Venous disease

Question 1

Causes of chronic venous disease?

Answer 1

1. Primary causes
   - Valve failure/reflux
   - Incompetent perforating veins
   - Venous thrombosis
2. Secondary causes
   - Chronic deep venous insufficiency
   - Deep venous or IVC obstruction
   - Trauma
   - Pelvic tumours

Question 2

Risk factors for chronic venous disease?

Answer 2

1. Female
2. Pregnant
3. Older Age
4. Prolonged standing
5. Smoking
6. History of thrombosis
7. Obesity
8. Family history

*All these increase venous pressure.

Question 3

What is telangiectasia ?

Answer 3

• Visible dilatation of small superficial veins

- Spider veins/ Flares

Question 4

What are varicose veins?

Answer 4

• Large, swollen, tortuous superficial veins

Question 5

Presentation of venous disease?

Answer 5

• Asymptotic or with cosmetic concerns.
• Pruritis, leg numbness/heaviness/pain
• Swelling (ankle and/or calf)
• Varicosities
• Hyperpigmentation
• Lipodermatosclerosis and scaliness
• Ulceration

Question 6

Clinical assessment of venous disease?

Answer 6

• Cough impulse
• Trendelenburg test
• Skin changes
• Figure out if it is in the GSV or SSV

Question 7

Diagnosis and investigations for venous disease?

Answer 7

• Duplex ultrasonography

- Ankle brachial index

Question 8

How to treat varicose veins/venous disease?

Answer 8

First Line Tx: Endovenous Thermal Ablation.

Alternative: Injection sclerotherapy.

Question 9

Complications of endovenous thermal ablation?

Answer 9

• Skin burn
• Paraesthesia
• DVT/PE
• Wound infection

Question 10

Conservative management of venous disease?

Answer 10

• Elastic stockings
• Emollients
• Dressings or stockings to treat wound or ulcer.

Question 11

Risk factors for DVT and PE?

Answer 11

• Preg
• Post-stroke
• Hospitalised
• Malignancy
• Inherited thrombotic disorders
• Joint arthroplasty
• Acute traumatic spinal cord syndrome

Question 12

Clinical features of DVT?

Answer 12

• Swelling
• Pain
• Erythema
• Homan’s sign
• Tenderness

*Usually unilateral

Question 13

How to investigate DVT?

Answer 13

• First choice: Duplex ultrasonography
• Check serum D-dimer lvls
• Contrast venography

Question 14

Criteria used to assess for PE?

Answer 14

Wells Criteria

Question 15

Clinical features of PE?

Answer 15

-Pleuretic chest pain
- Hemoptysis
- Dyspnoea
Also
- Tachycardia
-Fever
-Tachypnoea
- Pleural effusion/rub

Question 16

How to investigate for PE?

Answer 16

• CXR
  
  • Shows wedge shaped consolidation in lung
• ABG
  
  • Hypoxia and low saturation
• ECG
  
  • 10-20% show
    
    • prominent p waves, ST depression, T wave inversion in leads III, aVF, V1, V2, V3
• CTPA, V/Q scan, Spiral CT

Question 17

Treatment for DVT and PE?

Answer 17

Anticoagulation 
 - LMWH (first choice) subcutaneously.
 - Heparin (unfractionated) continous IV infusion.
 - Warfarin (maintenance therapy) PO
Compression stockings 
 - Post-operative prophylaxis 
 - May be perioperative

Question 18

Complications of DVT?

Answer 18

Chronic Venous Insufficiency

Question 19

Complications of PE?

Answer 19

Cardiac arrest 
Pulmonary infarction 
Haemoptysis 
Pneumonia 
Chronic breathlessness 
Pulmonary hypertension

Question 20

Relationship between DVT risk and flying?

Answer 20

Risk increases on long-haul flights/ flights greater than 4 hrs.

• Important to stay hydrated, exercise.
• Those at risk may need compression stockings or LMWH.