Venous Disease

Question 1

4 presentations of venous problems

Answer 1

DVT. varicose veins. superficial phlebitis. chronic venous insufficiencty

Question 2

vascular system: what is or isn’t preserved

Answer 2

only thing preserved = volume (blood leaving heart = amount coming back). pressure and velocity not preserved

Question 3

two components to how the vein system works

Answer 3

muscles surrounding veins push blood back to heart. valves keep blood from following gravity back down

Question 4

venous system: perforators? which way does blood go?

Answer 4

perforators have one way valves: blood can go from superficial to deep only

Question 5

when venous valves intact, what happens when we walk?

Answer 5

within a few steps, ambulatory pressure at the ankle drops for 80.90 to 5-10 mmHg –> decreases pressure and volume

Question 6

veins incompetent, what happens when we walk

Answer 6

ambulatory pressure increased to 80 mmHg, no matter how many steps you take

Question 7

causes of acute swelling: 3 main causes and examples?

Answer 7

occlusive problems (trhombosis, trauma). problems of return (right side heart failure, bad blood aka too much water or too little protein, dependent legs/hydrostatic issues). tissue causes (infection, trauma)

Question 8

phlegmasia alba dolens? what?

Answer 8

milk leg/white leg –> seen with acute thrombosis, when lymphatics rupture, really bad swelling

Question 9

virchow’s triad

Answer 9

stasis, vessel wall injury and hypercoagulability = thrombosis

Question 10

causes of thrombosis: stasis?

Answer 10

alteration to normal blood flow: venous stasis, mitral stenosis, prolonged immobility, varicose veins

Question 11

causes of thrombosis: endothelial injury?

Answer 11

vessel piercings, shear stress, hypertension, vessel surface contact with procoagulant surfaces like bacteria/implants/etc.

Question 12

causes of thrombosis: hypercoagulability?

Answer 12

antithrombin III, protein C and S, factor 5 leiden. traumas, burns, cancer, contraeptives, smoking, race, age, obesity

Question 13

phlegmasia cerulea dolens: what

Answer 13

venous occlusion so bad that arterial blood flow stops too

Question 14

thrombosis: treatment and prophylaxis

Answer 14

antiplatelet agents like ASA, clopidogrel, prasugrel, ticagrelor. UF or LMW heparin. warfarin. novel oral anticoagulants like dibigatran, apixaban, rivaroxaban

Question 15

ilio-femoral DVT: what? some thrombolysis treatment examples?

Answer 15

when clot gets to above groin. systemic thrombolysis not that effective. catheter directed thrombolysis effective but high recurrance. pharmacomechanical thrombolysis: trellis with balloons, or angiojet with a pulse spray

Question 16

duplex vs. venogram?

Answer 16

duplex: non invasive, good for functional flow, assess the femoral ileo system better, but poor availability. venogram: invasive, can cause DVTs, no functional info, better for calf veins –> recommend to wait for the duplex

Question 17

superficial phlebitis: what? what does it look like? what is it not?

Answer 17

non dangerous blood clot in superficial veins only. red, hot, painful leg in a localized area. inflammatory, not infectious! so treat with anti inflammatory not antibiotic (also not anticoagulant)

Question 18

chronic venous insufficiency: why do you get it? you can also get?

Answer 18

deep valves aren’t working –> can get varicose veins if you develop incompetent perforators or incompetent superficial valves

Question 19

CVI that develops after DVT is called?

Answer 19

post thrombotic syndrome or post phlebitic leg

Question 20

trendelenberg test

Answer 20

lie down, but on a tourniquet, stand up –> leg looks normal. if you take the tourniquet off: all the blood rushes down, valves aren’t working, see these large surface veins