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cardiovascular system > Venous and Lymphatic Disease > Flashcards

Venous and Lymphatic Disease Flashcards

1
Q

What is a Varicose Vein

A

Dilated and tortuous and most commonly found in the lower limbs

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2
Q

Anatomy Landmarks (3)

A

Long Saphenous Vein
Saphenofemoral Junction
Short Saphenous Vein

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3
Q

What drains the LSC

A

Dorsal venous arch

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4
Q

Where does the dorsal venous arch pass

A

Anterior to the medial malleolus, up the medial aspect of the leb

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5
Q

Where is the Saphenofemoral Junction found

A

2.5cm below and lateral to the pubic tubercle

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6
Q

What happens at the Saphenofemoral Junction

A

LSV perforates the cribiform fascia and empties into the femoral vein (deep vein)

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7
Q

What drains to SSV

A

Plantar venous arch

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8
Q

Where does the plantar venous arch pass

A

Travels posterior to the lateral malleolus, up the posterior aspect of the leg and drains the popliteal vein (deep system)

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9
Q

What 3 things are required to assist low flow against gravity back to the heart

A

Valves
Calf muscle
Perforating veins to drain blood into deep systems

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10
Q

Causes of valvular failure

A

Surgical or traumatic disruption of valve
DVT
Hormonal changes
Large pelvic tumour

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11
Q

How does DVT cause valvular failure

A

can initially cause obstruction to venous flow and even as the vein re-canalises through the thrombus, this canal will be a high-pressure avlvular channel

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12
Q

How can hormonal changes cause valvular failure (2)

A

 Hormonal changes in pregnancy can cause weakness of the veins and valves, leading to venous incompetence. The enlarges uterus can cause mechanical obstruction to the venous flow within the deep system

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13
Q

How can a large pelvic tumour causes valvular failure

A

 Large pelvic tumour also could lead to increased pressure within the distal venous system

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14
Q

Once the valve has failed what happens t the pressure and size of the vein

A

Pressure increases

Dilatation of distal vein

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15
Q

Risk Factors (6)

A
  • Age
  • Female
  • Pregnancies
  • DVT
  • Standing for long periods of time
  • Family history
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16
Q

Diagnosis (History) (11)

A
  1. Burning
  2. Itching
  3. Heaviness
  4. Tightness
  5. Swelling
  6. Discolouration
  7. Phlebitis
  8. Bleeding
  9. Disfiguration
  10. Eczema
  11. Ulceration
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17
Q

Diagnosis (Examination)

A

Look and feel

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18
Q

Diagnosis (Special tests) (4)

A

Tap Test
Trendelenburg/Tourniquet
Doppler
US

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19
Q

Tap Test (2)

A
  • Place one hand over the Saphenofemoral junction and one over the saphenous vein above the knee
  • Tap the Saphenofemoral junction and a transmitted impulse at the knee indicates an incompetence of the valves between the two hands
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20
Q

Trendelenburg/Tourniquet Test (5)

A
  • Lie patient flat
  • Raise leg to drain superficial veins and stroking the veins toward the trunk
  • Apply pressure over the Saphenofemoral junction and maintain pressure while asking the patient to stand up
  • If the varicose veins don’t dilate at standing you are preventing backflow of blood
  • Tourniquet: repeating the test at 10cm intervals down the leg to find the level of incompetence
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21
Q

Doppler (4)

A
  • Hold doppler probe over the Saphenofemoral junction
  • Squeeze the calf muscles
  • In a patient with competent superficial veins you will hear a whoosh of blood flowing into the deep system
  • In patients with an incompetent Saphenofemoral junction you will hear two waves as the blood flows upwards and then refluxes back down
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22
Q

Ultrasound

A

Can demonstrate valves, the anatomy of varicose veins and be used to show dynamic blood flow (reflux)

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23
Q

CEAP classification of Chronic venous disease

A

C0-C6

24
Q

C0

A

No visible or palpable signs of venous disease

25
Q

C1

A

Teleangiectasies or reticular veins

26
Q

C2

A

Varicose veins

27
Q

C3

A

Oedema

28
Q

C4a

A

Pigmentation or eczema

29
Q

C4b

A

Lipodermatosclerosis or athrophie blanche

30
Q

C5

A

Healed venous lcer

31
Q

C6

A

Active venous ulcer

32
Q

Etiological Classification (4)

A

Congenital
Primary
Secondary
No venous cause identifies

33
Q

Ec (3)

A

Congenital
Superficial veins
Reflux

34
Q

Es (3)

A

Secondary
Deep veins
Reflux and obstruction

35
Q

En (3)

A

No venous cause identified
No venous location identified
No venous pathophysiology

36
Q

Ep (3)

A

Perforating veins

Obstruction

37
Q

Treatment should be offered to patients complaining about (6)

A
  • Hold doppler probe over the Saphenofemoral junction
  • Squeeze the calf muscles
  • In a patient with competent superficial veins you will hear a whoosh of blood flowing into the deep system
  • In patients with an incompetent Saphenofemoral junction you will hear two waves as the blood flows upwards and then refluxes back down
38
Q

Management Options (3)

A
  1. First line: Endovenous treatment
  2. Second line: ultrasound guided foam scleropathy
  3. Third line: open surgery
39
Q

If intervention for varicose veins not possible

A

Offer compression hosiery

40
Q

When shouldn’t an intervention be offered

A

DVT

Pregnancy

41
Q

Endovenous Treatment (4)

A
  1. The LSV or SSV is cannulated under US guidance
  2. A catheter is passed up the length of the vein to just distal to the Saphenofemoral or saphenopopliteal junction
  3. Local anaesthetic is used for the small skin puncture and then this is infiltrated in the superficial tissues around the length of the vein
  4. The catheter causes injury to the vein wall- either by heat or laser, which causes fibrosis and occlusion of the vein leading to the ablation and disappearance on the vein
42
Q

Complications of Endovenous Treatment (4)

A

Skin burns
Paraesthesia
Phlebitis
DVT

43
Q

Foam Scleropathy (2)

A
  • Under US guidance a chemical foam is injected into the affected vein
  • The foam damages the venous wall causing fibrosis and occlusion
44
Q

Complications of Foam scleropathy

A

because the vein needs to be occluded proximally to prevent foam migrating this can cause stroke, TIA, MI, Thrombophlebitis and skin pigmentation

45
Q

Open Surgery (3)

A
  1. Under GA a groin incision is made and the Saphenofemoral junction is exposed
  2. The saphenous vein is ligated from the femoral vein. An instrument is passed along the length of the saphenous vein and then used to strip the vein out
  3. Small superficial varicose veins are avulsed using small stab incisions and a small hook instrument
46
Q

Complications of open surgery (4)

A

anaesthetic risk, wound infection, damage to nearby nerves (saphenous and sural nerves), bleeding

47
Q

Causes of Venous Insufficiency (4)

A
  • Failure of calf muscle pump
  • Superficial venous reflux
  • Deep venous reflux (surgery, DVT, congenital)
  • Venous obstruction (HF, portal hypertension, obesity)
48
Q

Symptoms of venous insufficiency (7)

A
  • Oedema
  • Telangiectasia- widened vessels cause thread like red lines
  • Eczema
  • Haemosiderin pigmentation
  • Hypopigmentation
  • Lipodermatosclerosis
  • Ulceration
49
Q

Pathophysiology of venous insufficiency (7)

A 
Venous hypertension
Endothelial leak
Oedema
Increased perfusion distance
Impaired healing
Inflammation
Fibrinogen tissue damage
50
Q

What is a venous ulcer

A

• Breach in the skin between the knee and ankle joint, present for more than 4 weeks

51
Q

Features of a venous ulcer (6)

A
  • Gaiter area
  • Granulomatous (red) base
  • Shallow
  • Irregular margins
  • Exudative, oedematous
  • Painless, pulses present
52
Q

Where are venous ulcers located (2)

A

above medial malleoli and above lateral malleoli

53
Q

Investigations of venous insufficiency (3)

A

History
Examination
Ankle Brachial Pressure index to exclude arterial clause

54
Q

Treatment of Venous insufficiency (5)

A
  • Exclude arterial disease (ABPI)
  • Wound care
  • Elevation
  • Compression bandaging
  • Shockwave therapy
55
Q

Primary cause of lymphoedema (3)

A

Congenital
Praecox- puberty
Tarda >35 years

56
Q

Secondary Cause of lymphoedema (4)

A

 Malignancy
 Surgery
 Radiotherapy
 Infection

57
Q

Treatment of Lymphoedema (2)

A

Elevation

Drainage

cardiovascular system (42 decks)

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