Lec 12 - Venous Disease Part 2
Lec 12 - Venous Disease Part 2
Lec 12 - Venous Disease Part 2
AXILLARY-SUBCLAVIAN VENOUS
THROMBOSIS
less than 5% of all cases of deep vein thrombosis.
Only 12% result in pulmonary thromboembolism,
upper ممكن يصير بالDVT ال
limb but less chance
MRV
Magnetic resonance venography (MRV) is an imaging test that is used to visualize
veins in the body
Treatment
remove indwelling central venous lines or pacemaker
wires
Arm elevation,
pain control,
Anticoagulation
Catheter directed thrombolysis
Surgery for thoracic outlet syndrome
compression of nerves or blood vessels in the area between the neck and shoulder
CHRONIC VENOUS INSUFFICIENCY
Due to reflux or obstruction
Pressure in
venous
system very
high
للدم )الدم بكون متجمع (بزيد الcongestion ا يكون واقف بصير9 الشخص
pressure
pressure للدم فبقل الpumpا تمشي بصير9
Hemodynamic charting of (a) healthy patients, (b) patients with only varicose veins,
(c) patients with incompetent perforator veins, and (d) patients with deep and
perforator incompetence.
"venous claudication" as the deep venous system fills
with blood during exercise. The leg becomes painful,
swollen, and heavy, mimicking arterial insufficiency.
Clinical Findings
ankle and calf edema worst at the end of the day and
improves with leg elevation
stasis dermatitis,
hyperpigmentation,
Chronic swelling
brawny induration,
Lipodermatosclerosis on gaiter area
ulceration.
Venous stasis ulcers are large, painless, and irregular in
outline.
They have a shallow, moist granulation bed,
occur in the gaiter area on the medial or lateral
aspects of the ankle
the "gaiter areas" around the ankles.
the location of the commonly affected perforator veins
a region with sparse soft tissue support to withstand
elevated venous pressures.
Brawny edema
extravasation of plasma fluid, red blood cells, and plasma
proteins.
Lysis of red blood cells results in deposition of hemosiderin,
which creates a brownish discoloration.
inflammatory response
Leukocytes become sequestered in the microcirculation,
leading to capillary occlusion and release of superoxide
radicals, proteolytic enzymes, and growth factors.
Macrophages and T lymphocytes are primary mediators of
this inflammatory response which results in fibroblast
activation and scarring and fibrosis of the subcutaneous
tissues.
compromised skin perfusion and ulceration.
Bilateral
Venous ulcer
Diagnostic Studies
Duplex ultrasound More sufficient
Treatment
Lymphedema is a chronic disease for which there is no
complete cure.
A variety of conservative measures can substantially
reduce the risk of further complications and disability.
Use of benzopyrones (coumarins) and steroid
injections to increase lymphatic transport has not
shown consistent benefit
external compression
meticulous skin care.
frequent leg elevation,
manual lymphatic drainage massage,
low-stretch wrapping techniques,
intermittent pneumatic compression
Operation may be considered in rare cases of severe
functional impairment and recurrent lymphangitis.
ablative techniques (excision of excess tissue)
(lymphatic reconstruction).
infection on lymphedema
along the course of the
lymphatic vessels