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Vascular YR3 > Venous disorders > Flashcards

Venous disorders Flashcards

1
Q

Veins vs arteries

A

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

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2
Q

Vein drainage simple structure

A
  • Superficial vein
  • Communicating/perforator vein
  • Deep vein

Blood moves superficical to deep

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3
Q

Examples of superficial veins and deep veins

A
  • Long and short saphenous vein = superficial
  • Popliteal = deep
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4
Q

Anatomy short vs long saphenous

A
  • Short saphenous - lateral, drains into popliteal vein at the saphenopopliteal junction
  • Long saphenous - medial, drain at saphenofemoral junction
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5
Q

Where are these junctions?

A

Great saphenous –> femoral

Short saphenous –> popliteal

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6
Q

Contents of femoral triangle

A
  • NAVEL
  • Femoral nerve, artery, vein, empty space, lymphatics
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7
Q

Drainage system of leg - veins

A

Great saphenous = medial
Image shows superficial and deep venous system

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8
Q

Two pumps in body

A
  • Heart
  • Calf muscles - containing venous sinusoids filled with blood ready to be returned to heart with contraction of muscle
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9
Q

What is ambulatory venous HTN?

A
  • 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
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10
Q

What is a varicose vein?

A
  • Abnormally dilated
  • Tortuous
  • SC veins
  • 3mm or more in diameter

More common in women than men

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11
Q

RF for varicose vein

A
  • Immbolity
  • Pregnancy
  • Standing still occupation
  • Obesity
  • FH
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12
Q

Classifying varicose veins

A
  • CEAP
  • Clinical
  • Etiological
  • Anatomical
  • Pathophysiology
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13
Q

5 questions to ask for varicose?

A
  • 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
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14
Q

CEAP classification of varicose veins

A
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15
Q

Symptoms of varicose veins

A
  • Aching/heaviness
  • Worse with prolonged standing
  • Relieved by elevation/compression
  • Swelling
  • Itching
  • Bleeding
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16
Q

Referral criteria for varicose vein surgery

A
  • 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
17
Q

Management VV other than surgery if do not meet criteria

A
  • Reassurance
  • Lifestyle advice - DATES, avoid prolonged standing
  • Compression hosiery - acts as calf muscle pump (can be below knee or above thigh)
18
Q

Investigations for VV

A
  • USS venous duplex - gold standard - flow and vessel wall findings not just flow like in doppler, asses for valve competence
19
Q

Surgery options for VV

A
  • 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)

20
Q

Problem with vein stripping

A
  • Nerve damage
  • Long saphenous - saphenous nerve
  • Short saphenous - sural nerve damage
21
Q

How to tell difference with USS of vein vs artery?

A
  • Artery pulsates
  • Veins do not
22
Q

What are phlebectomies?

A
  • Local small incisions to remove isolated superficial varicose veins
  • See scar in image
23
Q

Post op complications of varicose vein surgery

A
  • Haemorrhage
  • Recurrence
  • Wound infection
  • Injury to adjacent structure - saphenous or sural nerve
  • Parasthesia
  • Scar
24
Q

Intra-op complications during varicose vein surgery

A
  • Damage to surrounding structures - veins, arteries, nerves
  • Bleeding
  • DVT
  • MI
  • Stroke/TIA
25
Q

Management of venous ulcers

A
  • Compression bandaging - URGO KTwo
26
Q

What is Saphena Varix?

A
  • Dilatation of the saphenous vein at the saphenofemoral junction in the groin.
  • Displays a cough impulse, it is commonly mistaken for a femoral hernia
  • suspicion should be raised if the patient has concurrent varicosities present in the rest of the limb.
  • These can be best identified via duplex ultrasound and management is via high saphenous ligation.
27
Q

Signs on exam of varicose veins (other than vein itself)

A
  • Signs of venous insufficiency eg ulceration, varicose eczema, or haemosiderin deposition.
28
Q

When to not use compression stockings?

A
  • If mixed arterial and venous problem
  • Need to measure ankle brachial pressure index
29
Q

Pressures in RA to leg veins

A
  • Column of blood 100mmHg - each time walk increases by 2-3x to ensure venous return
30
Q

Arterial vs venous ulcer

A
31
Q

Management of venous ulceration

A
  • Compression therapy - 40mmHg pressure
  • Four layer bandaging, stockings, short stretch bandaging or compression wraps
  • UNLESS arterial insuffienciency
32
Q

Can you treat varicose veins if you have a DVT surgically?

A
  • NO - removing part of superficial venous when deep venous system is compromised can worsen the venous hypertension as drainage from leg is even worse now
  • If varicose veins and DVT, need to have non-surgical management and offer intervention potentially in future
33
Q

How does thermal ablation work?

A
  • Heating vein from inside
  • Using radiofrequency or laser catheters
  • = irreversible damage to vein
  • = fibrosis and closure of vein lumen
  • Under US guidance
  • Local or general anaesthetic
34
Q

How does foam sclerotherapy work?

A
  • Injecting sclerosing (irritating) agent into varicosed vein
  • = inflammatory response
  • = closure of vein
  • Under US guidance to ensure foam does not enter deep venous system
  • Local anaesthetic
35
Q
A

Vascular YR3 (16 decks)

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