Venous and Lymphatic Disease Flashcards
What are varicose veins a sign of?
Superficial venous disease
What does chronic limb insufficiency affect?
Deep venous system
Pathology of varicose veins
Damaged valves so backflow of blood
Tortous dilated superfifical veins
Sites of varicose veins
Long saphenous 80-87%
Short saphenous 21-30%
Alone 13%
Combined 21%
Which gender gets varicose veins more?
F > M
Common things found in a history of varicose veins
Occupation Pregnancies (twins, big babies) Previous DVT / major trauma FH IVDU
Presentation of varicose veins
Cosmesis Localised or general discomfort in leg Nocturnal cramps Swelling Acute haemorrhage Superficial thrombophlebitis Pruritus Skin changes e.g. bruising, eczema, spider veins
Definition of pruritus
Itching
Presentation of chronic venous insufficiency
Ankle oedema Telangectasia Venous eczema Haemoseridin pigmentation Hypopigmentation "atrophie blanche" Lipdermatosclerosis Venous ulceration
Pathology of chronic venous insufficiency
Venous HTN
Venous enlargement and stasis
Imbalance of stirling forces and fluid exudate
High AVP
Pathological causes of chronic venous insufficiency
Failure of the calf muscle pump
- superficial venous reflux
- deep venous reflux
- venous obstruction
- neuromuscular
- obesity
- inactivity
Definition of leg ulcer
A breach of the skin between the knee and the ankle joint, present for over 4 weeks
Differential diagnosis of leg ulcers
Venous (80%) Arterial (20%) DM RA Vasculitis CT disease Severe arterial disease
Investigations of leg ulcer
ABPI
Duplex
Investigations for varicose veins
Examination
Duplex
Indications for intervention in varicose veins
Symptoms Superficial thrombophlebitis Signs of chronic venous insufficiency Bleeding Cosmetic Anxiety that disease may progress
Treatment of varicose veins
Surgery Injection (sclerotherapy) Laser Heat Compression Conservative
Contraindications for superficial venous surgery
Previous CVT
Arterial insufficiency
Co morbidity
Morbid obesity
Complications of venous surgery for VV
Minor haemorrhage Thrombophlebtitis Haematoma Wound problems Severe pain Sural/saphenous nerves can be damaged Damage to deep veins A + V + DVT
How does laser treatment help varicose veins?
Vein scars and fibroses until it is occluded
How does compression help varicose veins?
Creating artificial mechanical pressure to drain the vein.
Minimally invasive Txs of main trunk varicosities
Foam sclerotherapy (chemical reaction with endothelium) Endovenous laser ablation (EVLA) Radiofrequency ablation
Treatment of chronic venous insuffiency
Multi layer, granulated, elastic, high grade compression therapy (exclude arterial disease)
Non adherent dressings
Exercise (calf muscle pump)
Causes of lymphodema
Primary - congenital - praecox (age 9-25) - tarda (over 35) Secondary - malignancy - surgery - radiotherapy - infection
