous insufficiency?
Damage that involves both the deep and superficial venous system.
Risk factors - age, female, previous DVT, trauma, and prolonged standing.
What is the pathophysiology of chronic venous insufficiency?
Venous hypertension.
An endothelial leak, increases perfusion distance, impairing healing.
Inflammation and tissue damage occur.
Oedema also occurs.
The end result is impaired tissue perfusion.
What are varicose veins?
Due to superficial venous insufficiency.
Blood flows backwards in veins with damaged valves, causing stasis and oedema.
Risk factors - recent DVT, pregnancy (uterus sits on the deep iliac veins), tumours, and trauma.
What is the presentation of varicose veins?
Distended veins that go away when they lie down (mild).
Ask them to stand and look at the saphenous veins. Check for oedema, eczema and discolouration. Palpate for thrombosis.
What are the symptoms of varicose veins?
Itching, burning, previous infection, phlebitis, ulceration, swelling, discolouration, and bleeding.
What is the Trendelenburg test?
Lay the patient flat.
Raise the leg above the left of the heart and press at the level of the saphenofemoral junction. Ask the patient to stand, and see if the vein fills.
If it does not fill when the junction is occluded, then this is likely where the incompetence lies.
What is the Tap test?
Lay the patient flat. Tap on the great saphenous vein above the knee. If tapping is transmitted - the vein is likely incompetent.
What is the Doppler test?
Monophasic - normal.
Biphasic - reflux.
What are investigations of varicose veins?
Peripheral pulse examination (ABPI).
Venous duplex US scanning - shows the size and (back)flow, normally done in secondary care.
CEAP (C1-C4 is treated via guidance).
What skin changes occur due to deep venous insufficiency?
Oedema.
Telangiectasia.
Venous eczema.
Hemosiderin pigmentation.
Lipodermatosclerosis.
Ulceration.
How is chronic venous insufficiency managed?
Normally conservative, with no easy target to fix. Compression bandaging and elevation, if there are no arterial problems.
Reduces oedema and ulcers. If not kept up - flare-ups of cellulitis and ulcers occur.
What surgical options are used to treat superficial varicose veins?
Endovenous thermal ablation.
Foam sclerotherapy.
