Venous disease - Presentation, Investigation and Treatment Flashcards
What are the two part of the venous system of legs?
- Deep venous system
- Superficial Venous Sytem
What is involved in the deep venous system?
main route for blood to return from the legs to the heart via the Inferior vena cava. Veins travel alongside the arteries.
What is involved in the superficial venous system?
collateral route for venous return via Great saphanous venin and Small saphanous vein. can be harvested for use as conduit
Where do deep and superficial nervous systems connect?
- Saphenofemoral Junction
- Popliteal Vein
- Perforators
Saphenofemoral Junction
GSV run ankle to groin on the medial aspect. Joins the systems at the saphenofemoral junction.
Popliteal Vein
(knee) - SSV runs from the ankle to the knee in the posterior aspect of calve joins the depp system at the popliteal vein.
Perferators
(various levels) - provide additional channels at connest superficial and deep systems various levels.
What is the 3 main functions of the veins?
- Return deoxygenated blood to the heart - Valves and calf muscle pump. Veins store 60% of blood volume. Can constrict and dilate to help manage changes in blood volume. For example to prevent large spikes of blood pressure in each cardiac cycle.
- Capacitance vessels - Low resistancy and elasticity
- Thermoregulation - Dilation of superficial veins
What is chronic venous insufficiency?
Chronic venous insufficency describes the abnormalities in the venous circulation in the blood return to the heart is signicantly compromised. Often provoked by factors that increase the venous pressure and cause damage to the valves
What does chronic venous insifficiency result in?
This results in changes to the wall of the vein including inflammatory infiltration and reduced elastin content which alters the integrity. Progressive enlargments of veins cause the valves to become leaky and blood to refluc with gravity.
How are varicose veins formed?
Progressive venous dilation, venous hypertension and valvular incompetency superifical veins become prominent and cause varicose veins.
What are the risk factors of chronic venous insufficiency?
- Genetics
- High BMI
- Sedentary lifestyle - prolonged standing
- Female, especially multiparous. Due to oestrogen
- In older patients
- Previous damage to veins - DVT, trauma
What is the end stage presentation of chronic venous insufficiency?
End stage presentation of chronic venous insufficeny is ulceration. Can be classified as arterial or venous. Usually ulceration is limb threatening ischaemia.
What are symptoms of venus insufficiency?
- Achy or tired legs
- Cramping in your legs at night
- Edema
- Flaking or itching skin
- Discoloured skin
- Burning, tingling or pins and needles feeling in the legs
- Varicose veins
Arterial Ulcers
- Painful
- Well circumcised
- Little granulation tissue
- Punched out appearance
- Deep
- Found in pressure areas
Venous Ulcers
- Often less painful
- Irregular border
- Shallow
- Sloughy (yellow appearance)- By product of wound healing.
- Granulation tissue present
- Found around medial alleois
- Fibrin and microorganisms, proteinatios material inside
What are the investigations of chronic venous insufficiency?
- Main imaging modality is venous duplex ultrasound
- Blood test - check for heamoglobin if there is excessive bleeding from a varicose vein and white cell count concerned found for potential infection in the ulcer.
- Ulcer hasnt healed in a few weeks it should be referred for ultrasound, according to guidelines.
What is the management of chronic venous insufficiency?
- Conservative management
- Endevenous Intervention
- Open surgery
What is deep vein thrombosis?
DVT secribes clot formotion in deep veins of the legs. Cosequences of this is it can travel to the lungs and embolise. Clot gets stuck in the pulmonary trunk and stop blood flow.
What are the risk factors of DVT?
- venous stasis - Prolonged immobility and surgery cause this
- Endothelial injury
- Hypercoaguility
What are the investigations of DVT?
- First line test for paitents with low probability of DVT - D-Dimer (blood test meausre proteins fragment if clot breakdown)
- First line test for patients with high probability of DVT - Venous Duplex Ultrasound if D-Dimer positive
What is the medical management of DVT?
- Anticoagulation
- Compression stockings - Improves acute symptoms
- If unprovoked investigate further causes. - Thrombophilia or maligancy depends on other relevant signs and symptoms
What is the surgical management of DVT?
Surgical management is required for large proximal DVT usually those affecting the ileo-femerol veins. It aims to reduce symptoms associated with post-thrombotic syndrome.
Techniques include catheteres directed thrombolysis or thrombectomy with or without stenting.
What are some rare management of DVT?
White leg (occlusion of deep flow not superficial) or blue leg (occlusion of deep and superficial - it is a precurssor to venous gangrene leading to leg amputation).
