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Systems: Cardiovascualar AB > Venous + Lymphatic Disease: Presentation, Investigation + Therapy > Flashcards

Venous + Lymphatic Disease: Presentation, Investigation + Therapy Flashcards

1
Q

What are varicose veins?

A

Torturous dilated superficial veins

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2
Q

What are the most common sites for varicose veins?

A

Long saphenous vein

Short saphenous vein

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3
Q

What are primary varicose veins caused by?

A

Valvular dysfunction

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4
Q

Which sex has the higher prevalence of varicose veins?

A

Females

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5
Q

What is important when taking a history of varicose veins?

A
  • Age of onset
  • Occupation
  • Pregnancies (esp, multiples + large babies)
  • Previous DVY/major trauma
  • Family history
  • Signs and symptoms
  • Complications
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6
Q

What are the signs and symptoms of varicose veins?

A
  • Cosmesis
  • Localised or generalised discomfort in the legs
  • Nocturnal cramps
  • Swelling
  • Acute haemorrhage
  • Superficial thrombophlebitis
  • Pruritus
  • Skin changes
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7
Q

How are varicose veins assessed?

A

Duplex ultrasound

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8
Q

What are the indications for intervention with varicose veins?

A
  • Superficial thrombophlebitis
  • Signs of chronic venous insufficiency
  • Bleeding
  • Cosmetic
  • Anxiety that disease may progress
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9
Q

What are the treatment options available for varicose veins?

A
  • Surgery
  • Injection
  • Minimally invasive procedures
  • Compression
  • Conservative
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10
Q

What surgical options are available for varicose veins?

A
  • High tie (ligation of the sapheno-femoral or sapheno-popiteal junctions)
  • Vein Stripping
  • Multiple stab avulsions
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11
Q

What are the relative contra-indications against superficial venous surgery?

A
  • Previous DVTs
  • Arterial insufficiency
  • Patient co morbidity
  • Morbid obesity
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12
Q

What are the common complications with VV surgery?

A
  • Minor haemorrhage
  • Thrombophlebitis haematoma
  • Wound problems
  • Severe pain
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13
Q

What are the less common VV surgery complications?

A

Sural/saphenous nerves

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14
Q

What are the rare VV surgery complications?

A

Damage to deep veins, arteries, nerves, DVT

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15
Q

What are the minimally invasive treatments of main trunk varicosities?

A
  • Foam sclerotherapy (chemical reaction with endothelium)
  • Endovenous laser ablation (thermal ablation)
  • Radiofrequency ablation (thermal ablation)
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16
Q

What are the potential advantages of local anaesthetic minimally invasive treatment options for VV?

A
  • Reduce surgical trauma= less pain
  • Reduce time off work
  • Do not require an operating theatre
  • Potential to increases patient throughput
17
Q

What are the results of minimally invasive treatment options for VV?

A
  • Short to medium term just as effective clinically as surgery
  • Long term results awaited
  • Cost effectiveness is not known
18
Q

Describe EVLA, laser technique in the treatment of VV.

A
  • Micro puncture needle inserted into the incompetent long or short saphenous veins using ultrasound
  • Guide wire introduced and manoeuvred to saphenous junction with deep vein using ultrasound
  • Catheter and laser fibre introduced over guide wire to 1 cm below junction
  • Closure by VNUS which heats vein to 85C
19
Q

Describe the foam sclerotherapy technique in the treatment of VV.

A
  • Needle inserted into incompetent veins under ultrasound control
  • Foam injected, prevented from entering deep venous system
20
Q

When are compression stockings usually used in the treatment of VV?

A

Normally following another treatment such as surgery

21
Q

What clinical presentations are associated with chronic venous insufficiency?

A
  • Ankle oedema
  • Telangectasia
  • Venous eczema
  • Haemosiderin pigmentation
  • Hypopigmentation ‘atrophie blanche’
  • Lipodermatosclerosis
  • Venous ulceration
22
Q

What is the pathophysiology of CVI?

A
  • Venous hypertension
  • Venous engorgement and stasis
  • Imbalance of Starling forces and fluid exudate
23
Q

What is the pressure at the foot when standing motionless?

A

~90mmHg

24
Q

What does the pressure drop to at the foot when there is active movement?

A

~30mmHg

25
Q

What is the ambulatory venous pressure?

A

Change in pressure from standing motionless to active movement

26
Q

What dose a raised AVP suggest?

A
  • Failure of muscle pump, valves or outflow obstruction

- Venous hypertension

27
Q

What can failure of calf muscle pump be due to?

A
  • Superficial venous reflux
  • Deep venous reflux
  • Venous obstruction
  • Neuromuscular
  • Obesity
  • Inactivity
28
Q

Leg ulcer

A

Breach in the skin between knee and ankle joint present for over 4 weeks

29
Q

What is the differential diagnosis of leg ulceration?

A
  • Diabetes
  • Rheumatoid arthritis
  • Vasculitis
  • CT disease
30
Q

What vessels are usually associated with leg ulceration?

A
  • Almost 80% purely venous in origin

- Up to 20% have significant arterial disease

31
Q

What would be found on clinical examination of leg ulceration?

A
  • Signs of CVI
  • Oedema
  • Locomotor system
  • Vascular
32
Q

What investigations should be carried out for leg ulceration?

A
  • ABPI (ankle brachial pressure index)

- Duplex

33
Q

What is a complication of CVI?

A

Leg ulceration

34
Q

What is the treatment for leg ulceration excluding arterial disease?

A
  • Multi-layer graduated, elastic, high grade compression therapy
  • Non-adherent dressings or hydrocolloid/foam dressing if painful
  • Systemic and topical therapy
  • Exercise the calf muscle pump
35
Q

What are the causes of primary lymphoedema?

A
  • Congenital
  • Praecox
  • Tarda
36
Q

What are the secondary causes of lymphoedema?

A
  • Malignancy
  • Surgery (radical mastectomy: groin/axillary dissection)
  • Radiotherapy
  • Infection (filariasis/tuberculosis/pyogenic)
37
Q

What are the treatment options for lympoedema?

A
  • Very limited treatment options

- Elevation and manual drainage

Systems: Cardiovascualar AB (42 decks)

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