Venous Hypertension Flashcards
Describe normal venous drainage of the legs?
Blood from foot/superficial lower leg drains to superficial veins (esp. saphenous system) which then drains into deep venous system and then into femoral vein
Blood from lower leg muscles drains into deep venous system
Why does venous hypertension occur?
Valvular incompetence => reflux down veins => column of uninterrupted blood forms => increased venous pressure due to gravity
List four complications of venous hypertension
Varicose veins
Lipodermatosclerosis
Venous eczema
Venous ulcers
What are varicose veins?
Dilated, tortuous superficial veins
May be painful
Assoc. with dull ache on standing still / sitting with legs low down
What is lipodermatosclerosis?
Scarring of skin and fat
Most commonly occurs superior to ankle on medial aspect of leg
Brown, smooth, tightened skin, which is often painful
Often results in classics inverse champagne bottle
What are the signs and symptoms of venous eczema?
Erythema
Hyperpigmentation
- brown pigment caused by haemosiderin deposition
Scaling
“Atrophie Blanche”
Exudative plaques
Secondary infection
What is haemosiderin deposition?
Haemoglobin breakdown product from RBCs that have escaped into tissue
What is “Atrophie Blanche”?
Patches of white, fibrotic scar tissue
What investigations are done for venous hypertension?
Trendelenburg Test
Venous refill time
Duplex USS of veins
MR venography
What is Tredelenburg test?
Demonstrates reflux and differentiates site of incompetent valve
Elevated leg to empty superficial veins, sapheno-femoral junction then occluded by pressing on it, patient then stands: slow refilling suggests problem at SF junction, fast refilling suggests incompetent perforators or other pathway
What is normal venous refill time in healthy patient?
> 120 seconds
(Symptomatic pts: usually
How should venous hypertension be treated?
Graduated compression bandaging
Surgival treatment of varicose veins
Treatment of stasis dermatitis (venous eczema)
- topical steroids may be of use
What must be excluded prior to using compression bandaging?
That there is no peripheral vascular disease
What are the methods of surgical treatments for varicose veins?
Saphenectomy
Stab phlebectomy
Endovenous ablation
Sclerotherapy
