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Vascular > Venous Insufficiency > Flashcards

Venous Insufficiency Flashcards

1
Q

Klippel Trenaunay Syndrome

A

Port wine stain
VV
Bone and soft tissue hypertrophy involving extremity

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2
Q

Venous hypertensive skin changes

A 
Corona phlebatactica
Atrophic blanche
Pigmentation (hemosiderin deposition)
Lipodermatosclerosis
Ezcema
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3
Q

CEAP classification categories

A

Clinical
Etiology
Anatomy
Pathophysiology

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4
Q 
Clinical classification of CEAP
C0
C1
C2
C3
C4
C5
C6
A 
C0 no visible disease
C1  telengectasia, reticular vein
C2 varicose veins
C3 edema
C4 skin changes
C5 healed ulcers
C6 active ulcers
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5
Q 
Etiology classification of CEAP
Ep
Es
Esi/Ese
Ec
A 
Ep: primary
Es: secondary
Esi: intravenous
Ese: extravenous
Ec: congenital
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6
Q

Anatomy classification of CEAP

A

As: superficial vein
Ad: deep vein
Ap: perforator vein
An: none identified

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7
Q

Pathophysiology classification of CEAP

A

Pr reflux
Po obstruction
Pro reflux + obstruction
Pn normal

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8
Q

Risk factors for varicose vein

A 
Obesity
Pregnancy
Previous DVT
Family history
Posture (standing for prolonged periods of time)
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9
Q

Course of long saphenous vein

A 
Medial end of dorsal venous arch
Pass anterior to medial malleolus
Runs along anteriomedial aspect of calf
Passes patella to anteromedial aspect of thigh
Joins saphenous vein at SFJ
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10
Q

Course of short saphenous vein

A

Lateral end of dorsal venous arch
Passes behind lateral malleolus
Joins popliteal vein in popliteal fossa

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11
Q

SSV is accompanied by which nerve?

A

Sural nerve

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12
Q

PE for VV

A

Abdominal exam: r/o VV secondary to abdominal mass
Peripheral pulse: r/o concomitant PVD
LL exam:
Look: skin changes, atrophic signs, ulcers
Trendelenberg test: SFJ incompetence
Tourniquet’s test: perforator incompetence
Perthe’s test: deep venous incompetence

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13
Q

European classification of compression hosiery
Class I
Class II
Class III

A

I: 14-17mmHg (light)
II: 18-24mmHg (medium)
III: 25-35 mmHg (strong)

CI in ABI < 0.9

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14
Q

Daflon

A

micronised purified flavonoid fraction
Phlebotonic drug: reinforces venous tone by prolonging parietal NA
Vascular protecting agents: combats venous inflammation by decreasing leukocyte activation

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15
Q

Treatment options for varicose veins

A 
Medical
Endovascular
-Sclerotherapy
-Radiofrequency ablation (RFA)
-Endovascular laser ablation (EVLA)
-Mechanico-chemical endovenous ablation
Open
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16
Q

DDX of chronic leg swelling

A 
Venous:
-primary vv
-primary deep vein incompetence
-post thrombotic syndrome
-AVM
Lymphoedema
General:
-Fluid overload (CHF, liver failure, nephrotic syndrome)
-Pretibial myxoedema
Tumor
Drug
Dependency (postural)
17
Q

Pathophysiology of CVI

A

Fibrin cuff hypothesis
White cell trapping hypothesis
Proliferation of capillary

18
Q

Fibrin cuff hypothesis

A

Venous hypertension lead to increase porosity
Extravasation of blood constituents including fibrin
Fibrin induced tissue ischemia and cell death

19
Q

White cell trapping hypothesis

A

Venous hypertension leads to white cell migration to interstitial space
release proteolytic enzymes and free radicals leading to tissue damage

20
Q

Aim of CVI management

A

Correct any underlying causes

Prevention and treatment of complications

21
Q

Management of CVI

A

Limb elevation
Exercise
Multilayered graduated elastic compression stockings
Medication - pentoxyfylline (Trental)
Surgery:
-superficial: endovenous
-deep: no definite guidelines, limited experience, highly subspecialized

22
Q

Layers in multilayered graduated elastic compression stocking

A 
Layer 1: orthopaedic wool/ Velband
Layer 2: cottone crepe (Steroplast)
Layer 3: elastic, extensible bandage (Elastoplast)
Layer 4
Cohesive bandage (Coban)
23
Q

Pentoxyfylline

A

Phosphodiesterase inbhitior

For better ulcer healing (RCTs)

24
Q

Benefits of multilayered graduated elastic compression

A

symptomatic relief
promote ulcer healing
prevent ulcer recurrence

Evidence: Cochrane review

Vascular (6 decks)

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