Mr. Adeel Abbas

AnatomySuperficial Venous System.

Deep Venous System.

Perforating Venous System.

Deep Venous System

Venous InsufficiencyCongenital.

Primary/Familial.

Secondary.

Varicose VeinsAbnormally Dilated, Tortuous, Prominent veins.

Common in Female Adults.

Duplex Ultrasound is Investigation of Choice.

Treatment help relieve symptoms, prevent or manage complications & improve cosmetic appearance.

Treatment Conservative & Surgical.

Deep Venous Thrombosis

DEEP VENOUS THROMBOSISBlood in the Deep Veins Clots.Affects Deep Veins of Legs & Pelvis.Can Occur in Upper Limbs.Major Cause of Morbidity & Mortality in

Hospitalized Patients.Embolization of Thrombus Results Pulmonary

Embolus.Local Venous Damage Leads to Chronic

Venous Insufficiency/Post-Phlebitic Syndrome.

Risk Factors;

Age > 65.Malignancy.Increased BMI.Pregnancy.Prolonged Immobilization.Tobacco Use,Prior DVT.

Virchow‘s Triad

Venous Stasis:

Site of Initiation Soleal Sinuses.

Endothelial Cellular Layer Contacting Activated Platelates & Procoagulants(Tissue Factors) DVT.

Venous Stasis occurs in;

Immobility.Long Operation.Obesity.Heart Failure.Trauma.

Hyper-Coagulable State:

Protien C & S Deficiency.Factor V Mutation.Prothrombin Gene Mutation.AntiThrombin III Deficiency.AntiPhospholipid Syndrome.Homocysteinemia.Lupus Antibody.Anticardiolipin Antibody.

Hypercoagulable State occurs in;Polycythaemia.Thrombocythaemia.Leukemia.Sepsis.Major Trauma.Diabetes.Pregnancy.Smoking.Malignancy.

Venous Injury:

Venous Thrombosis Occurs at Distant Site From Operation.

Microtears Develop within Valve Cusps Exposure of Subendothelial Matrix.

Mechanism NOT KNOWN.

Venous Injury occurs in;

Trauma.I/v Cannula.Inflammation.Infection.

DiagnosisUnder-Diagnosed Threat.

Asymptomatic (50%).Calf Tenderness/Ache.Pedal Edema.Mild Pyrexia/Red.

Varicose Veins.Venous Ulceration.

Diagnosis (cont)

Homan’s Sign

InvestigationsD-Dimer (Byproduct of Fibrinolysis);

95% Sensitive.Duplex Ultrasound;

Gold Standard.Excellent for Femoral/Popliteal DVT.

MRI Accurate for Calf & Iliac DVT.

Venography / Phlethysmography.CT Venography IF Ilio-Femoral DVT.

Management

Prophylaxis Against DVT.

Definitive Treatment.

Prophylaxis Against DVT;Mechanical Compression:

TED Stockings. Intermittent Pneumatic Compression Devices.

Prophylaxis Against DVT; (cont)

Pharmacological: LMWH. Unfractioned Heparin. Warfarin.

Definitive Treatment;AntiCoagulation:

For 12 weeks. Start with LMWH. Maintain with Warfarin Pregnancy??

TED Stockings: For 2 years.

Thrombolysis: for Ilio-Femoral DVT.

Outcome of DVT:Resolution.

Recurrent DVT.

P.E.

Chronic Venous Insufficiency.

Pulmonary Embolism Features;

Dyspnoea ± Pleuritic Chest Pain.Tachycardia & Tachypnoea.Cough ± Haemoptysis / Fever.

Massive P.E Circulatory Colapse.

Investigation for Pulmonary Embolism;Pulmonary Angiography Gold Standard.CTA or V/Q Scanning Diagnostic.

ECG.D-dimer.CXR.ABGs (HyperVent).

Treatment for Pulmonary Embolism;Emergency Treatment:

O2 Therapy. Fibrinolysis. Heparin. Pulmonary Embolectomy.

Later Management: Anticoagulation for 6 months. TED Stockings. IVC Filters.

SEQ71 yrs old female comes with H/o sore

ulcerated area above her medial ankle in her left leg, local eczema, and discomfort. Maintaining regular exercise. She has past H/o DVT in her right leg following long flight 10 yrs ago. She is not on any medication.

What is the Diangnosis?Define Virchow’s Triad?What treatment option are available?

Tricky Q & AWhere does DVT originate?Is DVT more common in the Right or Left

Iliac Vein?On Which Day Post-Operatively DVT/PE

causes Fever?

What is the usual source of a Pulmonary Embolus?

Whats Saddle Embolus?

Thank You…!