Venous and Lymphatic Disease Flashcards
Explain the structure of arteries
Thick walls with small lumen
Have strong elastic and smooth muscle layer
Makes greater control of blood and good for high pressure
Explain the structure of veins
Wider diameter than arteries and have limited amounts of elastic fibre as smooth muscle
Have valves so better at low pressure delivery
How does the deep venous system work?
Uses calf pump - acts with popliteal vein to push against blood and compress vein to help venous return
Also returns by long and short saphenous vein - gravity and valves
What is included in superficial venous system?
Long and short saphenous veins
Explain the long saphenous vein
Runs up medial aspect of calf and then thigh joining to deep venous system at saphenous-femoral junction in femoral junction
Has several perforating veins which transport blood from superficial to deep venous system
Explain the short saphenous vein
Sole of foot drains to this vein, then goes up posterior aspect of calf and drains to popliteal vein through perforations
What is the deep venous system made up of?
Tibial, popliteal and femoral vein
Explain the deep venous system
Carries deep within tissues under gastrocnemius and soleus and deep within muscular compartments of the thigh
Under inguinal ligament. Femoral becomes external iliac then internal iliac to become common iliac. Drains to IVC
What are the 2 main forms of venous disease?
Chronic venous insufficiency and varicose veins
What are varicose veins due to?
Superficial venous insufficiency - normally damage to the valves within the venous system
What are the risk factors for varicose veins?
Recent DVT, pregnancy, tumours as compression causes increased pressure, and any trauma - surgical or direct
How is pregnancy a risk factors for venous disease?
Hormonal changes and uterus sitting on deep iliac veins
What happens if the whole part of the superficial venous system is affected?
Blood flows back down leg and causes stasis and oedema
What are the risk factors for venous insufficiency?
Increasing age, female sex (pregnancy), previous DVT or trauma and prolonged standing which can increases venous pressure over long time
What is chronic venous insufficiency?
When there is damage to venous system over long period of time
Combination of deep and superficial diseases
Is followed by venous hypertension
Describe the cycle of chronic insufficiency?
Venous hypertension - endothelial leak as damage to veins - oedema
Oedema created distance for perfusion so causes impaired healing, inflammation and tissue damage
End up with ulceration
What are some minor symptoms for varicose veins?
Unsightly and distended veins
Mild so go away when lying down
What are the symptoms for venous disease?
Itching, burning, previous infection, ulceration, swelling, tightness in legs and discolouration if left unnoticed
What can be seen on examination of venous disease?
Most distended veins when standing
Look for the long and short saphenous vein
Oedema, discolouration and eczema
Explain the Trendelenburg test
Patient laying flat. Raise leg above level of heart. Press at level of saphenous-femoral junction. Ask patient to stand and look to see if vein fills
If vein does not distend then junction is occluded so where problem lies
Explain the tap test
Lay patient flat. Place hand of saphenous-femoral junction and tap over long saphenous vein just above the knee
If tapping is transmitted then likely backflow of blood
What does the Doppler test show?
Assesses flow
What investigations should be carried out in venous disease?
Complete peripheral vascular examination, ankle brachial pressure index and venous duplex ultrasound scanning which is used for diagnosing
What does the venous duplex ultrasound scan show?
Size of vessel, flow within and if it has backflow
Usually done in secondary care
Explain the CEAP classification
C- clinical manifestations
E - eitology
A - anatomic distribution
P - pathophysiology
What is C4 in CEAP classification?
Changes in skin and subcutaneous tissue secondary to chronic venous disease
Above C4 is treated by SIGN guidelines
Explain C5 and C6 on CEAP
C5 is healed to have to be C6 first which is active venous ulcer
What are the signs of venous insufficiency?
Oedema, telangiectasia, venous eczema, lipodermatosclerosis, ulceration and hemosiderin pigmentation
How is chronic venous insufficiency managed?
Conservative management as not easy target for superficial vein to fix.
What is involved in conservative management?
Compression bandaging and elevation if they do not have arterial supply problem
Allows reduction in oedema and reverses vicious cycle
What happens if patient does not keep on top of compression bandaging?
Intermittent flares of cellulitis and venous ulceration
What is the treatment for varicose veins?
Endovenous treatment
Foam sclerotherapy and surgical intervention
Explain laser or radiofrequency ablation
Endovenous treatment
Under duplex US which diagnoses superficial insufficiency.
Insert cannula into long saphenous vein above knee insert wire to saphenous-femoral junction
Insert Laser fibre or RFA fibre
How does laser or RFA treatment work?
Cause damage to tissues by intensely heating up the inside of the vein.
Laser and RFA removed and vein sticks to itself and closes off
Local anaesthesia used - 200ml in groin and knee area
What should patients do after endovenous treatment?
Compression bandaging immediately after
Helps vein wall keep stuck together
Explain foam sclerotherapy
If cant undergo laser or RFA
Common in smaller areas of varicosity
Scalarising agent is mixed with air to create foam which is ejected into veins. Causes irritant effect and causes vein to collapse down on itself. Then causes thrombosis of vein
Describe surgical intervention for varicose veins
Aimed at removing the diseased vein bur now rarely used
The long saphenous vein is pulled out then compression bandaging post-operatively will stop bleeding as venous and low pressure
Can cause bleeding and is painful
