dvt & varicose veins. dvt it is the most common venous disorders result from incompetent valves...
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DVT & VARICOSE
VEINS
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DVT It is the most common
venous disorders result from incompetent valves in the veins and obstruction of venous return to the heart, usually as a result of thrombus.
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ETIOLOGY
Venous stasis
Vessel wall injury
Hypercoagulability
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RISK FACTORS• Older age• Major surgery and orthopedic
surgery• Cancers• Immobilization• Pregnancy and the postpartum
period
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Cont…
• Trauma and minor leg injury• Previous VTE• Oral contraceptives• Hormonal replacement therapy
Central venous catheters• Obesity• Infection
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PATTERNS OF DEEP VEIN THROMBOSIS
Popliteal thrombosis
Femoral thrombosis
Iliac thrombosis
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PATHOPHYSIOLOGY
Clot formation
Clot can enlarged and extend
Venous valves are damaged(Inflammatory response)
Postphlebitic syndrome
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Cont…
Muscle spasm and changes in intravascular pressure
Developing thrombus to dislodge & moves towards heart and lungs
Obstruct perfusion to the lung segments
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Cont…
Pulmonary arteries partially or totally obstructed by embolus
Circulation of the lung segment affected
Lung may undergo severe infarction with massive tissue destruction
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Clinical manifestationsCalf thrombosis • Calf tenderness• Distal swellingFemoral thrombosis• Tenderness & pain in distal thigh &
popliteal regions• Swelling• Calf vein thrombosis
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Cont…Iliofemoral thrombosis• Massive swelling• Tenderness & pain in entire
extremityUpper extremity thrombosis• Swelling of affected extremity• Dilated superficial veins• Tenderness & pain• Impaired mobility
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Cont…• Local warmth
• Mild fever
• Possible venous cord in the
popliteal area
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DIAGNOSTIC EVALUATION
History collection
Physical examination
Color flow duplex ultrasound
imaging
D- Dimer test
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Cont….
Venography
CT venography
MR venography
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Treatment
Goals
To prevent propagation of the clot
Prevent the development of new
thrombi
Prevent pulmonary emboli
Limit venous valvular damage
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Cont…
Bed restLeg elevationCompression stockingsPharmacological measures–Heparin–Warfarin– Thrombolytic therapy
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Cont…
Unfractionated heparin
• Initial-5000U OR 80U/kg - IV
• Followed by maintain the APTT
between 1.5 & 2.5 times the
control.
• It given as 5 to 7 days
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Cont….
LMWH
Dosage – 250U/ kg every 12 hours.
Eg; enoxaparin, dalteparin.
Warfarin
Dose of 5 mg per day
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Cont…
Thrombolytic therapy
Eg;streptokinase, urokinase,
recombinant tissue
plasminogen(reteplase, alteplase)
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Surgical management
Thrombectomy- transvenous
filtration device
• Greenfield filter
• Bird’s nest filter
Guidelines for safe practice
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Green field filter
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Bird’s nest filter
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Varicose veins
These are swollen,twisted
and sometimes painful veins that
have filled with an abnormal
collection of blood.
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Causes
Hereditary
Thrombophelebitis
Risk factors
Prolonged standing
Obesity & distended belly
Pregnancy
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Cont…
Straining-chronic constipation,
urinary retention, chronic cough.
Prior surgery
age
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PathophysiologyGenerally blood flow from the
superficial veins to the deep veins
To the large veins to the heart
Venous blood flow work against gravity
This is assisted by unidirectional intraluminal valves in the veins
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Cont…Activity causes intermittent compression of the veins by
muscles
Pressure increases in the vein valves
Incompetent valves
Valve failure
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Cont….
Veins become swollon and enlarged
Become hard & tortuous
Feeling of heaviness & pressure
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Clinical manifestations
Aching ,heavy legsAppearance of spider veinsAnkle swellingBrownish blue shiny skin
discolourationRedness, dryness, itching of the
affected area
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Cont…
Cramps while standing
Bleeding during minor injuries
Hard swollon area
Whitened irregular scar like
patches in the ankles.
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Diagnostic evaluation
History collection
Physical examination
Tourniquet test
Doppler ultrasound
MRI
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TREATMENT
Conservative
Elevation of legs
Regular exercises
Compression stockings
Anti inflammatory medications
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Cont….Active
Stripping - Removal of all or part of
the saphenous vein .
Endovascular laser surgery – uses a
laser to destroy the veins.
Radiofrequency ablation – heat to
destroy the affected veins.
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Cont…
Ligation – it is usually involved in an
incision at the groin .here they tied
saphenous vein to the femoral vein
just at the entrance of the incision.
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Laser therapy
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Ablation therapy
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Non surgical
Sclerotherapy - Injecting the chemical
inside the vein .
Sclerosant agent-polidocanal,
sclerodex.
Lasers – it is used in case of small
veins with vacosity.
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Sclerotherapy
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Complications
Varicose ulsers
Severe bleeding
Acute necrosis
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