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Page 1: 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

DVT & VARICOSE

VEINS

Page 2: 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
Page 3: 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
Page 4: 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

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.

Page 5: 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

ETIOLOGY

Venous stasis

Vessel wall injury

Hypercoagulability

Page 6: 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

RISK FACTORS• Older age• Major surgery and orthopedic

surgery• Cancers• Immobilization• Pregnancy and the postpartum

period

Page 7: 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

Cont…

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

Central venous catheters• Obesity• Infection

Page 8: 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
Page 9: 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

PATTERNS OF DEEP VEIN THROMBOSIS

Popliteal thrombosis

Femoral thrombosis

Iliac thrombosis

Page 10: 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

PATHOPHYSIOLOGY

Clot formation

Clot can enlarged and extend

Venous valves are damaged(Inflammatory response)

Postphlebitic syndrome

Page 11: 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

Cont…

Muscle spasm and changes in intravascular pressure

Developing thrombus to dislodge & moves towards heart and lungs

Obstruct perfusion to the lung segments

Page 12: 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

Cont…

Pulmonary arteries partially or totally obstructed by embolus

Circulation of the lung segment affected

Lung may undergo severe infarction with massive tissue destruction

Page 13: 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

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

popliteal regions• Swelling• Calf vein thrombosis

Page 14: 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

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

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

Page 15: 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

Cont…• Local warmth

• Mild fever

• Possible venous cord in the

popliteal area

Page 16: 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

DIAGNOSTIC EVALUATION

History collection

Physical examination

Color flow duplex ultrasound

imaging

D- Dimer test

Page 17: 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

Cont….

Venography

CT venography

MR venography

Page 18: 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
Page 19: 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

Treatment

Goals

To prevent propagation of the clot

Prevent the development of new

thrombi

Prevent pulmonary emboli

Limit venous valvular damage

Page 20: 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

Cont…

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

Page 21: 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

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

Page 22: 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

Cont….

LMWH

Dosage – 250U/ kg every 12 hours.

Eg; enoxaparin, dalteparin.

Warfarin

Dose of 5 mg per day

Page 23: 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

Cont…

Thrombolytic therapy

Eg;streptokinase, urokinase,

recombinant tissue

plasminogen(reteplase, alteplase)

Page 24: 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

Surgical management

Thrombectomy- transvenous

filtration device

• Greenfield filter

• Bird’s nest filter

Guidelines for safe practice

Page 25: 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

Green field filter

Page 26: 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

Bird’s nest filter

Page 27: 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
Page 28: 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

Varicose veins

These are swollen,twisted

and sometimes painful veins that

have filled with an abnormal

collection of blood.

Page 29: 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
Page 30: 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

Causes

Hereditary

Thrombophelebitis

Risk factors

Prolonged standing

Obesity & distended belly

Pregnancy

Page 31: 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

Cont…

Straining-chronic constipation,

urinary retention, chronic cough.

Prior surgery

age

Page 32: 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

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

Page 33: 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

Cont…Activity causes intermittent compression of the veins by

muscles

Pressure increases in the vein valves

Incompetent valves

Valve failure

Page 34: 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

Cont….

Veins become swollon and enlarged

Become hard & tortuous

Feeling of heaviness & pressure

Page 35: 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

Clinical manifestations

Aching ,heavy legsAppearance of spider veinsAnkle swellingBrownish blue shiny skin

discolourationRedness, dryness, itching of the

affected area

Page 36: 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

Cont…

Cramps while standing

Bleeding during minor injuries

Hard swollon area

Whitened irregular scar like

patches in the ankles.

Page 37: 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

Diagnostic evaluation

History collection

Physical examination

Tourniquet test

Doppler ultrasound

MRI

Page 38: 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

TREATMENT

Conservative

Elevation of legs

Regular exercises

Compression stockings

Anti inflammatory medications

Page 39: 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

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.

Page 40: 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

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.

Page 41: 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
Page 42: 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

Laser therapy

Page 43: 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

Ablation therapy

Page 44: 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

Non surgical

Sclerotherapy - Injecting the chemical

inside the vein .

Sclerosant agent-polidocanal,

sclerodex.

Lasers – it is used in case of small

veins with vacosity.

Page 45: 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

Sclerotherapy

Page 46: 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
Page 47: 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

Complications

Varicose ulsers

Severe bleeding

Acute necrosis

Page 48: 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

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