W8: Venous & Lymphatic Disease

Question 1

VARICOSE VEINS: & common causative factors

Answer 1

dilated and tortuous superficial veins

d/t: DVT, hormonal, trauma/surgery, foetal/tumour obstr.

Question 2

varicose vein rf

Answer 2

age
female
hormonal
occupational
DVT

Question 3

venous lymphatic disease special diagnostic test

Answer 3

1. TAP TEST
   impulse transmission from saphenofemoral junction + saphenous vein
2. TOURNIQUET TEST
   raising leg lying down, apply pressure,. tourniquet acts as valve: dilation when letting go
3. USS - STANDARD
   shows anatomy and tortuousity: DVT ID.
4. DOPPLER
   squeeze calf muscle, whoosh sound using doppler probe

Question 4

Significant venous disease qualifying features

Answer 4

C3 above: oedema

• pigmentation, eczema
• lipodermatosclerosis, athrophie blanche
• healed / active venous ulcer

=> TREATMENT

Question 5

VENOUS LYMPHATIC DISEASE Tx.

Answer 5

1. ENDOVENOUS TX
   - LSC or SSV catheterised (USS)
   - passed to distal saphenofemoral or at saph.pop. junction
   - laser ablation

! burns, parathesia, DVT, phlebitis

2. USS-GUIDED FOAM CLEROTO.
   CI: active DVT or pathology
   - inject foam: occludes + ablates
   - EMBOLISATION RISK: stroke, TIA, MI
3. OPEN SURGERY
   saphfem junction entry -> saphenous vein ligated
   => small superficial varicose veins occluded and hook

! anaesthetic risk, wound infection, NERVE DMG.

Question 6

VENOUS INSUFFICIENCY

Answer 6

calf muslce pump failure, venous reflux, venous obstr.

IMPAIRED VENOUS PERFUSION d/t inflamm and scarring d/t endothelial leak

=> VENOUS ULCER (4w+)
shallow, irregular margin, exudate, granulomatous base, painless, pulse present, medial

Vs. NEUROPATHIC ULCERS: painless, pressure areas, metatarsal heads under heel

Vs. ARTERIAL ULCER: anterior, PAINFUL. deeper, defined margins. over malleoli, under heel, toe joints.