Venous Insufficiency Flashcards
What percentage of leg ulcers are due to venous insufficiency (VI)?
70–90% of leg ulcers are caused by venous insufficiency.
Which population is at greater risk of developing VI ulcers, and by how much?
Women are 3 times more likely than men to develop venous insufficiency ulcers.
What is the recurrence rate of VI ulcers following vein ablation and compression therapy compared to compression alone?
The recurrence rate at 4 years is 31% with vein ablation and compression compared to 55% with compression therapy alone.
What proportion of the U.S. adult population is affected by chronic venous insufficiency (CVI)?
10–35% of U.S. adults have CVI, with 1–4% experiencing active or healed ulceration.
What is the impact of compression therapy on venous ulcer healing rates?
Up to 80% of venous ulcers may heal with compression therapy alone, achieving similar results to surgical interventions.
What percentage of the total blood volume is stored in the venous system?
The venous system stores 70–80% of the total blood volume.
What is the primary function of the deep vein system in the legs?
The deep vein system, located beneath the muscle fascia, is responsible for 80–90% of venous return and drains the lower extremity musculature.
What are the functions of superficial veins in the legs?
Superficial veins drain the cutaneous microcirculation, assist with temperature regulation, and carry about 10% of venous return.
What is the role of perforator veins in the venous system?
Perforator veins connect the superficial and deep systems, directing blood flow from the superficial to the deep veins through one to three valves.
What three mechanisms help facilitate proximal flow of venous blood?
(pump, pump, valve)
Proximal flow relies on the
- respiratory pump
- calf muscle pump
- venous valves
What are the two primary causes of venous insufficiency?
Venous insufficiency is commonly caused by vein dysfunction and calf muscle pump failure.
How does venous hypertension lead to ulceration?
Venous hypertension causes leakage of fluid and white blood cells into the interstitial space, leading to edema, inflammation, and skin failure.
What is the role of inflammation in the pathophysiology of venous ulcers?
Inflammation resulting from venous hypertension leads to skin failure and ulceration.
What is a common consequence of scar tissue from a previous venous ulcer?
- scar tissue increases the risk of skin breakdown, and
- recurrence of venous ulcers.
How does aging contribute to venous insufficiency?
Aging leads to anatomical and functional changes, such as valve degeneration, which increases the risk of venous insufficiency.
What clinical signs and symptoms are assessed to suspect a DVT?
Swelling, tenderness in the calf, and increased warmth are key signs and symptoms of DVT.
What is the gold standard for diagnosing DVT?
A venogram is considered the gold standard for diagnosing DVT.
What is the Ankle-Brachial Index (ABI) used to evaluate, and what is the contraindication for its use?
- ABI evaluates arterial and venous insufficiency.
- Compression is contraindicated if ABI is < 0.5, and DVT should be ruled out first.
What does the Trendelenburg Test differentiate, and how is it performed?
- The Trendelenburg Test differentiates between perforator and great saphenous vein incompetence.
- The patient lies supine with the leg elevated for one minute, a tourniquet is applied below the saphenofemoral junction, and then the patient stands upright to observe venous distension.
What is venous filling time used to predict?
- Venous filling time predicts arterial insufficiency,
- Particularly in patients unable to tolerate ABI or with ABI > 1.3.
What is the primary use of Doppler ultrasound in venous assessment?
Doppler ultrasound is used to
- detect venous and arterial flow patterns
- identify DVT, and
- obtain pulse signals
What is the advantage of Duplex ultrasound over Doppler ultrasound?
Duplex ultrasound evaluates venous reflux and maps venous damage with high accuracy, but it is time-intensive.
Why is Homan’s sign not considered reliable for DVT diagnosis?
Homan’s sign has low sensitivity and specificity for DVT diagnosis.
What is the purpose of Doppler ultrasound in venous assessments?
Doppler ultrasound detects motion and differentiates venous and arterial flow patterns.
What is the primary function of Duplex ultrasound in venous evaluation?
Duplex ultrasound assesses venous reflux, maps venous damage, and identifies thrombosis with high accuracy.
Why is venography considered the gold standard for venous assessment, despite its limited use?
Venography provides the most detailed assessment of venous flow and DVT but is invasive and expensive.
What is the clinical significance of venous reflux lasting more than 0.5 seconds?
Venous reflux greater than 0.5 seconds after muscle contraction indicates venous insufficiency.
What are the disadvantages of Duplex ultrasound in venous assessments?
Duplex ultrasound is time-intensive, requiring 1–2 hours for a full leg evaluation.
How does Doppler ultrasonography use the Doppler effect in imaging?
It generates images of tissue and fluid movement relative to the probe to assess flow patterns.
What type of chemical is used in sclerotherapy, and what is its purpose?
Sclerotherapy uses a chemical that damages and scars the inside lining of veins, causing them to close.
What is the main limitation of the venogram procedure?
Venograms are rarely used due to their invasiveness and high cost.
What classification system is used for chronic venous disease?
The CEAP Classification System is used for chronic venous disease.
What are the features of C1 in the CEAP classification?
- C1 includes telangiectasis and reticular veins
- Indicating early stages of chronic venous insufficiency.
What is a characteristic feature of C4a in the CEAP classification?
C4a involves hemosiderin staining, where red blood cells leak into the interstitium, leading to brown pigment staining.
What are the five aspects of the ‘5PT’ method used to describe venous ulcers?
- Pain
- Position
- Presentation
- Periwound
- Pulses
- Teperature
What is the average healing time for full-thickness venous ulcers with appropriate interventions?
The average healing time is 8 weeks.
- Smaller ulcers healing in 5–7 weeks
- Larger ulcers in 10–16 weeks.
What is lipodermatosclerosis (C4b) in venous insufficiency?
- It is inflammation of the fat layer under the skin.
- Resulting in pain, hardening, redness, swelling, and a ‘champagne bottle’ deformity.
What is the characteristic pain associated with venous ulcers?
Venous ulcers typically have mild to moderate pain that decreases with elevation.
What are the primary goals of venous ulcer intervention?
- protect surrounding skin
- address the wound bed
- enhance venous return
- decrease edema
What is the role of compression therapy in venous ulcer management?
Compression promotes venous return and reduces edema, but it is contraindicated if ABI < 0.5.
What types of dressings are recommended for venous ulcers?
Absorptive and non-adherent dressings are used to manage exudate and protect delicate skin.
How does elevation help in managing venous insufficiency?
Elevation promotes venous return by reducing venous pressure and edema.
What exercises are beneficial for venous insufficiency patients?
Exercises targeting the calf pump are essential to enhance venous return.
What medical interventions are used to manage venous ulcers?
These include managing risk factors, using fibrinolytics (pentoxifylline), topical agents, and antibiotics when necessary.
What is the purpose of surgical interventions like vein ablation or microphlebectomy?
These procedures address incompetent veins and improve venous return to aid ulcer healing.
What is subfascial endoscopic perforator surgery (SEPS)?
Subfascial Endoscopic Perforator Surgery (SEPS):
- Involves clipping perforator veins via small incisions, often combined with saphenous vein ablation.
What is the purpose of valvuloplasty in venous insufficiency treatment?
Valvuloplasty restores valve competence in deep veins, reducing ulcer recurrence and improving hemodynamics.
What is radiofrequency (RF) ablation and its use in venous insufficiency?
RF ablation uses heat from electromagnetic waves to close off veins, commonly treating great and small saphenous veins.
What is the key difference between laser ablation and RF ablation?
Laser ablation: closes off the vein from the inside using heat using a laser to generate heat to seal the vein.
Radiofrequency (RF) ablation: heat generated by electromagnetic waves (radio waves) closes off the veins.
What is sclerotherapy, and when is it used?
Sclerotherapy involves injecting a chemical to scar and close veins.
- Often for smaller varicose veins or cosmetic purposes.
What are the risks associated with stripping and ligation of the great saphenous vein?
Complications include saphenous nerve injury and recurrence due to angiogenesis.
What is microphlebectomy, and what veins does it target?
Microphlebectomy removes visible varicose veins using small incisions and hooks, targeting tributaries or clusters.
What is the purpose of the inferior vena cava (IVC) filter in DVT management?
The IVC filter prevents DVT fragments from traveling to other parts of the body but does not improve venous flow.
Why are procedures like vein stripping recommended only for certain patients?
- They are invasive
- Typically reserved for young, active patients who have failed conservative treatments.
CEAP Classification
- C0 = ?
- C1= ?
- C2 = ?
- C3 = ?
- C4a = ?
- C4b = ?
- C5 = ?
- C6 = ?
- C0: No visibles or palpable signs
- C1: Telangiectasias, reticular veins
- C2: Varicose veins
- C3: Oedema
- C4a: Pigmentation and/or eczema
- C4b: lipodermatosclerosis and/or white atrophy
- C5: healed wound
- C6: open wound
