Venous Disease Flashcards
What are 8 causes of iliocaval venous occlusion?
DVT most common.
Also trauma, radiation, external compression from retroperitoneal fibrosis, tumours, cysts, aneurysms, May Thurner (compression of left common iliac vein by right common iliac artery).
What is May Thurner syndrome?
Compression of left common iliac vein by overriding right common iliac artery
What are 4 signs of chronic venous insufficiency?
Edema, lipadermatosclerosis, varicosities, ulcer
What are 9 risk factors for developing a DVT?
Previous DVT, recent trauma/surgery, hypercoag state, pregnancy, malignancy, hormone treatment, obesity, decreased activity level.
What is the perthes test?
Place a cuff on proximal cuff and ask pt to walk. Superficial veins should rapidly empty into deep veins through perforators. Distension of superficial veins indicates deep venous obstruction.
What are the criteria for a hemodynamically significant venous occlusion?
Pressure difference of 5 mm Hg between femoral and central venous pressure supine. Or 2x increase in fem vein pressure after exercise.
Which trial compared catheter directed thrombolysis to anticoagulation?
ATTRACT trial
What is the incidence of post thrombotic syndrome following catheter directed thrombolysis for iliofemoral DVT? What about anticoagulation alone?
ATTRACT - 47/48% developed PTS, no significant difference between CDT and anticoagulation
What is phlegmasia cerulea dolens?
Clinical spectrum from phlegmasia alba (White/milk leg) to venous gangrene
What are 5 presenting symptoms of phlegmasia cerulean dolens?
Sudden onset pain, swelling, venous gangrene, cyanosis, compartment syndrome
What is the treatment for phlegmasia cerulea dolens?
Thrombolysis and/or thrombectomy
Start IV heparin immediately
What is a d dimer
Product of fibrin proteolysis
What are 5 duplex ultrasound features of a DVT?
Increased echogenicity, increased venous diameter, incompressible, no flow, no flow augmentation with distal compression.
What are 5 items on wells score?
Active cancer, pitting edema confined to symptomatic leg, bedridden/recent surgery, entire leg swollen, previous DVT
What are 4 associated thrombophilias with DVT?
Antithrombin deficiency, factor 5 leidin, protein c & s deficiencies, elevated 7 or 12.
