Venous Anatomy and Physiology
The major superficial veins of the lower extremity (2).
What are the great saphenous vein and lesser saphenous vein?
Patient with a history of left femoro-inguinal lymph node dissection for melanoma presents with 1 month of swelling of his LLE.
What is lymphedema?
Tortuous, bluish, soft protrusions of branches of superficial veins.
What are varicose veins?
Most common agents used for chemoprophylaxis in the hospital (2).
What are...
1. Lovenox (enoxaparin)
2. Subcutaneous heparin
...?
This coagulation factor is inhibited by the medications apixaban, rivaroxaban, and endoxaban.
What is activated Factor X?
Tubular structures that connect the superficial venous system to the deep venous system and that have valves that prevent regurgitation from the deep system to the superficial system.
What are the perforator veins?
Patient with a history of diabetes and chronic venous insufficiency presents with 24 hrs of a swollen, painful, red, and warm right foot and ankle.
What is cellulitis?
Thin, spidery, red or purple vessels.
What are telangiectasias?
This procedure is done in patients with known DVT that cannot be treated with anticoagulants.
What is IVC filter insertion?
This lab test has a high negative predictive value for DVT and should only be checked first if there is low to moderate pretest probability of DVT.
What is D-dimer?
The major mechanism of venous return from the lower extremities.
What is skeletal muscle contraction?
Patient with EF of 15% presents with shortness of breath and is admitted for a CHF exacerbation. His bilateral feet and legs are incidentally found to have 2+ pitting edema, and he has brownish discoloration of the skin overlying his shins.
What is chronic venous insufficiency/stasis?
Most common non-operative management for treating venous ulcers and preventing recurrence.
What is compression therapy?
The set of guidelines used to direct appropriate antithrombin therapy for a variety of patient types and situations.
What are the CHEST guidelines?
Findings of acute DVT on US.
What are...
1) distended vein
2) non-compressible vein
3) hypoechoic thrombus
...?
Major anatomic differences between veins and arteries (2).
What are...
1. Thicker muscular layer (tunica media) in arteries
2. Presence of valves in veins
...?
Patient with a history of ACL tear presents with a painful, swollen leg below the level of the knee. On physical exam, there is a palpable cyst in the popliteal fossa that is firm on full knee extension and soft on full knee flexion (Foucher's sign).
What is a popliteal vein DVT secondary to compression from a Baker's cyst?
Treatments for varicose veins (4 types).
What are...
1) Endovenous ablation (laser, radiofrequency)
2) Chemical ablation
3) Mechanicochemical ablation
4) Vein stripping
...?
This anatomic defect can lead to a patient suffering a stroke after developing a lower extremity DVT.
What is a patent foramen ovale?
(paradoxical stroke)
The treatment of suppurative thrombophlebitis with sepsis.
What is surgical removal of the vein?
The major deep veins of the lower extremity (5).
What are the...
1. Common femoral vein
2. Deep femoral vein (profunda)
3. Femoral vein
4. Popliteal vein
5. Tibial veins
...?
Patient with no significant PMH and a normal BMI presents with 3 days of persistent swelling of her LLE. She has had chronic intermittent swelling, pain, tingling, and numbness of her left leg for several months. Hypercoagulability workup is negative.
What is May-Thurner Syndrome (compression of the left common iliac vein against the lumbar spine by the right common iliac artery as it crosses over)?
The treatment for telangiectasias and reticular veins.
What is sclerotherapy?
The length of time that the majority of patients with a DVT/PE should be treated with anticoagulation.
What is 3 months?
(longer for patients with unprovoked DVT/PE and for patients with DVT/PE and cancer)
The gold standard for diagnosing a PE.
What is pulmonary angiogram?
(CTA is much more readily available and is highly accurate).