Venous and Lymphatic Disease Flashcards
How do varicose veins arise?
Valvular dysfunction
Where is the most common site for Varicose veins?
Long saphenous (80-87%)
How many women have varicose veins?
20-25%
How many men have varicose veins?
10-15%
What are the symptoms and signs of varicose veins?
- Cosmesis
- Localised or generalised discomfort in the leg
- Noctural cramps
- Swelling
- Acute haemorrhage
- Superficial thromboplebitis (red inflamed skin)
- Pruritus (itching)
What is the treatment of varicose veins?
Surgery
- High tie,stripping,multiple stab avulsions
- Injection (scleropathy)
- compression
What are the contra-indications to have surgery for varicose veins?
- previous DVT (collaterals)
- Arterial insufficiency
- Patient Co-Morbidity
- Morbid obesity
Wha complications can happen for surgery of VV?
common
- Minor haemorrhage
- thrombophlepbitis, haematoma
- Would problems, severe pain
less common
-sural/saphenous nerves
Rare:
-Damage to deep veins , arteries, nerves, DVT
What are the three minimally invasive treatments of main treatments of main trunk varicosities
- Foam Sclerotherapy
- -Chemical reaction with endothelium
- Endothelial laser ablation (thermal)
- Radiofrequency ablastion (thermal)
What does PIN stand for when treating varicose veins?
(Perforate invaginate) stripping
What are the potential advantages of local anaesthetic minimally invasive treatment options?
- Reduce surgical trauma (bruising,scarring)-less pain
- Reduce time off work
- Do not require an operating theatre
- potential to increase patient throughput
What are the results of minimally invasive treatments for varicose veins?
- Short to medium term just as effective clinically as surgery
- Long term results awaited
What is the laser (ELVA) technique? (4 points)
- Micro puncture needle inserted into the incompetent long short saphenous veins using ultrasound
- Guidewire introduced, and manoeurvred to saphenous junction with deep vein using ultra sound
- Catheter and laser fibre intoduced over guidewire to 1cm below junction
- Closure (VNUS) -heats to 85 degrees
What is the technique for foam scleropathy?
- Needle inserted into the incompetent veins under ultrasound control
- Foam injected, prevented from entering deep venous system
What are the symptoms and signs of Chronic venous insufficiency?
- Ankle Oedema
- telangectasia -superficial changes
- Venous eczema
- Haemosiderin pigmentation (iron brown pigmentation)
- Hypopigmentation “atrophie blanche”
- Lipodermatosclerosis- narrow around ankles
- Venous ulceration
What is the pathophysiology of CVI?
- Venous hypertension
- Venous engorgement and stasis
- Imbalance of Starling forces and fluid exudate
Explain how CVI happens?
- Standing motionless- pressure at foot 90mmHg Active movements:pressure falls to 30mmHg Known as ambulatory pressure
- High AVP Failure of muscle pump, valves or outflow obstruction
Describe the Aetiology of CVI?
Failure of calf muscle pump
- Superficial venous reflux
- Deep venous reflux
- Venous obstruction
- Neuromuscular
- Obesity
- Inactive
What is the definition of a leg ulcer?
-Breach in the skin between knee and ankle jointpresent for over 4 weeks
What is the differential for a leg ulceration?
- Almost 80% purely venous in origin
- Up to 20% have significant arterial disease
- Diabetes, rheumatoid arthritis, vasculitis, CT disease
What can be found upon clinical examination of leg ulceration?
Signs of CVI
Oedema
What investigations should be preformed in regards to leg ulceration?
- ABPI (ankle brachial pressure index)
- Duplex
What is the definition of a leg ulcer?
Breach in the skin between knee and ankle joint, present for over four weeks
What is the differential diagnosis of leg ulcers?
- Almost 80% purely venous in origin
- Up to 20% have significant arterial disease
- Diabetes, rheumatoid arthritis, vasculitis, CT disease
Where anatomically are venous ulcers found?
Above medial malleoli
Above lateral malleoli
(less painful)
Where can arterial ulcers be found?
- Over toe joints
- Under heel
- Over Malleoli
- Anterior shin
Where can neuropathic ulcers be found?
- Over toe joints
- Under metatarsal head
- Underheel
- Over malleoli
- Innerside of first metarsal head
How can you tell venous from arterial ulcers?
venous are pinker because of the better blood supply
How do you treat CVI
- Multi-layer graduated, elastic, high-grade compression therapy– (Exclude arterial disease)
- Dressings -non adherent dressings if painful- hydrocolloid/foam dressing
- Systemic & topical therapy -Not proven
- Exercise– calf muscle pump
Describe the 3 types of primary lymphoedema?
- Congenital
- Praecox (before 30)
- Tarda (after 30)
Describe how you can get secondary lymphoedema?
- Malignancy
- Surgery
- Radiotherapy
- Infection (filariasis/tuberculosis/pyogenic)
How do you treat lymphoedema?
- Elvation and manual drainage
- Pneumatic compression
- Compression bandages
