DVT & VARICOSE VEINS. DVT It is the most common venous disorders result from incompetent valves...

DVT & VARICOSE

VEINS

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.

ETIOLOGY

Venous stasis

Vessel wall injury

Hypercoagulability

RISK FACTORS• Older age• Major surgery and orthopedic

surgery• Cancers• Immobilization• Pregnancy and the postpartum

period

Cont…

• Trauma and minor leg injury• Previous VTE• Oral contraceptives• Hormonal replacement therapy

Central venous catheters• Obesity• Infection

PATTERNS OF DEEP VEIN THROMBOSIS

Popliteal thrombosis

Femoral thrombosis

Iliac thrombosis

PATHOPHYSIOLOGY

Clot formation

Clot can enlarged and extend

Venous valves are damaged(Inflammatory response)

Postphlebitic syndrome

Cont…

Muscle spasm and changes in intravascular pressure

Developing thrombus to dislodge & moves towards heart and lungs

Obstruct perfusion to the lung segments

Cont…

Pulmonary arteries partially or totally obstructed by embolus

Circulation of the lung segment affected

Lung may undergo severe infarction with massive tissue destruction

Clinical manifestationsCalf thrombosis • Calf tenderness• Distal swellingFemoral thrombosis• Tenderness & pain in distal thigh &

popliteal regions• Swelling• Calf vein thrombosis

Cont…Iliofemoral thrombosis• Massive swelling• Tenderness & pain in entire

extremityUpper extremity thrombosis• Swelling of affected extremity• Dilated superficial veins• Tenderness & pain• Impaired mobility

Cont…• Local warmth

• Mild fever

• Possible venous cord in the

popliteal area

DIAGNOSTIC EVALUATION

History collection

Physical examination

Color flow duplex ultrasound

imaging

D- Dimer test

Cont….

Venography

CT venography

MR venography

Treatment

Goals

To prevent propagation of the clot

Prevent the development of new

thrombi

Prevent pulmonary emboli

Limit venous valvular damage

Cont…

Bed restLeg elevationCompression stockingsPharmacological measures–Heparin–Warfarin– Thrombolytic therapy

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

Cont….

LMWH

Dosage – 250U/ kg every 12 hours.

Eg; enoxaparin, dalteparin.

Warfarin

Dose of 5 mg per day

Cont…

Thrombolytic therapy

Eg;streptokinase, urokinase,

recombinant tissue

plasminogen(reteplase, alteplase)

Surgical management

Thrombectomy- transvenous

filtration device

• Greenfield filter

• Bird’s nest filter

Guidelines for safe practice

Green field filter

Bird’s nest filter

Varicose veins

These are swollen,twisted

and sometimes painful veins that

have filled with an abnormal

collection of blood.

Causes

Hereditary

Thrombophelebitis

Risk factors

Prolonged standing

Obesity & distended belly

Pregnancy

Cont…

Straining-chronic constipation,

urinary retention, chronic cough.

Prior surgery

age

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

Cont…Activity causes intermittent compression of the veins by

muscles

Pressure increases in the vein valves

Incompetent valves

Valve failure

Cont….

Veins become swollon and enlarged

Become hard & tortuous

Feeling of heaviness & pressure

Clinical manifestations

Aching ,heavy legsAppearance of spider veinsAnkle swellingBrownish blue shiny skin

discolourationRedness, dryness, itching of the

affected area

Cont…

Cramps while standing

Bleeding during minor injuries

Hard swollon area

Whitened irregular scar like

patches in the ankles.

Diagnostic evaluation

History collection

Physical examination

Tourniquet test

Doppler ultrasound

MRI

TREATMENT

Conservative

Elevation of legs

Regular exercises

Compression stockings

Anti inflammatory medications

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.

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.

Laser therapy

Ablation therapy

Non surgical

Sclerotherapy - Injecting the chemical

inside the vein .

Sclerosant agent-polidocanal,

sclerodex.

Lasers – it is used in case of small

veins with vacosity.

Sclerotherapy

Complications

Varicose ulsers

Severe bleeding

Acute necrosis