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18 Cards in this Set
- Front
- Back
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What are the two systems of veins in the legs and which veins belong to each?
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1. Superficial system: greater and lesser saphenous
2. Deep system: Common, deep and superficial femoral, popliteal and tibial |
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What vessels connect the superficial and deep venous systems in the legs and where are they located?
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Perforators located mostly on medial side of leg
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What pathology does insufficiency in the superficial venous system cause?
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Varicose veins
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What is the pathophysiology of varicose veins?
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Dysfunction of the bi-leaflet valves of the veins allowing blood to be pulled backwards due to gravity. This results in blood pooling and venous dilation. Blood clots, genetics and vasodilation can all lead to valve dysfunction.
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What are the different sizes of "varicaose veins" called?
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Small - telangectasias
Medium - reticular veins Large - varicose veins |
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What are risk factors for developing varicose veins? (7)
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Female
Pregnancy Prolonged standing Obesity Age (20-40) Trauma to leg Superficial thrombophlebitis (blood clot in superficial vein) |
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What are symptoms of varicose veins and how do they correlate with disease severity/size of veins?
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Pain, burning, itching, swelling aching
Do not correlate with size of veins |
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How do you diagnose varicose veins?
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History
Physical - examine veins in standing, palpate GSV, Brodie-Trendelberg test Duplex U/S - best |
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What are treatment options for varicose veins? (7)
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1. Nothing
2. Compression stockings - prevent symptoms with no effect on actual vein 3. Injection sclerotherapy - for small veins 4. Ultrasound guided foam sclerotherapy - for large veins but risk of PE 5. Surgical stripping - for large veins, long recovery 6. Endovenous laser therapy - destroy vessel from inside - less recovery 7. Endovenous RF ablation - similar to EVLT |
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Which vein is more likely to be varicose, greater saphanous or lesser saphanous?
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Greater saphanous (medial side of leg)
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What is disease of the deep venous system called?
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Ambulatory venous hypertension
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What is the pathophysiolgy of ambulatory venous hypertension?
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Valves of deep venous system are dysfunction so that normal venous return does not occur when walking which results in blood pooling and venous hypertension. This leads to the clinical manifestation of ulceration, swelling and skin changes.
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What are the clinical manifestations of ambulatory venous hypertension?
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Swelling of legs
Brown discoloration of skin and ulceration over the medial maleolus |
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What are the theories of how venous pooling causes ulceration?
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Venous stasis theory
AV fistula theory Diffusion block theory Leukocyte trapping theory |
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How do you diagnose Ambulatory venous hypertension
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Physical exam usually - Duplex U/S and venogram can help
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What are risk factors for ambulatory venous hypertension? (7)
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>50 years old
Female PMx DVT Obesity Family Hx Prolonged standing Trauma |
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How do you treat ambulatory venous hypertension?
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Elevate leg at night
Antibiotics for cellulitis Treat ulcer with multilayer dressing Avoid trauma Compression stockings - only when ulcer healed and if ABI is >0.7 (or will kill the limb) |
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Is surgery helpful for treatment of ambulatory venous hypertension?
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Not really
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