1. DVT & VARICOSE VEINS

4. DVT
It is the most common venous disorders result from incompetent valves in the veins and obstruction of venous return to the heart, usually as a result of thrombus.

5. ETIOLOGY
Venous stasis
Vessel wall injury
Hypercoagulability

6. RISK FACTORS Older age Major surgery and orthopedic surgery Cancers
Immobilization
Pregnancy and the postpartum period

7. Cont… Trauma and minor leg injury Previous VTE Oral contraceptives
Hormonal replacement therapy Central venous catheters
Obesity
Infection

9. PATTERNS OF DEEP VEIN THROMBOSIS
Popliteal thrombosis
Femoral thrombosis
Iliac thrombosis

10. PATHOPHYSIOLOGY
Clot formation Clot can enlarged and extend Venous valves are damaged(Inflammatory response) Postphlebitic syndrome

11. Cont…
Muscle spasm and changes in intravascular pressure Developing thrombus to dislodge & moves towards heart and lungs Obstruct perfusion to the lung segments

12. Cont…
Pulmonary arteries partially or totally obstructed by embolus Circulation of the lung segment affected Lung may undergo severe infarction with massive tissue destruction

13. Clinical manifestations
Calf thrombosis
Calf tenderness
Distal swelling
Femoral thrombosis
Tenderness & pain in distal thigh & popliteal regions
Swelling
Calf vein thrombosis

14. Cont… Iliofemoral thrombosis Massive swelling
Tenderness & pain in entire extremity
Upper extremity thrombosis
Swelling of affected extremity
Dilated superficial veins
Tenderness & pain
Impaired mobility

15. Cont… Local warmth Mild fever
Possible venous cord in the popliteal area

16. DIAGNOSTIC EVALUATION
History collection
Physical examination
Color flow duplex ultrasound imaging
D- Dimer test

17. Cont….
Venography
CT venography
MR venography

19. Treatment Goals To prevent propagation of the clot
Prevent the development of new thrombi
Prevent pulmonary emboli
Limit venous valvular damage

20. Cont… Bed rest Leg elevation Compression stockings
Pharmacological measures
Heparin
Warfarin
Thrombolytic therapy

21. Cont… Unfractionated heparin Initial-5000U OR 80U/kg - IV
Followed by maintain the APTT between 1.5 & 2.5 times the control.
It given as 5 to 7 days

22. Cont….
LMWH Dosage – 250U/ kg every 12 hours. Eg; enoxaparin, dalteparin. Warfarin Dose of 5 mg per day

23. Cont…
Thrombolytic therapy Eg;streptokinase, urokinase, recombinant tissue plasminogen(reteplase, alteplase)

24. Surgical management Thrombectomy- transvenous filtration device
Greenfield filter
Bird’s nest filter
Guidelines for safe practice

25. Green field filter

26. Bird’s nest filter

28. Varicose veins
These are swollen,twisted and sometimes painful veins that have filled with an abnormal collection of blood.

30. Causes Hereditary Thrombophelebitis Risk factors Prolonged standing
Obesity & distended belly
Pregnancy

31. Cont…
Straining-chronic constipation, urinary retention, chronic cough.
Prior surgery
age

32. Pathophysiology
Generally blood flow from the superficial veins to the deep veins To the large veins to the heart Venous blood flow work against gravity This is assisted by unidirectional intraluminal valves in the veins

33. Cont…
Activity causes intermittent compression of the veins by muscles Pressure increases in the vein valves Incompetent valves Valve failure

34. Cont….
Veins become swollon and enlarged Become hard & tortuous Feeling of heaviness & pressure

35. Clinical manifestations
Aching ,heavy legs
Appearance of spider veins
Ankle swelling
Brownish blue shiny skin discolouration
Redness, dryness, itching of the affected area

36. Cont… Cramps while standing Bleeding during minor injuries
Hard swollon area
Whitened irregular scar like patches in the ankles.

37. Diagnostic evaluation
History collection
Physical examination
Tourniquet test
Doppler ultrasound
MRI

38. TREATMENT Conservative Elevation of legs Regular exercises
Compression stockings
Anti inflammatory medications

39. Cont….
Active Stripping - Removal of all or part of the saphenous vein . Endovascular laser surgery – uses a laser to destroy the veins. Radiofrequency ablation – heat to destroy the affected veins.

40. Cont…
Ligation – it is usually involved in an incision at the groin .here they tied saphenous vein to the femoral vein just at the entrance of the incision.

42. Laser therapy

43. Ablation therapy

44. Non surgical
Sclerotherapy - Injecting the chemical inside the vein . Sclerosant agent-polidocanal, sclerodex. Lasers – it is used in case of small veins with vacosity.

45. Sclerotherapy

47. Complications
Varicose ulsers
Severe bleeding
Acute necrosis