Venous Stasis And Elephantaitis

Wagner’s Last Lecture – Part 1: Veins: •

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Vein probs o Varicose veins o Deep vein thrombosis o Chronic venous insufficiency Venous death o Before learning about probs, you should know something about veins and how they func • Veins must carry blood to the heart against the force of gravity • The flow of blood is maintained by 2 factors  A system on one-way valves in veins  Calf muscle pumping action Important veins in legs o Femoral o Popliteal o Lesser saphenous - post o Greater saphenous - medial • Drains medial aspect of foot and leg • Empties into deep sys at femoral o Short saphenous • Drains lateral • Empties into deep at popliteal - enters into deep system sooner - superficial thrombosis can convert into deep vein thrombosis more easily - can cause death 3 types of veins o Superficial o Communicating - carry blood btw deep and sup o Deep - in muscle carry 90% of blood back to heart Plexus in leg o Planter plexus into post tibial V o Calf plexus into popliteal V o Adductor plexus into femoral V Plexus in pelvis o All empty into deep sys • On left - left ovarian into left renal o Plexuses: • Perirectal • Periuterine • Perivesicular o CC- left testicular sagging (see Dr. Duenk's lect for details) • Boys drop pants and check tonight Drainage o Sup femoral • Pop • Ant tib • Post tib • Plantar o Deep femoral • Adductor mm o Hypogastric • Uterine • Rectal • Etc. Ultimate drainage is iliac to IVC Other heart in body

When you are walking get soleus pump effect - allows for return of blood from lower extremities Interstital pressure of relaxed muscle is 30mm, it rises up to 400 for contracted muscle - moves blood towards heart Varicose vein o Incompetent valve - leads to back flow, swelling, and pooling of blood in lower leg o Ladies - After 3rd month of pregnancy put on elastic stockings to prevent varicose veins do if you want nice legs after pregnancy Venous statis disease o Results from deep vein throm which leaves scarred, unclosable valves, which leads to pooling in lower 1/3 of leg - ultimately develop ulcers o Normal • When muscle relaxes, valve relaxes and holds blood in place • When mm contracts, valve opens and blood moves o Abnormal • Blood presses on vein wall causing it to twist - ropy vein • An ulcer forms if skin is broken - fluid comes out, and damages surrounding tissue  Flares up - not pretty  Difficult to treat Varicose vein treatment o Bandages o Exercise o Diet o Sclerotherapy - injection of veins to close them off o Surgical management - vein stripping, ie removes veins (greater saph) - first must be sure that deep circulation is adequate • Do complete physcial to make sure various symptoms are working well Causes of venous thrombosis- (Virchow's triad) - KNOW UNTIL YOU DIE o Intimal injury (damage to vessel wall) o Inc coagulability of the blood o Stasis of the venous circulation • Ladies - knee highs are like tying a tourniquet around leg - damage saphenous vein, causes stasis of superficial system  Thus long stockings of no stockings Hospital bed postiongs o Legs slightly elevated STRAIGHT - DO NOT BEND KNEES • Bending knees causes stasis - leads to pooling blood in ankles or pelvis  Bad: o

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Deep venous thrombosis - DVT o Causes • Pregnancy • Obesity • Cancer • Inmobility • Injury • Cardiac disease • Surgical procedures o Testing - to see where it is • Doppler - flat line in abnormal doppler

Thrombosis reduces near by arterial flow • Can lead to complete shut off of arterial flow o Sequence - 4 stages • Area of injury - vein wall • Platelet - platelet thrombus • Larger platelet structure (?) - layered thrombus • Clot over platelet - propagating thrombus o If clot is bigger than pulmonary vessels and it gets knocked out of vein, can travel and block pulmonary vessels in lungs and causes death • Pulmonary embolism  Testing: - If time • Chest x-ray • Angiogram  Symptoms • Aphrehension • Shortness of breath • Sweating • Chest pain • Fainting • Cough with bloody sputum • Rapid oulse  SEEK EMERGENCY MEDICAL CARE  Treatment • Anticoagulants • O2 • If recurring, put on tephlon clip - clip below renal vessels to prevent further embolization of clot • Thromobolytic drugs to dissolve clot until better (may be for life) • Place filter in inf Vena cava below renal vessels - prevent emboli getting to lungs Dress sensibly o Arterial disease - wear seasonly appropriate clothes, frostbite more common when circulation is poor • Loose clothes - prolonged pressure can cause sores o Venous disease - stockings to provide support when awake Elephantaitis o Clogging of lymphatics - legs look like elephant legs (very swollen) • In creases of leg can get irritation/infection - thus be careful with hygiene of skin of leg • Wheel chair bound o

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