Venous and Lymphatic Disease Flashcards
Varicose vein
A dilated and tortuous vein
Varicose veins are often which kind of vein
Superficial
Varicose veins are most commonly found in
The lower limbs
Varicose veins are usually found in the
Saphenous veins
Factors that assist flow of blood in the veins back to the heart
Valves
Calf muscle pump
Perforating veins to drain blood into the deep system
Blood is drained into the deep veins because
They are within muscular compartments and can withstand higher pressure
Causes of valvular failure
Surgical or traumatic disruption of valve
DVT - obstruction
Hormonal changes during pregnancy cause weakness
Large pelvic tumour
Effects of one valve failing
Venous pressure increase
Dilation of the distal veins
Further valvular incompetence
Risk factors of varicose veins
Age Female Pregnancies DVT Standing for long periods Family history
Symptoms of varicose veins
Burning
Itching
Heaviness
Tightness
Examination findings of varicose veins
Swelling Discolouration Phlebitis - inflammation Bleeding Disfiguration Eczema Ulceration
Special test for diagnosing varicose veins
Tap test
Trendelenburg/tourniquet test
Doppler
Tap test
Place one hand over the saphenofemoral junction and other over the long saphenous vein above the knee
Tap the saphanofemoral junction - a transmitted impulse at the knee indicates incompetence of the valves between the two hands
Trendelendburg/tourniquet test
Drain superficial veins by raising the leg
Apply pressure over the saphenofemoral junction and keep it on as patient stands
On release if the veins refill then the saphenofemoral junction valve is incompetent
Tourniquet is same but with tourniquet instead of hands
Doppler
Hold doppler probe over the saphenofemoral junction
Squeeze calf muscles
Hear a ‘whoosh’ as the blood flows upwards into the deep system if competent superficial veins.
Hear two waves if incompetent.
Investigations for varicose veins
Special tests
Ultrasound
Varicose veins C0
No visible or palpable signs of venous disease
Varicose veins C1
Teleangiectasies or reticular veins
Varicose veins C2
Varicose veins
Varicose veins C3
Oedema
Varicose veins C4a
Pigmentation or eczema
Varicose veins C4b
Lipodermatosclerosis or atrophie blanche
Varicose veins C5
Healed venous ulcer
Varicose veins C6
Active venous ulcer
What classification of varicose veins qualifies you for treatment
C3 or above
Treatment should be given to patients complaining of varicose veins that are
Bleeding Symptomatic Recurrent symptomatic Lower limb skin changes of chronic venous insufficiency Superficial venous thrombosis Venous leg ulcer
First line management of varicose veins
Endovenous treatment
Second line management of varicose veins
Ultrasound guided foam sclerotherapy
Third line management of varicose veins
Open surgery
If intervention of varicose veins in unsuitable, offer
Compression hosiery
Intervention of varicose veins shouldn’t be offers if
Deep venous system is obstructed eg DVT or pregnancy
Endovenous treatment
Injury to vein wall via heat or laser resulting in fibrosis and occlusion of the vein and so ablation
Complications of endogenous treatment
Skin burns
Paraesthesiae
Phlebitis
DVT
Foams sclerotherapy
Chemical foam injected into affected vein, damaged the venous walls causing fibrosis, occlusion and ablation
Complications of foams sclerotherapy
Foam migration - causes potential complications of stroke, TIA or MI
Thrombophlebitis
Skin pigmentation
Open surgery
Removal of saphenous vein
Complications of open surgery
Anaesthetic risk
Wound infection
Damage to nearby nerves
Bleeding
Venous insufficiency causes
Failure of calf muscle pump
Superficial venous reflux
Deep venous reflux
Venous obstruction
Pathophysiology of venous insufficiency
Insufficiency - venous hypertension - endothelial leak - oedema - increase perfusion distance - impaired healing - inflammation - fibrinogen, tissue damage - impaired tissue perfusion
Examination findings on chronic venous insufficiency
Oedema Telangiectasia Eczema Haemosiderin pigmentation - orange Hypopigmentation - white Lipodermatosclerosis Ulceration
Features of venous ulcers
In gaiter area Granulomatous (red) base Shallow Irregular margins Exudative, oedematous Painless Pulses present
Features of arterial ulcers
Defined borders
Smaller and deeper
Painful
Food on anterior skin, under heel, around malleolus
Features of neuropathic ulcers
Can’t feel them
Found at metatarsal head, under heel, around malleolus
Investigation of chronic venous insufficiency
Ankle-brachial pressure index (ABPI) - excludes arterial disease
Treatment of chronic venous insufficiency
Wound care - antibiotics
Elevation
Compression bandaging
Shockwave therapy
Secondary causes of lymphoedema
Malignancy
Surgery
Radiotherapy
Infection
Treatment of lymphoedema
Elevation
Drainage
Compression bandaging
