Venous Disease

Question 1

anatomy of the veins

Answer 1

*thin walled vessels
*three histologic layers
*interconnected deep and superficial systems, connected by perforators
*UNIDIRECTIONAL VALVES

Question 2

normal venous function

Answer 2

*low pressure, high volume
*flow:
-PHASIC (with VENTILATORY cycle, not cardiac cycle)
-driven by leg muscles and thoracic pressure
-valves are CRITICAL to maintaining normal pressures in legs [loss of valve function leads to ambulatory venous hypertension]

Question 3

DVT - etiologies

Answer 3

*Virchow’s Triad: problems with:
1. venous flow: stasis from “pump failure” - usually due to immobilization or venous obstruction
2. venous blood: hypercoagulability states
3. luminal interface: physical damage exposing pro-coagulant media or luminal upregulation of procoagulant ICAMs

Question 4

DVT - clinical presentation

Answer 4

*leg swelling
*leg pain
*pulmonary embolization symptoms
*paradoxical embolization
*cellulitis-type presentation
*abdominal pain

Question 5

DVT - diagnosis

Answer 5

*DUPLEX ULTRASOUND (gold standard for extremities)
*CT scan (standard for portal/mesenteric)
*lab tests: D-dimer

Question 6

DVT treatment

Answer 6

1. ANTICOAGULATION - prevent PE or propagation; promote recanalization
2. graded compression - minimize/prevent post-thrombotic syndrome sequelae

Question 7

post-thrombotic syndrome - overview

Answer 7

*a syndrome that develops after significant, extensive DVTs that affect the iliac veins, causing chronic, severe swelling
*due to the effects of ambulatory venous hypertension
*valve failure
*persisting obstruction (resultant hypertension and distension exacerbates valve issues)

Question 8

post-thrombotic syndrome - clinical presentation

Answer 8

*leg swelling (chronic)
*stasis dermatitis (brownish, thickened skin around ankles - gaiter distribution)
*recurrent cellulitis
*stasis ulcers (gaiter distribution; usually not painful)

Question 9

post-thrombotic syndrome - treatment

Answer 9

*graded compression therapy
*wound care

Question 10

varicose veins - risk factors

Answer 10

*family history
*prior DVT
*prior pregnancy
*female gender

Question 11

varicose veins - presentation

Answer 11

GRADIENT of severity:
*cosmetic issues
*pain (exacerbated by prolonged standing)
*bleeding
*thrombosis
*ulcer development