Venous Insufficiency and Current Treatments

1. Spontaneity

2. Phasicity

3. Augmentation

4. Competency

picking up venous flow without help from maneuvers.

veins should have spontaneity

may or may not and still be normal

venous flow varying with respiration

1. Continuous flow

2. Pulsatility

An proximal obstruction

1.) proximal obstruction

2.) tumors

3.) 3rd trimester of pregnancy

Can roll patient onto side so continuous flow would stop. Baby may just looks like proximal compression.

response to cardiac cycle

NO

• 1.) CHF (Rt. sided heart failure)
• 2.) Lt. sided heart failure

1.) CHF

2.) Drinking copious amount of water

3.) Receiving a large amount of IV fluids or blood transfusion.

increase in venous flow due to maneuver

should stop.

If not its reflux

1.) valve malfunction

2.) venous occlusion

1.) Fluid accumulation= edema

2.)Hemosiderin = hyperpigmentation =         brownish color

3.) Venous ulcer

• 1.) not much pain
• 2.) red (rubor) in color
• 3.) tissue granulated
• 4.) wet and juicy
• 5.) like wet sandy texture

• 1.) Vein stripping
• 2.) Sclerotherapy
• 3.) New valves
• 4.) Compression stockings
• 5.) Una boot and medication
• 6.) RFA ablation
• 7.) ELVS ablation

inject saline solution into the reticular (spider) veins

Clotting occurs

Wrap in bandage and put compression stockings on.

Una boot and medication

Radiofrequency Ablation

Endovascular Lazer Venous System

• 1.) Check for reflux on a tilt table.
• 2.) Check for DVT
• 3.) Find out how bad the reflux is = severity
• 4.) Measure vein size (diameter)
• 5.) Map the vein and any tributaries or perforators coming from the vein
• 6.) May need to find most optimal access point to enter the vein
• 7.) Note any aneurysmal areas or largest diameter size that is not throughout

Tributary

Perforator

need to know the size of catheter to be used.

Check on patient. Patient can pass out.

Blood pooling in legs and repeatively doing valsalva stops blood flow from returning to hear.

Have patient take deep breaths and more feet/toes to help return blood.

Posterior thigh circumflex vein

Giacomini vein

Posterior tibial perforators

B/C in gaitor zone and increase in hydrostatic pressure.

connect superficial veins to deep veins

1.) make sure there is still flow within the superficial epigastric vein.

2.) check for DVT

3.) check if ablation was successful

Normal = < 0.5 seconds

Mild to Moderate = 0.5 to 1 second

Moderate = 1 to 2 seconds

Severe = > 2 seconds

• PPG testing
• Place PPG sensor above the medial malleolus 10 cm. Empty calf by heal toe raises.
• Never over varicosities
• Normal = >= 20 secs.
• Abnormal = < 20 seconds = valves not competent.

Compress of the superficial system by inflating a cuff 20 mmHg or use an tourniquet.

Klippel-Trenaunay

• 1.) congential
• 2.) can be totally absent or hypoplastic (they are there but non-functioning, underdeveloped.)
• 3.) Usually affects one limb
• 4.) May have birth marks- port wine stain

Sturge-Weber

Arterial/ Venous malformations in cerebral vessels like an A-V fistulas.

Kasabach-Merritt

Yes

• 1.) White leg (milk leg)
• 2.) painful
• 3.) swollen

Alba dolens

Arterial spasms that occur secondary to extensive acute iliofemoral vein thrombosis.

So clot pushes on arteries and causes them to spasm

Blood can't get out because DVT occlusion

and

Blood can't get in because clots pushing on arteries.

1.) Bluish in color

2.) Painful

3.) Swollen

Cerulea dolens

The arterial circulation is being compromised.

Usually caused by an acute iliofemoral vein thrombosis.

Roleau Formation

Evaluate for DVT or congential abnormalitites or chronic venous obstruction

Inject contrast into dorsal vein in the foot.

Incompetency in venous valves

• 1.) Expensive
• 2.) Invasive
• 3.) Allergic RXN possible
• 4.) Not good on kidneys

Vena Cava filters

1.) Heparin

2.) Lovenox

3.) Coumadin

when the clot is above the knee

Increase in flow with expiration.

Decrease in flow with inhalation.

Increase in flow with inspiration.

Decrease in flow with expiration.