Venous and Lymphatic Disease Flashcards
what are varicose veins?
tortuous dilated superficial veins
what creates varicose veins?
valvular dysfunction
what should you get from a history from a person with varicose veins?
> age they appeared > occupation > pregnancies > previous deep vein thrombosis > family history
what are common symptoms and signs associated with varicose veins?
> cosmesis (look bad) > discomfort in the leg > nocturnal cramps > swelling > acute haemorrhage > superficial thrombophlebitis > pruritis > skin changes
how would you assess varicose veins?
check the deep venous system is patent and the superficial system is draining
what are the indications for intervention of varicose veins?
> superficial thrombophlebitis
signs of chronic venous insufficiency
bleeding
what is the treatment for varicose veins?
> surgery
injection
minimally invasive procedures
compression
what surgery can be performed on varicose veins?
> high tie
stripping
multiple stab avulsions
what are the relative contraindications for performing surgery on varicose veins?
> previous deep vein thrombosis
arterial insufficiency
patient comorbidity
morbid obesity
what are some common complications with varicose vein surgery?
> minor haemorrhage
thrombophlebitis
haematoma
wound problems
what are some rare complications with varicose vein surgery?
> damage to deep veins, arteries or nerves
> deep vein thrombosis
name some minimally invasive treatment for main trunk varicosities
> foam sclerotherapy
endovenous laser ablation
radiofrequency ablation
what are the potential advantages of using a local anaesthetic during minimally invasive treatment?
> reduction in surgical trauma
reduce time off work
does not require operating theatre
potential increase patient through put
describe laser surgery of varicose veins
- micro puncture needle inserted into the incompetent vein using ultra sound
- guide wire introduced and manoeuvred to the saphenous junction with deep vein using ultrasound
- catheter and laser fibre introduces over guide wire to 1cm below the junction.
describe the foam sclerotherapy surgery in varicose veins
- needle inserted into the incompetent veins under ultrasound control
- foam injected prevented form entering the deep venous system
describe the pathophysiology of chronic venous insufficiency
venous hypertension leads to engorment and stasis. this creates an imbalance of starlings forces and fluid exudate.
what is the aetiology of chronic venous insufficiency?
> failure of the calf muscle pump (superficial/deep venous reflux, venous obstruction, neuromuscular, obesity, inactivity)
what is the definition of leg ulceration?
breach in the skin between the knee and ankle joint present for over 4 weeks
what would you find on clinical examination of someone with a leg ulceration?
> signs of chronic venous insufficiency
oedema
locomotor system
what investigations would you carry out on someone with a leg ulceration?
> ankle brachial pressure increase
> duplex
where are venous ulcerations found on the leg?
above the lateral or medial malleoli
are venous ulcers pinker or yellower compared to arterial ulcers?
pinker as they have a good blood supply
what is the treatment for ulcerations?
> multi-layer graduated elastic high grade compression therapy with non-adherent dressings.
calf muscle pump.
name some secondary causes of lymphoedema
> malignancy
surgery
radiotherapy
infection
