chronic venous insufficiency (1)
TRANSCRIPT
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Also known as
Post phlebetic syndrome
Post thrombotic leg
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CAUSES
Congenital absence of venous valves
Trauma leading to damage to valves
Deep venous thrombosis
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PATHOPHYSIOLOGY
irreversible damage to the valve.
During normal ambulation, calf muscles
decrease venous pressures by
approximately 70% in the lower extremities.
With rest, pressures return to normal inapproximately 30 seconds. In diseased
veins, ambulation decreases venous
pressures by only 20%.
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Ambulatory venous hypertension
Low-flow states within the capillaries cause
leukocyte trapping.
release proteolytic enzymes and oxygen
free radicals, which damage capillarybasement membranes.
Plasma proteins, such as fibrinogen, leak
into the surrounding tissues, forming afibrin cuff.
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Interstitial fibrin and
resultant edema
decrease oxygen delivery
to the tissues, resulting in
local hypoxia.Inflammation and tissue
loss result.
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CLINICAL FEATURES
Leg swelling
Leg discomfort
Varicose veins
Lipodermatosclerosis
Nonhealing ulcers
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IMAGING STUDIES
Doppler bidirectional-flow studies and
Doppler color-flow studies
to assess venous flow, its direction, and
the presence of thrombus.
Venography
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MEDICAL THERAPY
Leg elevation
Compression stockings
Anticoagulation
Phlebotonics no established role
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SURGICAL THERAPY reserved for those with discomfort or ulcers
refractory to medical management.
Chronic venous insufficiency resulting from
superficial vein disorders
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Vein ligation for varicose veins in the
absence of deep venous disease
Clot lysis and thrombectomy
Saphenous vein crossover graft
Vein segment transposition
Valvuloplasty
Vein valve transplantation
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DEFINITION
a chronic non-healing wound on leg or foot
that takes longer than six weeks to heal
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CAUSES OF LEG ULCERS
Venous Causes - 60% 70%
Arterial Causes - 20%
Other Causes
Rheumatoid ulcers
Traumatic
Neuropathic (diabetic)
neoplastic
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VENOUS LEG ULCERS
Blood stasis theory
AV fistula theory
Fibrin cuff theory
THE REASON FOR ALL IS AMBULATORY
VENOUS HYPERTENSION
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CLINICAL FEATURES
Situated in gaiter area
Sloping edge
Base contains granulation tissue
Surrounding lipodermatosclerosis
Varicose veins +
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LIPODERMATOSCLEROSIS
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ALWAYS EXAMINE
For varicosities
Arterial system
Sensation and proprioception
joints
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INVESTIGATE
ROUTINE
Blood CP
ESR
Sickle cell test
Blood glucose
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SPECIAL
Arterial Doppler
Duplex assessment of venous system
venography
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MANAGEMENT
Compression bandaging regimen
Dressings
Biological dressings
Excision and graft
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