Disorders of the venous system

What are venous disorder?

Disorders that are common conditions and include both mild (varicose veins) to serious (deep vein thrombosis)

What are some major vein disorders?

Venous insufficiency, DVT, varicose veins, venous ulcers.

What are veins?

Thin-walled, flexible structures that return blood to the heart by a low pressure system and valves.

What are the three layers of a vein?

Tunica intima (endothelial cell lining), tunica media (thin layer of smooth muscle), tunica adventitia (exterior layer of connective tissue)

What are the two systems of veins?

Superficial (small diameter veins, drain into deep veins, skin and subcutaneous tissue), deep (large diameter veins)

What connects the two vein systems together?

Perforating veins

What are veins susceptible to?

Statis of blood.

What do veins rely on?

Skeletal muscle pump and valves.

What is a familial predisposition of veins?

Hardiness of veins

What is a result of superficial vein distension?

Varicose veins

What are deep veins susceptible to?

Increased hydrostatic pressure (standing), edema in tissues, deep veins insufficiency can lead to DVT

What can weaken valve leaflets in veins?

Obesity and pregnancy

What does DVT encompass?

DVT and pulmonary embolism

What is Virchow’s triad?

Venous stasis, vascular damage, hypercoagulability

Why are hospital admissions for DVT increasing?

Greater sensitivity to detect

What is an example of venous stasis?

Sedentary behavior, immobility

What is an example of venous injury?

Trauma or surgery (especially orthopedic- may occur in 30-80% of post-op patients)

What is an example of hypercoagulability?

Cancer, estrogen, smoking

How does a DVT turn into a pulmonary embolism?

Stasis of venous blood leads to thrombus, the thrombus then travels into inferior vena cava then right atrium, it then moves into the pulmonary artery, once it is in the pulmonary artery it is referred to as a pulmonary embolism. This clot may block blood supply to area of lungs, a PE can be fatal.

What are some clinical presentations of a DVT?

Virchow’s triad, unilateral leg pain, redness, ropiness, tenderness, warmth over the vein, calk may be swollen.

What is the clinical presentations of a pulmonary embolism?

Can be silent, dyspnea, chest pain, tachycardia, hypotension, hemoptysis.

How can a DVT be diagnosed?

Can not be diagnosed by symptoms alone, not ideal to preform imaging studies in all patients with suspected DVT. Methods include duplex ultrasonography (ultrasound plus Doppler blood flow), impedance plethysmography (measures blood volume of extremity), CT venography and MRI, D-dimmer (measure fibrin clot degradation, used to rule out if DVT has not occurred levels remain elevated in DVT and PE for about 7 days), Well’s criteria (clinical signs of DVT, scale of 0-3)

What rules out a DVT?

A negative D-dimer and Well’s score less than 2 rules out DVT

What makes a positive DVT?

Positive D-dimer and Well’s score greater than 2, use duplex ultrasonography to confirm

What is the best test to diagnose a PE?

High-resolution multidector computed tomographic angiography (MDCTA)

What is a V-Q scan?

A ventilation-perfusion scan, used to diagnose a PE

What are some preventative strategies for avoid a DVT?

Sequential venous compression devices, anti-embolism stockings, elevation of extremities where possible

What are some anticoagulant treatments for DVT?

Prophylactic treatment, prolong clotting time, Factos Xa inhibitors, direct thrombin inhibitors, low molecular weight heparin, unfractionated heparin, warfarin

What are varicose veins?

Also called a varicosity, an abnormally dilated superficial vein, more likely to happen in superficial veins

What causes varicose veins?

High pressure within the superficial veins that weaken veins, pressure increased by prolonged standing or sitting, pregnancy, or obesity. Chance increased with age. More common in women.

What is the treatment for varicose veins?

Removal of superficial veins, surgery, endovenous ablation, sclerotherapy ablation (inject sclerosing substance in vein), elastic, supportive stockings.