DVT &
VARICOSE VEINS
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.
ETIOLOGY
Venous stasis
Vessel wall injury
Hypercoagulability
RISK FACTORS
• Older age
• Major surgery and orthopedic
surgery
• Cancers
• Immobilization
• Pregnancy and the postpartum
period
Cont…
•
•
•
•
Trauma and minor leg injury
Previous VTE
Oral contraceptives
Hormonal replacement therapy
Central venous catheters
• Obesity
• Infection
PATTERNS OF DEEP VEIN
THROMBOSIS
Popliteal thrombosis
Femoral thrombosis
Iliac thrombosis
PATHOPHYSIOLOGY
Clot formation
Clot can enlarged and extend
Venous valves are
damaged(Inflammatory response)
Postphlebitic syndrome
Cont…
Muscle spasm and changes in
intravascular pressure
Developing thrombus to dislodge &
moves towards heart and lungs
Obstruct perfusion to the lung
segments
Cont…
Pulmonary arteries partially or totally
obstructed by embolus
Circulation of the lung segment
affected
Lung may undergo severe infarction
with massive tissue destruction
Clinical manifestations
Calf thrombosis
• Calf tenderness
• Distal swelling
Femoral thrombosis
• Tenderness & pain in distal thigh &
popliteal regions
• Swelling
• Calf vein thrombosis
Cont…
Iliofemoral thrombosis
• Massive swelling
• Tenderness & pain in entire
extremity
Upper extremity thrombosis
• Swelling of affected extremity
• Dilated superficial veins
• Tenderness & pain
• Impaired mobility
• Local warmth
Cont…
• Mild fever
• Possible venous cord in the
popliteal area
DIAGNOSTIC EVALUATION
History collection
Physical examination
Color flow duplex ultrasound
imaging
D- Dimer test
Cont….
Venography
CT venography
MR venography
Treatment
Goals
To prevent propagation of the clot
Prevent the development of new
thrombi
Prevent pulmonary emboli
Limit venous valvular damage
Cont…
Bed rest
Leg elevation
Compression stockings
Pharmacological measures
– Heparin
– Warfarin
– Thrombolytic therapy
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
Cont….
LMWH
Dosage – 250U/ kg every 12 hours.
Eg; enoxaparin, dalteparin.
Warfarin
Dose of 5 mg per day
Cont…
Thrombolytic therapy
Eg;streptokinase, urokinase,
recombinant tissue
plasminogen(reteplase, alteplase)
Surgical management
Thrombectomy- transvenous
filtration device
• Greenfield filter
• Bird’s nest filter
Guidelines for safe practice
Green field filter
Bird’s nest filter
Varicose veins
These are swollen,twisted
and sometimes painful veins that
have filled with an abnormal
collection of blood.
Causes
Hereditary
Thrombophelebitis
Risk factors
Prolonged standing
Obesity & distended belly
Pregnancy
Cont…
Straining-chronic constipation,
urinary retention, chronic cough.
Prior surgery
age
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
Cont…
Activity causes intermittent
compression of the veins by
muscles
Pressure increases in the vein valves
Incompetent valves
Valve failure
Cont….
Veins become swollon and enlarged
Become hard & tortuous
Feeling of heaviness & pressure
Clinical manifestations
Aching ,heavy legs
Appearance of spider veins
Ankle swelling
Brownish blue shiny skin
discolouration
Redness, dryness, itching of the
affected area
Cont…
Cramps while standing
Bleeding during minor injuries
Hard swollon area
Whitened irregular scar like
patches in the ankles.
Diagnostic evaluation
History collection
Physical examination
Tourniquet test
Doppler ultrasound
MRI
TREATMENT
Conservative
Elevation of legs
Regular exercises
Compression stockings
Anti inflammatory medications
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.
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.
Laser therapy
Ablation therapy
Non surgical
Sclerotherapy - Injecting the chemical
inside the vein .
Sclerosant agent-polidocanal,
sclerodex.
Lasers – it is used in case of small
veins with vacosity.
Sclerotherapy
Complications
 Varicose ulsers
 Severe bleeding
 Acute necrosis