venous vascular disease Flashcards
what are the types of inflammatory venous diseases ?
superficial thrombophlebitis
thrombophlebitis migrans
when do you see thrombophlebitis migrans ?
in the cases of abdominal cancers such as pancreatic cancers- known as Trousseau’s sign
when do you see superficial thrombophlebitis ?
appears spontaneously in patients with varicose veins , in Buergers disease, after IV therapy
what is the treatment for superficial thrombophlebitis ?
NSAIDs, elevation of the limb, local application of heat are the primary treatment
when is surgery indicated with superficial thrombophlebitis ?
after 2 weeks of the primary treatment if there is no effect
what are the causes of DVT?
stasis of blood flow
hypercoaguability
endothelial damage
what factors increase the risk of DVT?
immobilization hypercoaguability surgery trauma malignancy pregnancy venulitis
what are examples of venulitis?
Buerger’s disease
Behcet’s disease
homocysteinuria
what is Homan’s sign ?
calf pain on passive dorsiflexion ( not very accurate)
what are the stages of complications of DVT ?
phlegmasia alba dolens
phlegmasia cerulea
venous gangrene
what investigation are required to make a diagnosis of DVT ?
duplex ultrasound
MRA
what are the different outcomes of DVT ?
post-phlembetic syndrome
paradoxical embolisms
who are the potential candidates for prophylactic care of DVT ?
- elderly patients undergoing major abdominal surgery or orthopaedic surgery
- patients with major trauma
- prolonged immobility >3 days
what are the approaches to preventing DVT ?
1.pharmacological - low dose unfractioned heparin
low molecular weight heparin
2.mechanical -early ambulation
elastic stocking
intermittent pneumatic compression device
why is the treatment of DV necessary ?
- to limit further thrombosis
- to prevent morbidity related to pulmonary embolism
- to decrease the recurrence rate
what are the different treatment options for DVT ?
antithrombotics
thrombolytic
IVC filters
Thrombolectomy
when are thrombolytics indicated ?
when phlegmasia develops
when are IVC filters indicated ?
indicated to whom antithrombotic therapy is contraindicated or failure of anticoagulation
when is thrombolectomy indicated ?
indicated phlegmasia cerulae dolens and impending venous gangrene
what are the types of primary venous insufficiency ?
Telangiectasia
reticular vein
Varicose vein
how do varicosities develop?
failure of one or more of these factors
- valvular competence
- patency of veins
- calf muscle pump
what are the sources of venous hypertension ?
gravitational
dynamic ( muscular contraction)
what is CEAP classification ?
C - clinical
E - etiological
A - anatomical
P - pathophysiological
what is a saphenovarix ?
is a dilation of the saphenous vein at its junction with the femoral vein in the groin
what is the gaiter’s zone associated with ?
handbreadth area around the malleoli , where complications of venous disease occurs
what are the minimally invasive methods used in varicose veins
sclerotherapy
endovascular laser
radiofrequency ablation
foam sclerotherapy
what is lipodermatosclerosis ?
pigmentation
thickening
induration of the skin due to venous disease
what other manifestations may be seen with lipodermatosclerosis ?
inverted champagne bottle ( prominent calf and thin ankle), contracted skin and subcutaneous tissue
what are the clinical methods for testing varicose veins ?
trendelenburg’s test
ochsner-Mahorner test
schwartz test
modified perthe’s test
what may a patient with venous vascular disease complain of ?
heaviness, swollen leg
what are the pharmacological treatments of varicose veins ?
calcium dobesilate
diosmin
rutin, troxerutin
what are the indications for Trendelenburg surgery?
varicosity more than 4 mm
varicosity with complication
refractory to medical therapy
what surgery could be indicated in the presence of lipodermatosclerosis ?
subfascial endoscopic perforator surgery
what clinical method can be used to test the competence of a specific perforator ?
Ochsner- Mahorner test ( multiple tourniquet test )
what type of compression therapy can be used in varicose ?
pneumatic compression
elastic graduated compression stockings
when are class II stockings used ?
uncomplicated varicose veins
when are class III stockings used ?
complicated varicose veins
when are stockings contraindicated ?
peripheral arterial disease
heart failure
never in DVT
