Venous and Lymphatic Disease Flashcards
What are varicose veins?
Veins that have become enlarged and twisted
Why do varicose veins happen?
Because the leaflet valves in veins are leaky and so veins swell and enlarge.
Where are varicose veins usually found?
Greater saphenous vein
Lesser saphenous vein
What is the prevalence of varicose veins?
20-25% in females
10-15% in men
What are the signs and symptoms of varicose veins?
Localised or generalised discomfort in the leg Nocturnal cramps Swelling Acute haemorrhage Superficial thrombophlebitis Pruritus - itching Skin changes
What should be asked when taking a history for varicose veins?
Occupation Pregnancies - twins or big babies Previous DVT (or good reason for DVT such as white leg of pregnancy) Family history When the veins appeared
What are the indications for intervention with varicose veins?
Superficial thrombophlebitis
Signs of chronic venous insufficiency
Bleeding
Cosmetic
What is the surgical treatment of varicose veins?
Superficial venous surgery Ligation of the sapheno-femoral or sapheno-popliteal junction Vein stripping Multiple stab avulsion Perforate invaginate stripping
What are the contraindications for superficial venous surgery?
Previous DVT
Arterial insufficiency
Patients co morbidity
Morbid obesity
What are common complications of varicose vein surgery?
Minor haemorrhage Thrombophlebitis Haematoma Wound problems Severe pain
What is thrombophlebitis?
Vein inflammation related to thrombus
What are the more rare complications of varicose vein surgery?
Damage to deep veins, arteries and nerves
DVT
What are the minimally invasive treatments of main trunk varicosities?
Foam sclerotherapy
Endogenous laser ablation
Radio frequency ablation
What is EVLA?
Endogenous laser ablation
What is VNUS?
Radio frequency ablation
How is EVLA done?
- Micro puncture needle inserted into saphenous vein using ultrasound
- Guidwire moved to saphenous junction with deep vein
- Catheter and laser fibre put in 1cm below the junction
How does VNUS work?
- Catheter inserted into vein
- Vein heated to 85 degrees and collapsed
- Catheter slowly withdrawn, closing vein
How is foam sclerotherapy done?
- Needle inserted into vein using ultrasound
2. Foam injected
What is the conservative option for varicose vain treatment?
Compression hosiery
What is chronic venous insufficiency?
When veins cannot pump enough blood back to the heart
What are the symptoms of chronic venous insufficiency?
Ankle oedema Telangiectasia Venous eczema Haemosiderin pigmentation Hypopigmentation Lipodermatosclerosis Venous ulceration
What is the pathophysiology of CVI?
Venous hypertension
Venous engorgement and stasis
Imbalance of Starling forces and fluid exudate
What is ambulatory venous pressure?
The blood pressure in the veins during active movement
What is normal AVP?
30mmHg
What does it mean if AVP is high?
Failure of muscle pump, valves or outflow obstruction
Venous hypertension
What are some possible reasons for the failure of the calf muscle pump?
Superficial venous reflect Depp venous reflux Venous obstruction Neuromuscular Obesity Inactivity
What is a leg ulcer?
Breach in the skin between the knee and ankle joint, present for over 4 weeks
What is the differential diagnosis for leg ulceration?
Venous disease Arterial disease Diabetes Rheumatoid arthritis Vasculitis Connective tissue disease
What investigations should be done on patients with leg ulceration?
Ankle brachial pressure index
Duplex ultrasonography
Where are leg ulcers typically found in venous disease?
Above lateral and medial malleoli
Where are leg ulcers typically found in atrial disease?
Over toe joint
Anterior shin
Over malleoli
Under heel
Where are leg ulcers typically found in neuropathic disease?
Over toe joint Under metatarsal head Under heel Over malleoli Medial side of the first metatarsal head
What is the treatment of leg ulcers?
Compression therapy
Dressings
Systemic and topical therapy
Exercise
What are the surgical treatments of CVI?
Ligation Vein stripping Surgical repair Endovenous Laser Ablation Vein transplant Subfascial endoscopic perforator surgery
What are the conservative treatment methods of CVI?
Manual compression Skin lubrication Sequential compression pump Ankle pump Compression stockings Blood pressure medication Elevating the legs above the heart level
What is lymphoedema?
Localised fluid retention and tissue swelling because of a compromised lymphatic system
What is Klippel-Trenaunay Syndrome?
A rare congenital medical condition in which blood vessels and/or lymph vessels fail to form properly.
What are the primary types of lymphoedema?
Congenital
Praecox
Tarda
What are the possible causes of secondary lymphoedema?
Malignancy
Surgery
Radiotherapy
Infection
What are the signs and symptoms of lymphoedema?
Swelling of the limbs A feeling of heaviness or tightness Restricted range of motion Aching or discomfort Recurring infections Hardening and thickening of the skin
What is the treatment of lymphoedema?
Manual lymphatic drainage
Compression bandages
Skin care
Exercise
