Venous Disease and Lymphedema Flashcards
What is the term given for dilated small superficial veins seen in chronic venous disease?
Telangiectasia
To be categorized as a varicose vein they need to be >___ mm in size
3 mm
Varicose veins occur most commonly in what vein?
greater saphenous vein
chronic venous disease progression is related to what?
extent of venous valvular incompetence
swelling that goes away with limb elevation or overnight is consistent with chronic venous disease OR lymphadema?
chronic venous disease
a dorsal pedal hump is consistent with chronic venous disease OR lymphadema?
lymphadema
what is the distinguishing symptom with stasis dermatitis?
pruritus
What is the diagnostic study of choice for varicose veins? What is a positive finding?
- venous duplex ultrasound
- retrograde flow > 0.5 s duration
what is the treatment of choice for chronic venous disease?
compression socks with 20-30 mmHg compression
What wound care treatment is used for chronic venous disease?
Apligraf
What do you do with a longstanding wound?
biopsy to check for cancer
What are the 3 indications for surgical intervention?
- failure of conservative therapy
- bleeding from varicosities/telangiectasia
- phlebitis or thrombosis of superficial veins
What is the best ablation treatment for small spider veins?
sclerotherapy (Chemical ablation)
What is the best ablation treatment for recurring bleeding veins?
phlebectomy
Phlebectomy or ligation should only be used in what veins?
superficial vein system NOT including saphenous vein
What is the best ablation treatment for the greater saphenous vein insufficiency?
thermal ablation
need to have competent deep vein
This is defined as interstitial collection of protein-rich fluid due to disruption of lymphatic flow
lymphedema
What is the cause of primary vs. secondary lymphedema?
- primary = congenital developmental abnormalities
- secondary = inflammatory or mechanical obstruction
What are the 3 types of primary lymphedema and what differentiates them?
- congenital lymphedema = occurs from birth-2 years old
- lymphedema praecox = occurs during puberty/pregnancy prior to age 35
- lymphedema tarda = occurs after age 35
What is the most common cause of lymphedema worldwide?
Filarisis (infection by Wuchereria bancrofti)
What is the most common cause of lymphedema in the developed world?
- malignancy or treatment for malignancy
Heaviness or tightness of the limb is consistent with chronic venous insufficiency OR lymphedema?
lymphedema
What is the positive stemmer sign and what does it correlate with?
- inability to lift skin of affected limb
- correlates with lymphedema
How is extremity measurements for lymphedema completed?
- measure extremity at 4 points in BOTH the affected and contralateral extremities
What are the 4 points of measurement for upper extremity lymphedema?
- At the metacarpal-phalangeal joints (if edematous)
- Around the wrist
- 10 cm below to the olecranon process
- 10 cm above to the olecranon process
What are the 4 points of measurement for lower extremity lymphedema?
- At the metatarsal-phalangeal joints (if edematous)
- 2 cm superior to the medial malleolus
- 10 cm above the superior pole of the patella
- 10 cm below the inferior pole of the patella
A difference of more than ____ cm between the affected and contralateral arm is considered clinically significant for lymphedema
2
What are the 4 clinical stages of lymphedema?
0 - swelling not evident
1 - subsides with elevation
2 - does not subside with elevation
3 - lymphostatic elephantiasis
What is the mainstay of treatment for lymphedema?
compression therapy with 40mmHG compression
