Interactive Learning Session

Transcription

1 Chronic Venous Disease - Part I Interactive Learning Session 2011 Ali Sabbour Prof of Vascular Surgery

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3 Intended Learning Outcomes {Part I } By the end of this learning session, students should be able to: Describe applied anatomy of LL veins Explain the pathophysiology underlying chronic venous disease (CVD) Describe the symptoms & signs of CVD Correlate symptoms & signs with pathophysiology 3

4 Chronic venous insufficiency (CVI) is because a major health care problem. It produces painful, swollen and sometimes ulcerated legs It can result in severe incapacitating symptoms causing disability, absence of work and hospitalization.

5 ILO 1 Describe applied anatomy of LL veins 5

6 Student s Work Which of the following is the superficial femoral vein a. b. c. a b c 6

7 The saphenofemoral junction lies: a. Below & lat. to the pubic tubercle b. Below & medial to the pubic tubercle c. Above & lateral to the pubic tubercle d. Above & medial to the pubic tubercle 7 Fem. V. G. Saph. V.

8 Surgical Anatomy of the Lower Limb Veins Anatomically, LL veins can be divided into two systems I. Superficial Veins (in the subcutaneous tissue) II.Deep Veins (deep to the deep fascia, accompany major arteries) Communicating Veins (communicate the two systems & perforate the fascia)

9 Superficial Veins 1.Long & short saphenous veins and their tributaries. 2.Run in the subcutaneous tissue superficial to the muscle fascia. 3.They have their own, well- developed muscle coat.

10 Deep Veins 1.Accompany axial arteries. 2.Run within the muscles deep to the muscle fascia.

11 Comunicating Veins Perforators Perforate the fascia connecting the superficial & deep veins at certain points.

12 All lower limb veins have valves to direct venous return in one direction only From below upwards and from superficial to deep

13 ILO 2 Explain the pathophysiology underlying chronic venous disease (CVD) 13

14 Veins drain the lower limbs Veins function optimally when they are patent & competent 14 Ali Sabbour - Chronic Venous Disease

15 Normal Venous Dynamics Superficial vein Perforator Resting upright position During muscle contraction With muscle relaxation

16 Definition The ankle venous pressure during walking is called the ambulatory venous pressure

17 For effective LL drainage, we should have: Patent veins Competent valves Good LL muscles That is what we call: 17 Competent Veno-muscular Pump Pumps blood towards the heart, lowering the ambulatory venous pressure

18 Venous flow dynamics in 1ry varicose veins Standing Muscle contraction Muscle relaxation Sluggish flow in normal direction Deep veins empty upwards Venous reflux into saph. vein

19 Student s Work Complete the missing words Veins may fail to perform their drainage function because of two main underlying pathologies These two pathologies can affect: The cause (or the etiology) may be:

20 Veins fail to perform their drainage function because of two main underlying pathologies Venous reflux Venous obstruction The cause (or the aetiology) may be: Primary Secondary Congenital These two pathologies can affect: Superficial veins Deep veins Perforators 20

21 When the venous pump fails to drain the LL effectively Venous congestion will gradually develop The effect of venous congestion on the MICROCIRCULATION will give all the symptoms & signs of CVD Depending on the duration & severity of CVI: A variety of clinical presentations from mild discomfort to venous ulcers All of which can be addressed under the main title of 21 CVD

22 ILO 3 Describe the symptoms & signs of CVD ILO 4 22 Correlate symptoms & signs with pathophysiology

23 Clinical presentation of CVD Depends on the severity & duration of CVI Early Late Postural discomfort, relieved by leg elevation 23 Mild oedema Night cramps Ankle pigmentation Itching & eczema Venous ulcer Lipodermatosclerosis Ali Sabbour - Chronic Venous Disease

24 Clinical presentation of CVD Early Explanation Postural discomfort, relieved by leg elevation 24 Mild oedema Night cramps This effect on the microcirculation is reversible

25 Clinical presentation of CVD Late Explanation Ankle pigmentation Itching & eczema Venous ulcer Lipodermatosclerosis 25

26 Brown pigmentation Venous eczema

27 Venous Ulcer

28 Lipodermatosclerosis Venous Ulcer

29 Some types of CVD have a spot diagnosis Congenital CVD Klippel Trenaunay Syndrome 29

30 Some types of CVD have a spot diagnosis Secondary varicose veins due to IVC obstruction 30

31 Student s Work 31 Clinical assessment of CVD A 32 year old multipara presented C/O dilated disfiguring Lt. lower limb veins that developed with her 1 st pregnancy and have been progressively increasing in size with her following pregnancies. What are the important points in the history that will help to reach a sound provisional diagnose? Explain the importance of each point you are asking about.

32 Conclusion CVD is a clinical term describing failure of L.L. veins to drain limbs properly resulting in chronic venous congestion This may result from incompetence of venous valves (causing venous reflux into the superficial or deep veins), or residual venous obstruction following incomplete recanalization of deep venous thrombosis Severity of symptoms depends on the severity & duration of chronic venous congestion