Venous disorders Flashcards
Veins vs arteries
Veins:
* Valves
* Larger lumen
* Thin muscle and elastic layers
* Use pulsation of arteries in upper limb for venous return
Arteries:
* Thick muscle and outer wall
* No valves
Vein drainage simple structure
- Superficial vein
- Communicating/perforator vein
- Deep vein
Blood moves superficical to deep
Examples of superficial veins and deep veins
- Long and short saphenous vein = superficial
- Popliteal = deep
Anatomy short vs long saphenous
- Short saphenous - lateral, drains into popliteal vein at the saphenopopliteal junction
- Long saphenous - medial, drain at saphenofemoral junction
Where are these junctions?
Great saphenous –> femoral
Short saphenous –> popliteal
Contents of femoral triangle
- NAVEL
- Femoral nerve, artery, vein, empty space, lymphatics
Drainage system of leg - veins
Great saphenous = medial
Image shows superficial and deep venous system
Two pumps in body
- Heart
- Calf muscles - containing venous sinusoids filled with blood ready to be returned to heart with contraction of muscle
What is ambulatory venous HTN?
- When relax calf muscle, blood drains from superficial to deep system through perforators
- Each time this occurs, superficial vein pressure reduces
- Valve failure/obstruction = AVH due to pressures not being reduced
- = dilation of superficial venous system
What is a varicose vein?
- Abnormally dilated
- Tortuous
- SC veins
- 3mm or more in diameter
More common in women than men
RF for varicose vein
- Immbolity
- Pregnancy
- Standing still occupation
- Obesity
- FH
Classifying varicose veins
- CEAP
- Clinical
- Etiological
- Anatomical
- Pathophysiology
5 questions to ask for varicose?
- Is it definetely varicose?
- Site - great saphenous, short saphenous or unamed?
- Uncomplication or complicated - pigmentation, ulceration, thrombosed, bleeding etc
- Level of incompetent valve
- Deep venous system competency? - if rubbish = relying on superficial only, cannot remove superficial ones as will be no venous drainage
CEAP classification of varicose veins
Symptoms of varicose veins
- Aching/heaviness
- Worse with prolonged standing
- Relieved by elevation/compression
- Swelling
- Itching
- Bleeding
Referral criteria for varicose vein surgery
- Symptomatic primary or symptomatic recurrent
- Lower limb skin changes eg pigmentation/eczema caused by chronic venous insifficiency
- Superficial vein thrombosis - hard painful veins
- Venous leg ulcer - not healed within 2 weeks
Management VV other than surgery if do not meet criteria
- Reassurance
- Lifestyle advice - DATES, avoid prolonged standing
- Compression hosiery - acts as calf muscle pump (can be below knee or above thigh)
Investigations for VV
- USS venous duplex - gold standard - flow and vessel wall findings not just flow like in doppler, asses for valve competence
Surgery options for VV
- EVLA - high temp waves to ablate veins (endovenous laser ablation)
- ERFA - high freq to ablate (endovenous radiofrequency ablation)
2nd line
* Foam sclerotherapy US guided (can cause transient vision loss)
* Venous stripping - high tie (find saphenofemoral junction and tie, strip vein out)
Problem with vein stripping
- Nerve damage
- Long saphenous - saphenous nerve
- Short saphenous - sural nerve damage
How to tell difference with USS of vein vs artery?
- Artery pulsates
- Veins do not
What are phlebectomies?
- Local small incisions to remove isolated superficial varicose veins
- See scar in image
Post op complications of varicose vein surgery
- Haemorrhage
- Recurrence
- Wound infection
- Injury to adjacent structure - saphenous or sural nerve
- Parasthesia
- Scar
Intra-op complications during varicose vein surgery
- Damage to surrounding structures - veins, arteries, nerves
- Bleeding
- DVT
- MI
- Stroke/TIA
