Venous and Lymphatic Disease Flashcards
Which disease affects the superficial veins only?
Varicose Veins
Varicose veins in more common in…
Middle aged women
Name the two superficial veins in the leg
Short saphenous (greater) Long Saphenous (lesser)
Describe the drainage of superficial veins
Long Saphenous- drains into the femoral at the proximal medial thigh.
Short Saphenous- drains into the popliteal at the back of the knee.
Describe the pathophysiology of VV
Valves are damaged which allows backflow & pooling of blood in veins.
Can be hereditary or secondary to venous disease.
Which vein is more commonly affected?
Long Saphenous (80%)
Points to look for in a history and why?
Age- indicate primary vs secondary Occupation- standing all day? Pregnancy- big baby/ twins Previous DVT/ major trauma Family History Impact on lifestyle
Name 5 symptoms of VV
- Cosmesis- look ugly
- Localised or General discomfort in legs
- Nocturnal Cramps
- Swelling
- Venous eczema/ itching
Name two signs which would be indications for intervention
- Acute Haemorrhage- fragile skin and blood under pressure leads to bleeding
- Superficial Thrombophlebitis- thrombus in vein leads to swelling and inflammation.
Investigations for VV
Duplex Ultrasound
Findings on D.U.S
Backflow of blood
Check patency of deep veins in case of surgery.
Indications for intervention VV
- Bleeding
- Impacting on functionality
- thrombophlebitis
- signs of chronic venous insufficiency.
- anxiety or depression.
Options for treatment of VV
- Surgery
- Foam Sclerotherapy
- Minimally invasive therapy
- Conservative- compression
Describe the process of surgery
Open vein and strip it out- pull it out at the junction with the saphenous.
Contraindications for surgery in VV
Previous DVT
Arterial Insufficiency
Morbid obesity
Co-morbidity
Possible complications of surgery in VV
Wound pain Thrombophlebitis Scarring Damage to sural or saphenous nerve. Damage to arteries, nerves, deep veins, DVT.
Name two types of Minimally Invasive procedures
- EVLA- endovenous laser ablation
2. VNUS- radiofrequency ablation- heat (85 degrees)
Advantages of less invasive
Local Anaesthetic ( surgery needs GA)
No operating theatre
Shorter recovery time.
Chronic Venous Insufficiency- what is it?
Failure of calf muscle pump, valve failure or obstruction leads to high AVP, leads to venous hypertension, leads to imbalance of starling forces (oedema), portal hypertension and potential R heart failure.
what is AVP?
Ambulatory Venous Pressure
Factors affecting the calf muscle pump?
Inactivity (bedridden)
Obesity
Superficial/deep venous reflux
Neuromuscular disease.
5 Signs of CVI
Ankle oedema Telangectasia- spider veins Venous eczema Haemosiderin Pigmentation Hypopigmentation Lipodermatosclerosis Venous Ulceration.
Define a leg ulcer
Breach of skin between knee and ankle for over 4 weeks.
Differential diagnosis in CVI and leg ulcers
80% venous
20% arterial
Also Diabetes, Rheumatoid Arthritis, CT disease.
Investigations for CVI
ABPI & Duplex US
Treatment for CVI
Compression
Dressings
Systemic or topical therapy
Exercise and elevate at rest
When would you not use compression?
In arterial disease- would further limit perfusion.
Name two main types of Lymphoedema
Primary
Secondary
Name three subtypes of primary Lymphoedema
- congenital
- praecox- before 30
- tarda- after 30
Name 3 causes of Secondary Lymphoedema
- Malignancy
- Radical Mastectomy
- radiotherapy
- infection (TB/filariasis)
What is hyperplasia?
Enlarged but dysfunctional lymph vessels.
Treatment for Lymphoedema
- Elevation
- Manual Drainage
- Compression Bandaging
- Pneumatic Compression
