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35 Cards in this Set
- Front
- Back
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Manifestations of CVI?
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Varicose Veins
Lipodermatosclerosis Stasis Dermatitis Venous Ulceration |
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CVI is due to?
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Incompetent Valves
Obstruction Venous HTN |
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How many people in US w/ some evidence of CVI?
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5 million
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how many have or will have a leg ulcer?
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400,000 - 500.000
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What % of CVI pts develop recurrent ulcers?
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67-75%
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Why is long term management difficult?
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poor compliance
high rate of recurrences |
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Why talk about CVI?
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common
miserable and disabling may be associated w/ life-threatening disease treatable and preventable |
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Three systems of veins
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Deep Venous System
Superficial Venous System Perforator Veins |
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Which sets of veins have valves?
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ALL OF THEM
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Which was does blood go normally between systems?
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Superficial to Deep
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Causes of Incompetent Valves
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Congenital (familial
Acquired: DVT, Standing, AVF |
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Normal superficial vein pressure in exercise?
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20-30 torr
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Vein Pressure w/ valvular incompetence or obstruction?
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60-90 torr
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Pathophysiology of CVI?
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Increased venous pressure leads to:
Fluid leak => edema Protein leak => lipodermatosclerosis (brawny edema) Red Cells: hemosiderin |
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What causes venous obstructoin?
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Thrombosis
Pregnancy Tumor Ligation Other Compression |
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Risk Factors of CVI?
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Multiple Pregnancies
FH Fat Standing profession H/O leg trauma Previous DVT |
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Sx's of CVI?
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Pain
Spider Veins Varicose Veins Leg heaviness and fatigue Swollen Limbs Skin Changes and Skin Ulcers |
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Rx for bleeding from ulcers?
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NOT PRESSURE
ELEVATE! |
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Define Varicose Veins?
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Saccular Dilatations of Veins which are often Tortuous
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Define Lipodermatosclerosis?
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Progressive replacement of skin and subcu tissue by fibrous scarring
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Acute vs Chronic Lipodermatosclerosis?
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Acute: painful, hot, tender, mistaken for cellulitis
Chronic: Thick, hard, tight, ankle is narrower |
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Two Noninvasive Examination tools?
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Continuous Wave Doppler (for incompetent valves)
Digital Ultrasound |
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What is abnormal w/ DUS?
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Retrograde flow longer than 2 seconds
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4 tools to prevent complications of DVT
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Education
Anticoagulation of DVT Graduated Compression Stockings Perioperative Anticoagulation or Intermittent Calf Compression |
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Non-Surgical Rx Options for CVI?
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Leg Elevation
Compressive Stocking Therapy Multi-Layer Compression Therapy |
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Where are Graduated Compression Stocking tighter?
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tighter at ankle
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What is up with Multi-Layer Compression Therapy?
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Unna Boot
Moist, Rigid Boot for Active Ulcers or Severe Edema |
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What is Sclerotherapy? indicated for?
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injection of agents -->aseptic thrombosis of veins
good for small spider veins or less extensive varicose veins |
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Indications for Surgery for CVI?
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Cosmetic
Pain Venous Ulcers Lipodermatosclerosis Failure of non-surgical Rx |
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Surgical options?
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Saphenous Vein Stripping
Subfascial Endoscopic Perforator Surgery (SEPS) Endovenous Occlusion w/ RF Skin Grafting Deep Vein Reconstruction (valvuloplasty, axillary vein transfer) Stab Avulsion Phlebectomy |
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Rx for incompetent perforating veins?
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ligate em
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Relationship of perforating veins and ulcers?
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often a perforating vein at base of ulcer
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Who is the new kid on the block that works well?
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RF Endovenous Occlusion
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how does RF Endovenous Occlusion work?
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Uses radiofrequency energy to close vessels.
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why is RF Endovenous Occlusion good?
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minimally invasive
local anesthetic outpatient |
