Venous & Lymphatic Disease - Presentation, Investigation & Therapy Flashcards
1
Q
What are varicose veins?
A
Swollen and enlarged veins that usually occur in the legs and feet
2
Q
What are swollen and enlarged veins that usually occur in the legs and feet called?
A
Varicose veins
3
Q
What percentage of the population is estimated to be affected by varicose veins?
A
33%
4
Q
What is A?
A
Saphenofemoral junction
5
Q
What is B?
A
Superficial iliac circumflex vein
6
Q
What is C?
A
Anterior lateral tributary
7
Q
What is D?
A
Femoral vein
8
Q
What is E?
A
Deep femoral vein
9
Q
What is F?
A
Anterior tributary vein
10
Q
What is G?
A
Dorsal venous arch
11
Q
What is H?
A
Posterior arch vein
12
Q
What is I?
A
Greater saphenous vein
13
Q
What is J?
A
Posterior medial tributary
14
Q
What is K?
A
Pudendal vein
15
Q
What is L?
A
Deep and superficial inferior epigastric vein
16
Q
What is A?
A
Posteromedial superficial thigh vein
17
Q
What is B?
A
Vein of Giacomini
18
Q
What is C?
A
Saphenopopliteal junction
19
Q
What is D?
A
Lesser saphenous vein
20
Q
What is E?
A
Dorsal venous arch
21
Q
What is F?
A
Posterolateral tributary vein
22
Q
What is G?
A
Anterolateral superficial thigh vein
23
Q
What is the course of the long saphenous vein?
A
Dorsal venous arch drains into the long saphenous vein which passes anterior to the medial malleolus, up the medial aspect of the leg
24
Q
What does LSV stand for?
A
Long saphenous vein
25
Where is the saphenofemoral junction?
2.5cm below and lateral to the pubic tubercle
26
What happens at the saphenofemoral junction?
Long saphenous vein perforates the cribiform fascia and empties into the femoral vein (deep system)
27
What does the dorsal venous arch drain into?
Long saphenous vein
28
What does the long saphenous vein drain into?
Femoral vein
29
Where does the long saphenous vein drain into the femoral vein?
Saphenofemoral junction
30
Where is the short saphenous vein?
Planter venous arch drains into the short saphenous vein which travels posterior to the lateral malleolus, up the posterior aspect of the leg and drains into the poplital vein (deep system)
31
What does SSV stand for?
Short saphenous vein
32
What does the planter venous arch drain into?
Short saphenous vein
33
What does the short saphenous vein drain into?
Poplital vein
34
What things assist blood flow back to the heart against gravity?
Valves
Calf muscle pump
Perforating veins to drain blood into deep system (deep veins are within muscular compartments and can withstand higher pressures)
35
Why can deep veins withstand higher pressures than superficial veins?
They are within muscular compartments
36
What are some causes of valvular failure?
Surgical or traumatic disruption of the valve
Deep vein thrombosis (DVT)
Hormonal changes in pregnancy
Large pelvic tumour
37
What does DVT stand for?
Deep vein thrombosis
38
How can hormonal changes in pregnancy cause valvular failure?
Weakness of the veins and valves, leading to venous incompetence
Enlarged uterus can cause mechanical obstruction to venous flow deep within the system
39
How can a large pelvic tumour cause valve failure?
Increase pressure within the distal venous system and disrupt it
40
What happens to venous pressures once one valve fail?
It increases
41
What is venous incompetence?
Veins do not work correctly
42
What is it called when veins do not work correctly?
Venous incompetence
43
What are risk factors for venous incompetence?
Age
Females more than males
Pregnancies
Deep vein thrombosis
Standing for long periods of time (occupation)
Family history
44
What is seen in the history for venous incompetence?
Burning
Itching
Heaviness
Tightness
Swelling
Decolourisation
Phlebitis
Bleeding
Disfigurement
Eczema
Ulceration
45
What is phlebitis?
Inflammation of a vein
46
What is inflammation of a vein called?
Phlebitis
47
What does the examination for venous incompetence involve?
Looking
Feeling
48
What are some special tests for venous incompetence?
Tap test
Trendelenburg test
Doppler
49
What is the tap test?
1) Place one hand over the saphenofemoral junction and one over the long saphenous vein above the knee
2) Tap the saphenofemoral junction
3) A transmitted impulse at the knee indicates an incompetence of the valves between the two hands
50
What is the trendelenburg test?
1) Lie the patient flat and drain the superficial vein by raising the leg and stroking the vein towards the trunk
2) Apply pressure over the saphenofemoral junction, keep this pressure on as the patient stands
3) If the varicose veins don't dilate on standing (you are preventing this by your hands acting like a valve) release your hands and you will see the veins refill as the patients saphenofemoral junction valve is incompetent
51
What is the process of using a doppler for venous incompetence?
1) Hold the doppler probe over the saphenofemoral junction
2) Squeeze the calf muscle, in competent superficial veins you will hear a 'whoosh' as the blood flows upwards into the deep vein system
3) In a patient with an incompetent saphenofemoral hunction you will hear two waves as the blood flows upwards and then refluxes downwards again
52
What investigation is done for venous incompetence?
Ultrasound
53
How can ultrasound help diagnose venous incompetence?
Can demonstrate the valves, anatomy of the varicose veins and can be used to show dynamic blood flow such as reflux
54
What are the different classifications of chronic venous disease?
C0
C1
C2
C3
C4a
C4b
C5
C6
55
What is C0?
No visible or palpible signs of venous disease
56
What is C1?
Teleangiectasies or reticular veins
57
What is C2?
Varicose veins
58
What is C3?
Oedema
59
What is C4a?
Pigmentation or eczema
60
What is C4b?
Lipodermatosclerosis or athrophie blanche
61
What is C5?
Healed venous ulcer
62
What is C6?
Active venous ulcer
63
When should treatment for varicose veins?
When the patient is compaining of:
Bleeding varicose veins
Symptomatic varicose veins (including aching, discomfort, swelling, heaviness and itching)
Recurrent symptomatic varicose veins
Lower limb skin changes of chronic venous insufficiency
Superficial venous thrombosis
Venous leg ulcer (active or healed)
64
What are the management options for varicose veins?
1) Endovenous treatment (laser treatment used to treat varicose veins)
2) Ultrasound guided foam sclerotherapy (injecting a chemical into the affected vein that inflames the lining and causes them to block)
3) Open surgery
65
What is endovenous treatment for varicose veins?
Laser treatment
66
What is laser treatment for varicose veins known as?
Endovenous treatment
67
What is ultrasound guided foam sclerotherapy?
Injecting a chemical into the affected vein that inflames the lining and causes them to block
68
What is a process involving injecting a chemical into the affected vein that inflames the lining and causes the vessel to block?
Ultrasound guided foam sclerotherapy
69
What should be offered if interventional treatment is unsuitable?
Compression hosiery
70
What is a compression hosiery?
Stocking that helps to preven the occurence of venous disorders such as oedema or thrombosis
71
When should intervention for varicose veins not be offered?
Deep vein system is occluded, hosiery should be used instead
72
What is the process of endovenous treatment for varicose veins?
1) The LSV or SSV is cannulated under ultrasound guidance
2) Catheter is passed up the length of the vein to just distal of the saphenofemoral or saphenopoplital junction
3) Local anaesthetic is used for the small skin puncture, and is then infiltrated in the superficial tissues around the length of the vein
4) Catheter causes injury to the vein wall (either by heat or laser) which causes fibrosis and occlusion of the vein, the subsequent ablation/disappearance of the vein
73
What are some complications of endovenous treatment?
Skin burns
Paraethesiae
Phlebitis
Deep vein thrombosis
74
What is paraethesiae?
Abnormal sensation, typically tingling or prickling (pins and needles)
75
What is an abnormal sensation, typically tingling and prickling (pins and needles) called?
Paraethesiae
76
What is the process of foam sclerotherapy?
1) Under ultrasound guidance a chemical foam is injected into the affected vessel
2) Foam damaged the venous wall, causing fibrosis and occlusion
77
What are some complications of foam sclerotherapy?
Vein should be occluded with pressure proximally to prevent foam migrating and causing stroke, TI or MI
Thrombophlebitis
Skin pigmentation
78
What is thrombophlebitis?
Inflammatory process that causes a blood clot to form and block a vein, usually in your leg
79
What is an inflammatory process that causes a blood clot to form and block a vein, typically in your leg?
Thrombophlebitis
80
What is the process of open surgery?
1) Under general anaesthetic a groin incision is made and the saphenofemoral junction is exposed
2) The saphenous vein is ligated from the femoral vein, an instrument is passed along the length of the saphenous vein and then used to strip the vein out
3) Small superficial varicose veins are avulsed as using small, stab incisions and a small hook instrument
81
What are some complications of open surgery?
Anaesthetic risk
Wound infection
Damage to nearby nerves (saphenous and sural nerves)
Bleeding
82
What nerves are near the saphenofemoral junction that can become damaged in open surgery?
Saphenous and sural nerves
83
What is venous insufficiency?
Condition that occurs when the venous walls and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart
84
What is a condition that occurs when the venous walls and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart?
Venous insufficiency
85
What can venous insufficiency be caused by?
Failure of calf muscle pump
Superficial venous reflux
Deep venous reflux (due to surgery, DVT or congenital)
Venous obstruction (due to heart failure, portal hypertension or obesity)
86
What is the pathophysiology of venous insufficiency?
1) Venous insufficiency
2) Venous hypertension
3) Endothelial leak
4) Oedema
5) Increase perfusion distance
6) Impaired healing
7) Inflammation
8) Fibrinogen tissue damage
9) Impaired tissue perfusion
87
What are some symptoms of chronic venous insufficiency?
Oedema
Telangiectasia
Eczema
Hemosiderin pigmentation
Hypopigmentation
Lipodermatosclerosis
Ulceration
88
What is telangiectasia?
Widened venules cause threadlike red lines on the skin
89
What is it called when widened vessels cause threadlike red lines on the skin?
Telangiectasia
90
What is eczema?
Condition that causes the skin to become itchy, red, dry and cracked
91
What is a conditiont that causes the skin to become itchy, red, dry and cracked?
Eczema
92
What is hemosiderin pigmentation?
Hemosiderin accumulates under your skin and causes yellow, brown or black staining or bruise like appearance
93
What is it called when hemosiderin accumulates under your skin and causes yellow, brown or black staining or bruise like appearance?
Hemosiderin pigmentation
94
What is hypopigmentation?
Skin lacks colour
95
What is it called when the skin lacks colour?
Hypopigmentation
96
What is lipodermatosclerosis?
Form of inflammation of the layer of fat under the skin
97
What is a form of inflammation of the layer of fat under the skin?
Lipodermatosclerosis
98
What is ulceration?
Break in a bodily membrane that impedes the organ of which the membrane is a part from, continuing normal function
99
What is a break in a bodily membrane that impedes the organ of which the membrane is a part of, continuing normal function called?
Ulceration
100
What is hemosiderin?
Protein compound that stores iron in your tissues
101
What are venous ulcers?
Breach in the skin between the knee and ankle joint present for more than 4 weeks
102
What is the presentation of venous ulcers?
Granulomatous (red) base
Shallow
Irregular margins
Exudative
Painless
Pulses present
103
What investigations are done for venous ulcers?
ABPI (ankle-brachial pressure index)
104
What does ABPI stand for?
Ankle-brachial pressure index
105
What is the treatment of venous ulcers?
Exclude arterial disease
Wound care
Elevation
Compression bandaging
Shockwave therapy
106
When looking at venous ulcers, what excludes arterial disease?
Ankle-brachial pressure index (ABPI)
107
What is lymphoedema?
Long term chronic condition that causes swelling in the body's tissues
108
What is a long term chronic condition that causes swelling in the body's tissues?
Lymphoedema
109
What are the different categories of lymphoedema?
Primary
Secondary
110
What are different kinds of primary lymphoedema?
Congenital
Praecox (around puberty)
Tarda (age \> 35)
111
What can lymphoedema be secondary to?
Malignancy
Surgery
Radiotherapy
Infection
112
How is lymphoedema treated?
Elevation
Drainage
113
What is praecox?
Around puberty
