Venous Disease Flashcards
What are the 3 elements of Virchow’s triad?
Stasis
Hypercoagulability
Endothelial damage
What is a deep vein thrombosis?
Blood clot/thrombus within the deep veins
What can cause a DVT?
Surgery
Varicose veins
Reduced motility
Genetics
- Inherited thrombophilia
- Factor 5 Leiden
Pregnancy
Drugs
Malignancy
Dehydration
What drugs can cause a DVT?
COCP
Tamoxifen
Raloxifene
Hormone replacement therapy
How does a DVT present?
Persisting discomfort
Unilateral limb swelling
Calf tenderness
Erythema
Warmth
Prominent collateral veins
Unilateral pitting oedema
What investigations are used in DVT diagnosis?
D-Dimer
Doppler US
- If wells score is over 2, US within 4 hours
Venography
What is a D-Dimer test?
Test for fibrin degradation product produced during fibrinolysis
What is the management of a DVT?
Anticoagulation
Thrombectomy
Thrombolysis
Describe management of DVT if patient has begun DOAC, d dimer is positive but US is negative?
Stop anticoagulation and repeat scan in 1 week
How can DVTs be prevented?
Early mobilisation
Anti-embolisation stockings
Give complications of DVT
Post Thrombotic Syndrome/damage to venous valves
Valvular Incompetence/venous insufficiency
How does valvular incompetence/venous insufficiency present?
Swelling
Discomfort
Brown/red discolouration
Ulceration
Dry skin
Varicose veins
What are varicose veins?
Torturous/twisted dilated superficial veins that occur secondary to incompetent venous valves, allowing blood to flow back, away from the heart
Name some risk factors for varicose veins
F>M
Age
Obesity
Pregnancy
Trauma
Previous DVT
Prolonged standing
How do varicose veins present?
Present for cosmetic reasons
Pruritis
Nocturnal cramps/aching
Hyperpigmentation/Darkening of skin
Ulceration
Bleeding
Swelling
Lipodermatosclerosis/hard tight skin
Superficial thrombophlebitis
What is the management of varicose veins?
Conservative
- Leg elevation
- Weight loss
- Regular exercise
- Graduated compression stockings
Endothermal ablation
Foam sclerotherapy
- Irritant foam causes inflammatory response and closure of vein
Surgery
- Ligation
- Stripping
Give complications of varicose veins
Acute haemorrhage
Superficial Thromboemblitis
Give indications to refer varicose veins to secondary care
Significant/troublesome lower limb symptoms, such as pain or swelling
Previous bleeding from varicose veins
Skin changes secondary to chronic venous insufficiency
Superficial thrombophlebitis
Active or healed venous leg ulcer
What is superficial thrombophlebitis?
Describes the inflammation associated with thrombosis of one of the superficial veins, usually the long saphenous vein of the leg
This process is usually non-infective in nature but secondary bacterial infection may rarely occur resulting in septic thrombophlebitis
What conditions are associated with superficial thrombophlebitis?
DVT
- 20% of patients will also have an underlying DVT at presentation
Varicose veins
How is superficial thrombophlebitis managed?
NSAIDS
- Topical for limited/mild disease and oral for more severe
Compression stockings
LMWH
- Mainly for DVT prophylaxis
Describe venous ulcers
Painless
Shallow
Large
Medial calf
Irregular granulomatosis base
Describe arterial ulcers
Painful
Deep
Small
Pressure areas such as heels, base of big toe
Well defined punched out lesions
Reduced pulses
Describe neuropathic ulcers
Punched out
Soles, heels, toes
Painless
Small
Deep
Sensory loss
Debridement
Describe the management of venous ulcers
Rule out arterial with ABPI
Compression bandaging, usually four layer
Oral pentoxifylline, a peripheral vasodilator that improves healing rate
Give features of paradoxical embolus
Thromboembolism travelling from IVC to left heart circulation
DVT features followed by acute limb ischaemia
