Venous and lymphatic disease Flashcards
What are varicose veins?
Tortuous dilated superficial veins
What causes primary varicose veins?
Valvular dysfunction
Where are the main sites of varicose veins?
Long saphenous (80-87%) - midline Short saphenous (21-30%) - back
What are some signs and symptoms of varicose veins?
Localised or general discomfort Nocturnal cramps Swelling Acute haemorrhage Superficial thrombophlebitis Pruritis Skin change
How can you assess varicose veins?
Doppler ultrasonography - assess direction of blood flow
When should we intervene with varicose veins?
Signs of venous insufficiency Superficial thrombophlebitis Bleeding Cosmetic/anxiety Painful
How can you treat varicose veins?
Surgery - high tie, stripping, stab avulsions
Injection - sclerotherapy
Compression - stockings
What are some contraindications for superficial venous surgery?
Previous DVT
Arterial insufficiency
Patient co-morbidity
Morbid obesity
What are some contraindications for varicose vein surgery?
Haemorrhage Thrombophlebitis Haematoma Pain Infection Damage to neighbouring anatomy
List some minimally invasive treatments of varicose veins
Foam sclerotherapy Endovenous laser ablation (EVLA) radiofrequency ablation (VNUS)
What are some advantages of minimally invasive procedures?
Reduce trauma
Reduced time off work
Do not require operating theatre
Increased patient throughput
To what temperature does raiofrequency ablation of varicose veins does the veins get heated to?
85C
What are some signs of chronic venous insufficiency?
Ankle oedema Telangectasia (spider veins) Venous eczema Haemosiderin pigmentation (brown iron) Hypopigmentation (blanching) Lipodermatosclerosis - inflammation of fat Venous ulceration
What causes chronic venous insufficiency?
Failure of calf muscle pump
Venous hypertension and exudate
How is CVI treated?
Compression therapy
Define a leg ulcer
Breach in the skin between knee and ankle joint present for over 4 weeks
How many ulcers are of arterial origin?
20%
How many ulcers are of venous origin?
80%
What causes leg ulcers?
Arterial or venous disease, usually caused by: - diabetes - rheumatoid arthritis - vasculitis - connective tissue disease Can be neuropathic
What are the clinical signs of leg ulcers?
Signs of CVI
Oedema
Locomotor system affected
What investigations are carried out for leg ulcers?
Ankle brachial pressure index
Duplex ultrasound
Where are venous leg ulcers usually found?
Above the medial or lateral malleoli (ankles)
Where are arterial leg ulcers usually found?
Anterior shin
Over toe joints
Under heel
Over malleoli
Where are neuropathic leg ulcers usually found?
Over toe joints Under metatarsal head Under heel Over malleoli Inner side of first metatarsal head
How do you treat ulcers?
Compression therapy in venous disease
Dressings
Systemic and topical antibiotic therapy
Exercise - calf muscle pump
What syndrome can be confused with lymphoedema?
Klippel-Trénaunay syndrome, rare congenital condition in which blood vessels and lympathic vessels fail to form properly
What are the 3 main features of Klippel-Trenaunauy syndrome?
Nevus flammeus (port wine stain)
Venous and lymphatic malformations
Soft tissue hypertrophy of affected limbs
What causes primary lymphoedema?
Congenital
What causes secondary lymphoedema?
Malignancy
Surgery
Radiotherapy
Infection
How do you treat lymphoedema?
Elevation Manual drainage Compression Exercise Surgery e.g. lymph vessel grafting Laser therapy
