Venous Drainage Of Lower Limb

Former pub landladyVal Clark admits she was blissfully ignorant of the dangers of deep vein thrombosis (DVT) when she set out with friends for a holiday in the US. But cramped conditions on the return flight led to blood clots, a lengthy spell in hospital and eventually the loss of her leg.

• Six weeks later she was released from hospital, but her legs became worse and just before Christmas 1995 she was brought back in to have her leg amputated."Even though they had taken all the clots away my legs were swollen and I needed to have the leg amputated."

Vital signs• Just two days after her US flight Mrs Clark started to suffer serious problems. • Her feet were swollen and sore, but because Mrs Clark had never heard of DVT she missed the vital signs.• She then started suffering from excruciating pains and needed to be rushed to hospital."I could not walk, my legs were numb and I was in pain. "I was rushed to hospital and needed to be resuscitated twice."

Veins of Lower Limb

Superficial Deep Perforators

Greater Saphenous

Vein

Small Saphenous

Vein

Femoral Vein

Profunda Femoris

Vein

Popliteal Vein

Peroneal Vein

Anterior &

Posterior Tibial Vein

SAPHENOUS VEINS

Great saphenous vein originates from the medial side of the dorsal venous arch, and then ascends up the medial side of the leg, knee, and thigh to connect with the femoral vein just inferior to the inguinal ligament

Small saphenous vein originates from the lateral side of the dorsal venous arch, ascends up the posterior surface of the leg, and then penetrates deep fascia to join the popliteal vein posterior to the knee; proximal to the knee, the popliteal vein becomes the femoral vein.

DEEP VEINS

Venous drainage of foot

Venous drainage of foot

Plantar digital veins connect with dorsal digital veins to form 4 plantar metatarsal veins which run proximally in the intermetatarsal spaces and connect via perforating veins ,dorsal veins.

A plantar venous arch is formed from which medial and later plantar veins are formed.

The dorsal digital veins receive rami from plantar digital vein and then form 4 dorsal metatarsal veins which unite to form dorsal venous arch

PERFORATORS

MUSCULO-VENOUS PUMPContractions of large muscles within closed facial compartments compress the deeply placed veins and force blood up the limbThe superficial veins are not subjectedto these high pressure compression forces.Valves in perforators prevent high pressure venous blood from being forced outward into low pressure superficial veins.As the muscles within the closed facial

compartments relax, venous blood is sucked from superficial into deep veins

VENOWAVE

Venowave Innovation As a medical device, the Venowave has been scientifically proven to alleviate the symptoms of post-thrombotic syndrome (PTS) / post-phlebitic syndrome (PPS) or chronic venous insufficiency (CVI), allowing patients to resume activities of daily living.

Venowave sits on the back of the calf and mimics the body’s vein system by forcing the blood from the affected leg. 

Pumping action reduces swelling, pain, heaviness and other symptoms of PTS/PPS.

Unique, lightweight (350g )No wires, tubes or sleeves and the device can be worn all day long.

Varicose veins• Normal flow of blood in the venous system depends upon the presence of competent valves, which prevent reflux.• Venous return is supplemented with contraction of the muscles in the lower limb, which pump the blood toward the heart. When venous valves become incompetent they tend to place extra pressure on more distal valves, which may also become incompetent.• This condition produces dilated tortuous superficial veins (varicose veins) in the distribution of the great (long) and small (short) saphenous venous systems.Some individuals have a genetic predisposition to developing varicose veins.

TREATMENT Surgical stripping

Endovenous Thermal Ablation (closure)

Sclerotherapy

VNUS Closure (Also known as endovenous radiofrequency ablation)

Surgical Stripping

HEAT ABLATION

GRADUATED COMPRESSION HOSIERY

Endovenous Radio Frequency Ablation Endovenous radio frequency ablation (Closure

procedure) is a minimally invasive.In-office treatment alternative to surgical stripping of

the great saphenous vein. The skin on the inside of the knee is anesthetized and a radiofrequency catheter is inserted into the damaged vein through a needle stick in the skin. The catheter delivers Radiofrequency energy to the vein wall causing it to heat. As the vein warms, it

collapses and seals shut.

A condition in which a blood clot forms in one or more of the deep veins of the body, usually the legs.

Can develop if one is sitting still for a long time, such as when travelling by plane or if one has a medical condition affecting the normal clotting of blood.

Serious condition because blood clot that formed in the vein can travel through the blood stream and lodge in the lungs, blocking blood flow ( pulmonary embolism)

DEEP VEIN THROMBOSIS

VIRCHOW’S TRIADMore than 100 years ago, Virchow described a

triad of factors of venous stasis : prolonged bed rest, limb paralysis ,cast on the leg.endothelial damage and hypercoagulable state: surgery, trauma, pregnancy.

Factors Causing DVT

Presentation and Physical Examination

Calf pain or tenderness, or both Swelling with pitting oedema Swelling below knee in distal deep vein thrombosis and up to groin in proximal deep vein thrombosis Increased skin temperature Superficial venous dilatation Cyanosis can occur with severe

obstruction

Not always possible to detect it because there may be no clinical signs. Calf muscle tenderness, postoperative pyrexia, and limb swelling can be helpful clues

Diagnosis- Duplex Doppler sonography Ascending venography.

• If DVT is confirmed, intravenous and oral anticoagulation are started to prevent extension of the thrombus.

• Patients undergoing surgery are likely to develop DVT, so most surgical patients are given specific prophylactic treatment which includes anticoagulant injections and graduated stockings (to prevent deep venous stasis and facilitate emptying of the deep veins).

Presentation and Diagnosis

COLOR DUPLEX SCAN OF DVT

Ascending Venogram shows DVT

DIAGNOSISBLOOD TEST: almost everyone

with a blood clot has elevated blood level of naturally occurring clot dissolving substance called D dimer. Not a conclusive test

ULTRASOUND: CT SCAN

TreatmentInferior vena cava Filter : It maybe

inserted into the vena cava to prevent pulmonary embolism

Thrombolysis: drugs or tPAAnticoagulants : heparin or warfarin.Blood thinners: Eliquis (was found to be safer than any other blood thinner)

Graduated Compression stockings

Great Saphenous Vein Cut DownUsually performed at the ankle. Thus, it

would be called Ankle Vein Cut Down.The saphenous nerve branches are

blocked with anaesthesia.The great saphenous vein can also be

entered through the groin – Groin Vein Cut Down

The branches of Ilioinguinal nerve and intermediate cutaneous nerve of the thigh

Great Saphenous Vein in Coronary Bypass Surgery

In patients with occlusive coronary disease caused by atherosclerosis, the diseased arterial segment can be bypasses by inserting a graft consisting of a portion of Great saphenous vein.Vein segment is reversed to prevent

obstruction by valves

Trendelenburg’s Test