[02.19] CMD - Diseases of the Veins and Lymphatics V2.1.pdf

Chronic Venous Disease

What is the spectrum of venous disorders caused by either structural or functional abnormalities of veins?

Telangiectasia, reticular veins, varicose veins, chronic venous insufficiency, and venous ulcers

What is the clinical spectrum of chronic venous disease from mildest to most severe?

Reticular veins

What is the term for the bigger, violet veins in the legs?

Varicose veins

What is the term for the large, protruding veins in the legs?

Chronic venous insufficiency

To what condition do reticular and varicose veins commonly progress?

Disability and chronic pain

What are two major health impacts that make chronic venous disease a significant public health issue despite seeming benign?

15 percent

What percentage of men in the US are affected by varicose veins?

30 percent

What percentage of women in the US are affected by varicose veins?

Associated edema or swelling

What clinical sign is associated with the severe forms of chronic venous insufficiency?

7.5 percent

What percentage of men experience the severe form of chronic venous insufficiency with associated edema?

5 percent

What percentage of women experience the severe form of chronic venous insufficiency with associated edema?

20 percent

What percentage of patients with chronic venous insufficiency will develop venous ulcers?

10 percent

What is the prevalence rate of chronic venous insufficiency among individuals over 70 years of age?

Superficial, perforator, and deep veins

What are the three systems of veins in the lower extremities?

One-way valves

What structural feature within veins prevents the backflow of blood?

Calf muscle pump

What is an example of a muscle pump that is essential for venous return by pumping blood upward?

Deep venous system

Which venous system acts as the channel through which 90 percent of the blood is pumped out of the legs?

90 percent

What percentage of blood is pumped out of the legs through the deep venous system?

Superficial venous system

Which venous system serves as the collecting system of the veins?

Perforating veins

Which veins serve as conduits for blood to travel from the superficial system to the deep venous system?

Musculo-venous pump

What pump mechanism promotes the contraction of foot and leg muscles to pump blood through one-way valves?

Bicuspid

What is the term for the two-flap structure of venous valves?

Elastic tissue

What tissue makes up the bicuspid flap-like structures of venous valves?

Upwards

In which direction do competent venous valves keep blood moving?

Standing

In what physical position must the venous system move blood against the force of gravity to promote venous return?

Anti-reflux valves and resistance of vein walls

What two physiological factors allow blood to move in one direction only in the standing position?

Pump mechanism

What physiological mechanism activates and maintains the blood flow through the veins?

Dilated and tortuous superficial veins measuring 3 mm or greater

What is the definition of varicose veins?

3 mm

What is the minimum diameter threshold for a dilated superficial vein to be classified as a varicose vein?

Valve incompetence and wall weakness

What are the two primary causes of varicose veins?

Reflux of blood

What does valve incompetence cause, which subsequently promotes wall weakness in veins?

Pregnancy, obesity, and prolonged standing

What are the three major risk factors listed for varicose veins?

Varicose veins

In patients with what pre-existing condition is chronic venous insufficiency most commonly seen?

Retrograde flow or reflux

What does the failure of venous valves cause in chronic venous insufficiency?

Venous hypertension

What does retrograde flow cause, which subsequently leads to capillary dilation and leakage?

Extravasation of plasma proteins and red blood cells

What microcirculatory change occurs in the interstitial tissue due to venous hypertension?

Hemosiderin deposition

What process causes hyperpigmentation in patients with chronic venous insufficiency?

Red patches

How does pigmentation initially start in the lower extremities of CVI patients?

Peripheral arterial disease

What condition is hyperpigmentation in CVI patients sometimes mistaken for, even though it is venous in nature?

Leukocyte trapping and inflammatory cytokines

What two inflammatory processes in CVI lead to skin and tissue injury?

Edema

What tissue consequence of CVI is defined as swelling of the leg that can be accompanied by pigmentation?

Scaling

What skin change occurs when constant edema stretches the skin?

Stasis dermatitis, lipodermatosclerosis, and atrophie blanche

What are three classic skin changes seen in patients with chronic venous insufficiency?

Atrophie blanche

What is the term for a whitish scar on the leg caused by chronic venous insufficiency?

Venous ulceration

What is the end-stage tissue consequence of CVI that starts from constant stretching, scaling, and scratching?

Impaired oxygen and nutrient diffusion

What microvascular impairment in the area directly causes venous ulceration?

Primary CVI

Which type of CVI is due to congenital or degenerative valve defects and is often associated with varicose veins?

Congenital or degenerative

What are two etiologies of valve defects in primary CVI?

Familial

What inheritance pattern is usually associated with primary CVI and varicose veins?

Secondary CVI

Which type of CVI is due to deep venous obstruction or prior deep vein thrombosis?

Deep vein thrombosis

What condition destroys valves and causes secondary CVI and reflux over time?

Extrinsic compression

What non-thrombotic mechanism can cause secondary CVI by obstructing flow?

May-Thurner syndrome

What syndrome is characterized by the iliac artery compressing the iliac vein, causing stasis or obstruction?

Iliac artery

Which artery compresses the iliac vein in May-Thurner syndrome?

Iliac vein

Which vein is compressed by the iliac artery in May-Thurner syndrome?

Heaviness, throbbing, aching, and pressure

What are four common symptoms of chronic venous insufficiency?

Standing

What physical position makes the symptoms of CVI worse?

Elevation of the leg

What action makes the symptoms of CVI better?

Cramping, itching, and burning

What are three sensory symptoms associated with the discomfort of CVI?

Varicose veins, edema, and skin changes

What are three classic physical signs of CVI?

Hyperpigmentation, eczema, and lipodermatosclerosis

What are three specific skin changes observed as signs of CVI?

Eczema

What skin condition presents as scaly legs and peeling skin due to constant swelling in CVI?

Lipodermatosclerosis

What is the clinical term for the thickening and hardening of the skin in CVI?

Shallow with irregular borders and an exudative base

What are the classic physical borders and base characteristics of a venous ulcer?

Medial malleolus

Near what specific anatomical landmark are venous ulcers most commonly located?

Venous

Are ulcers located near the medial malleolus typically venous or arterial in nature?

Diabetic patients

In what patient population are arterial ulcers more commonly seen, making it important to differentiate them from venous ulcers?

Chronic inflammation

With what systemic process are venous ulcers associated?

Clinical, Etiologic, Anatomic, and Pathophysiologic

What does the acronym CEAP stand for?

Stage CVI/CVD

What is the clinical purpose of the CEAP classification?

C0 to C6

What is the full staging range of the clinical component of the CEAP classification?

C0

Which CEAP stage denotes no visible or palpable signs of venous disease?

C1

Which CEAP stage denotes spider veins, telangiectasias, or reticular veins?

C2

Which CEAP stage denotes varicose veins?

C2r

Which CEAP subtype denotes recurrent varicose veins?

C3

Which CEAP stage denotes edema or constant/recurrent swelling of the legs?

C4

Which CEAP stage denotes skin changes secondary to CVD?

C4a

Which CEAP subtype denotes pigmentation or eczema?

C4b

Which CEAP subtype denotes lipodermatosclerosis or atrophie blanche?

C4c

Which CEAP subtype denotes corona phlebectatica?

C5

Which CEAP stage denotes a healed venous ulcer?

C6

Which CEAP stage denotes an active venous ulcer?

C6r

Which CEAP subtype denotes a recurrent active venous ulcer?

Primary, secondary, and congenital

What are the three categories under the Etiologic component of the CEAP classification?

Superficial, perforator, and deep

What are the three anatomical classifications under the Anatomic component of the CEAP classification?

Reflux, obstruction, or both

What are the three pathophysiological states classified under the Pathophysiologic component of the CEAP classification?

Duplex Ultrasound

What is the gold standard diagnostic test for chronic venous insufficiency?

B-mode imaging and Doppler ultrasound

What two ultrasound modalities are combined in a duplex ultrasound to evaluate anatomy and flow?

Structural anatomy

What does B-mode imaging evaluate during a duplex ultrasound?

Blood flow assessment

What does Doppler ultrasound evaluate during a duplex ultrasound?

Reflux, obstruction, and thrombi

What three clinical findings can a duplex ultrasound detect?

Differentiate primary versus secondary CVI

What key clinical distinction can a duplex ultrasound make regarding CVI etiology?

Operator-dependent

What is a major limitation of duplex ultrasound related to the examiner?

Obese patients or those with extensive edema or ulcers

In what three patient profiles is duplex ultrasound difficult to perform due to poor penetration?

Plethysmography

What diagnostic test is rarely used but can assess the severity of venous reflux?

MR or CT venography

What two advanced imaging modalities are rarely used for CVI diagnosis?

Avoid prolonged standing, weight loss, exercise, and leg elevation

What are four non-surgical supportive measures for CVI?

Leg elevation

Which supportive measure is highly effective for relieving the active symptoms of CVI?

Compression therapy

What is the first-line non-surgical treatment for chronic venous insufficiency?

20 to 30 mmHg

What compression stocking pressure range is recommended for patients with varicose veins?