Venous mx 16-17
Simple spider veins to complex dermal sclerosis and ulcer formations. Venous Disease (CVI) Simple spider veins to complex dermal sclerosis and ulcer formations.
Venous Anatomy
Obstruction Reflux and/or incompetence Venous Pathology Obstruction Reflux and/or incompetence
Venous Obstruction As a result of DVT or superficial phlebitis As a result of extrinsic compression 1. Tumors 2. Vascular compression (May-Thurner syndrome)
Venous Reflux Spider Veins Varicose Veins
Venous Statis w/wo Ulcer Venous Reflux Edema Venous Statis w/wo Ulcer
Venous History of Patient Pain Edema Ulcers
Physical Exam of Patient Supine and Standing Objective findings of spider or varicose veins Skin changes (hypopigmentation to atrophic blanch and atherosclerosis) Edema (typically pitting) Ulcer formation Pulses
Interventional Therapy Sclerotherapy Endovenous Ablation Surgical
Sclerotherapy
Endovenous Ablation
Treatment 1. Leg elevation – above heart level 30 min. 2. Compression therapy - compression stockings , pneumatic compression device 3. Exercises – With leg elevation Ankle mvts. external rotation of hips, Hip adduction, Repeated walking movement
Self care Avoid static posture for more than hour Avoid constructing clothing around calves Avoid high heels Watch you weight Exercise Avoid crossing your legs while sitting
Similarities and Differences Arterial symptoms produced by exercise and relieved by resting even standing Venous symptoms worsened by standing and improved by exercise and leg elevation
Treatment Differences In the arterial system, treatment is aimed at opening and restoring blood flow In the venous system, treatment is aimed at obstructing and eliminating dysfunctional blood vessels
ANATOMY & PHYSIOLOGY LYMPHATIC FLUID COLLECTS & RETURNS TO VENOUS CIRCULATION BY EMPTYING INTO SUBCLAVIAN VEINS WHEN INTERSTITIAL FLUID PRESSURE INCREASES LYMPHATIC FLOW INCREASES WHEN DRAINAGE IS IMPAIRED EDEMA ENSUES (FLUID COLLECTS)
INTERVENTIONS Elevation and immobilization of the extremity Elastic stockings Na restriction Antibiotics/antifungals for infection Diuretics Analgesics