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DPT 773 - Integumentary > Venous Insufficiency > Flashcards

Venous Insufficiency Flashcards

1
Q

What percentage of leg ulcers are due to venous insufficiency (VI)?

A

70–90% of leg ulcers are caused by venous insufficiency.

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2
Q

Which population is at greater risk of developing VI ulcers, and by how much?

A

Women are 3 times more likely than men to develop venous insufficiency ulcers.

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3
Q

What is the recurrence rate of VI ulcers following vein ablation and compression therapy compared to compression alone?

A

The recurrence rate at 4 years is 31% with vein ablation and compression compared to 55% with compression therapy alone.

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4
Q

What proportion of the U.S. adult population is affected by chronic venous insufficiency (CVI)?

A

10–35% of U.S. adults have CVI, with 1–4% experiencing active or healed ulceration.

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5
Q

What is the impact of compression therapy on venous ulcer healing rates?

A

Up to 80% of venous ulcers may heal with compression therapy alone, achieving similar results to surgical interventions.

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6
Q

What percentage of the total blood volume is stored in the venous system?

A

The venous system stores 70–80% of the total blood volume.

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7
Q

What is the primary function of the deep vein system in the legs?

A

The deep vein system, located beneath the muscle fascia, is responsible for 80–90% of venous return and drains the lower extremity musculature.

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8
Q

What are the functions of superficial veins in the legs?

A

Superficial veins drain the cutaneous microcirculation, assist with temperature regulation, and carry about 10% of venous return.

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9
Q

What is the role of perforator veins in the venous system?

A

Perforator veins connect the superficial and deep systems, directing blood flow from the superficial to the deep veins through one to three valves.

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10
Q

What three mechanisms help facilitate proximal flow of venous blood?

(pump, pump, valve)

A

Proximal flow relies on the

  • respiratory pump
  • calf muscle pump
  • venous valves
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11
Q

What are the two primary causes of venous insufficiency?

A

Venous insufficiency is commonly caused by vein dysfunction and calf muscle pump failure.

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12
Q

How does venous hypertension lead to ulceration?

A

Venous hypertension causes leakage of fluid and white blood cells into the interstitial space, leading to edema, inflammation, and skin failure.

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13
Q

What is the role of inflammation in the pathophysiology of venous ulcers?

A

Inflammation resulting from venous hypertension leads to skin failure and ulceration.

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14
Q

What is a common consequence of scar tissue from a previous venous ulcer?

A
  • scar tissue increases the risk of skin breakdown, and
  • recurrence of venous ulcers.
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15
Q

How does aging contribute to venous insufficiency?

A

Aging leads to anatomical and functional changes, such as valve degeneration, which increases the risk of venous insufficiency.

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16
Q

What clinical signs and symptoms are assessed to suspect a DVT?

A

Swelling, tenderness in the calf, and increased warmth are key signs and symptoms of DVT.

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17
Q

What is the gold standard for diagnosing DVT?

A

A venogram is considered the gold standard for diagnosing DVT.

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18
Q

What is the Ankle-Brachial Index (ABI) used to evaluate, and what is the contraindication for its use?

A
  • ABI evaluates arterial and venous insufficiency.
  • Compression is contraindicated if ABI is < 0.5, and DVT should be ruled out first.
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19
Q

What does the Trendelenburg Test differentiate, and how is it performed?

A
  • 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.
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20
Q

What is venous filling time used to predict?

A
  • Venous filling time predicts arterial insufficiency,
  • Particularly in patients unable to tolerate ABI or with ABI > 1.3.
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21
Q

What is the primary use of Doppler ultrasound in venous assessment?

A

Doppler ultrasound is used to

  • detect venous and arterial flow patterns
  • identify DVT, and
  • obtain pulse signals
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22
Q

What is the advantage of Duplex ultrasound over Doppler ultrasound?

A

Duplex ultrasound evaluates venous reflux and maps venous damage with high accuracy, but it is time-intensive.

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23
Q

Why is Homan’s sign not considered reliable for DVT diagnosis?

A

Homan’s sign has low sensitivity and specificity for DVT diagnosis.

24
Q

What is the purpose of Doppler ultrasound in venous assessments?

A

Doppler ultrasound detects motion and differentiates venous and arterial flow patterns.

25
Q

What is the primary function of Duplex ultrasound in venous evaluation?

A

Duplex ultrasound assesses venous reflux, maps venous damage, and identifies thrombosis with high accuracy.

26
Q

Why is venography considered the gold standard for venous assessment, despite its limited use?

A

Venography provides the most detailed assessment of venous flow and DVT but is invasive and expensive.

27
Q

What is the clinical significance of venous reflux lasting more than 0.5 seconds?

A

Venous reflux greater than 0.5 seconds after muscle contraction indicates venous insufficiency.

28
Q

What are the disadvantages of Duplex ultrasound in venous assessments?

A

Duplex ultrasound is time-intensive, requiring 1–2 hours for a full leg evaluation.

29
Q

How does Doppler ultrasonography use the Doppler effect in imaging?

A

It generates images of tissue and fluid movement relative to the probe to assess flow patterns.

30
Q

What type of chemical is used in sclerotherapy, and what is its purpose?

A

Sclerotherapy uses a chemical that damages and scars the inside lining of veins, causing them to close.

31
Q

What is the main limitation of the venogram procedure?

A

Venograms are rarely used due to their invasiveness and high cost.

32
Q

What classification system is used for chronic venous disease?

A

The CEAP Classification System is used for chronic venous disease.

33
Q

What are the features of C1 in the CEAP classification?

A
  • C1 includes telangiectasis and reticular veins
  • Indicating early stages of chronic venous insufficiency.
34
Q

What is a characteristic feature of C4a in the CEAP classification?

A

C4a involves hemosiderin staining, where red blood cells leak into the interstitium, leading to brown pigment staining.

35
Q

What are the five aspects of the ‘5PT’ method used to describe venous ulcers?

A
  • Pain
  • Position
  • Presentation
  • Periwound
  • Pulses
  • Teperature
36
Q

What is the average healing time for full-thickness venous ulcers with appropriate interventions?

A

The average healing time is 8 weeks.

  • Smaller ulcers healing in 5–7 weeks
  • Larger ulcers in 10–16 weeks.
37
Q

What is lipodermatosclerosis (C4b) in venous insufficiency?

A
  • It is inflammation of the fat layer under the skin.
  • Resulting in pain, hardening, redness, swelling, and a ‘champagne bottle’ deformity.
38
Q

What is the characteristic pain associated with venous ulcers?

A

Venous ulcers typically have mild to moderate pain that decreases with elevation.

39
Q

What are the primary goals of venous ulcer intervention?

A
  • protect surrounding skin
  • address the wound bed
  • enhance venous return
  • decrease edema
40
Q

What is the role of compression therapy in venous ulcer management?

A

Compression promotes venous return and reduces edema, but it is contraindicated if ABI < 0.5.

41
Q

What types of dressings are recommended for venous ulcers?

A

Absorptive and non-adherent dressings are used to manage exudate and protect delicate skin.

42
Q

How does elevation help in managing venous insufficiency?

A

Elevation promotes venous return by reducing venous pressure and edema.

43
Q

What exercises are beneficial for venous insufficiency patients?

A

Exercises targeting the calf pump are essential to enhance venous return.

44
Q

What medical interventions are used to manage venous ulcers?

A

These include managing risk factors, using fibrinolytics (pentoxifylline), topical agents, and antibiotics when necessary.

45
Q

What is the purpose of surgical interventions like vein ablation or microphlebectomy?

A

These procedures address incompetent veins and improve venous return to aid ulcer healing.

46
Q

What is subfascial endoscopic perforator surgery (SEPS)?

A

Subfascial Endoscopic Perforator Surgery (SEPS):

  • Involves clipping perforator veins via small incisions, often combined with saphenous vein ablation.
47
Q

What is the purpose of valvuloplasty in venous insufficiency treatment?

A

Valvuloplasty restores valve competence in deep veins, reducing ulcer recurrence and improving hemodynamics.

48
Q

What is radiofrequency (RF) ablation and its use in venous insufficiency?

A

RF ablation uses heat from electromagnetic waves to close off veins, commonly treating great and small saphenous veins.

49
Q

What is the key difference between laser ablation and RF ablation?

A

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.

50
Q

What is sclerotherapy, and when is it used?

A

Sclerotherapy involves injecting a chemical to scar and close veins.

  • Often for smaller varicose veins or cosmetic purposes.
51
Q

What are the risks associated with stripping and ligation of the great saphenous vein?

A

Complications include saphenous nerve injury and recurrence due to angiogenesis.

52
Q

What is microphlebectomy, and what veins does it target?

A

Microphlebectomy removes visible varicose veins using small incisions and hooks, targeting tributaries or clusters.

53
Q

What is the purpose of the inferior vena cava (IVC) filter in DVT management?

A

The IVC filter prevents DVT fragments from traveling to other parts of the body but does not improve venous flow.

54
Q

Why are procedures like vein stripping recommended only for certain patients?

A
  • They are invasive
  • Typically reserved for young, active patients who have failed conservative treatments.
55
Q

CEAP Classification

  • C0 = ?
  • C1= ?
  • C2 = ?
  • C3 = ?
  • C4a = ?
  • C4b = ?
  • C5 = ?
  • C6 = ?
A
  • 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

DPT 773 - Integumentary (20 decks)

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