Venous disease Flashcards
Causes of chronic venous disease?
- Primary causes
- Valve failure/reflux
- Incompetent perforating veins
- Venous thrombosis - Secondary causes
- Chronic deep venous insufficiency
- Deep venous or IVC obstruction
- Trauma
- Pelvic tumours
Risk factors for chronic venous disease?
- Female
- Pregnant
- Older Age
- Prolonged standing
- Smoking
- History of thrombosis
- Obesity
- Family history
*All these increase venous pressure.
What is telangiectasia ?
- Visible dilatation of small superficial veins
- Spider veins/ Flares
What are varicose veins?
- Large, swollen, tortuous superficial veins
Presentation of venous disease?
- Asymptotic or with cosmetic concerns.
- Pruritis, leg numbness/heaviness/pain
- Swelling (ankle and/or calf)
- Varicosities
- Hyperpigmentation
- Lipodermatosclerosis and scaliness
- Ulceration
Clinical assessment of venous disease?
- Cough impulse
- Trendelenburg test
- Skin changes
- Figure out if it is in the GSV or SSV
Diagnosis and investigations for venous disease?
- Duplex ultrasonography
- Ankle brachial index
How to treat varicose veins/venous disease?
First Line Tx: Endovenous Thermal Ablation.
Alternative: Injection sclerotherapy.
Complications of endovenous thermal ablation?
- Skin burn
- Paraesthesia
- DVT/PE
- Wound infection
Conservative management of venous disease?
- Elastic stockings
- Emollients
- Dressings or stockings to treat wound or ulcer.
Risk factors for DVT and PE?
- Preg
- Post-stroke
- Hospitalised
- Malignancy
- Inherited thrombotic disorders
- Joint arthroplasty
- Acute traumatic spinal cord syndrome
Clinical features of DVT?
- Swelling
- Pain
- Erythema
- Homan’s sign
- Tenderness
*Usually unilateral
How to investigate DVT?
- First choice: Duplex ultrasonography
- Check serum D-dimer lvls
- Contrast venography
Criteria used to assess for PE?
Wells Criteria
Clinical features of PE?
-Pleuretic chest pain
- Hemoptysis
- Dyspnoea
Also
- Tachycardia
-Fever
-Tachypnoea
- Pleural effusion/rub
How to investigate for PE?
- 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
- 10-20% show
- CTPA, V/Q scan, Spiral CT
Treatment for DVT and PE?
Anticoagulation - LMWH (first choice) subcutaneously. - Heparin (unfractionated) continous IV infusion. - Warfarin (maintenance therapy) PO Compression stockings - Post-operative prophylaxis - May be perioperative
Complications of DVT?
Chronic Venous Insufficiency
Complications of PE?
Cardiac arrest Pulmonary infarction Haemoptysis Pneumonia Chronic breathlessness Pulmonary hypertension
Relationship between DVT risk and flying?
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.
