VENOUS DISEASE

Dr. Juwanto SpPD-KKV Divisi Kardiovaskular Bagian Ilmu Penyakit Dalam FK UR

Introduction

Venous disease are common conditions of the American population Varicose veins are estimated 27 % Chronic venous insufficiency are 1-3 % Venous Thromboembolism ( VTE ) Varicose veins refer to any dilated totuous elongated vein

Introduction

Varicocities can be divided into three categories :

1.Trunk vein varicocities Enlargement of the greater and the lesser saphenous systems 2.Reticular veins Subcutaneous veins arising from tributaries of trunk vein 3.Telangiectasias / spider vein Small intradermal varicosities

CLINICAL FEATURE

Demographics
Age ; CVI increases with age Gender ;Women have three to four-fold higher risk for varicose veins than men Race ; Whites at greater risk than Hispanics, who are at greater risk than Asians Obesity ; Obesity increases the risk for varicosities in women

CLINICAL FEATURE

History of Present Illness Symtoms of venous desease are pain, swelling, and cutanous changes Clinical risk factors for acute venous thromboembolism ; Strong risk ( OR> 10 ) ;
knee or hip replacement; Major trauma; fracture hip or knee ; spinal cord injury

CLINICAL FEATURE

Moderate risk ( OR 2-9 ) ;

Abdominal and thoracic surgery Arthroscopic surgery CHF Chemotherapy Hormone replacement therapy Thrombophilia

CLINICAL FEATURE

Low risk ( Odds ratio < 2 )

Age Bed rest > 3 days Obesity Varicose vein Prolonged car or airplane travel Pregnancy

Past Medical and Surgical History

A History of DVT A History of malignancy Paralysis due to spinal cord injury Pregnancy increases the risk of VTE Medication such as estrogen Thrombophilia and hypercoagulable

DEEP VENOUS THROMBOSIS (DVT)

General Consideration
The deep veins of the lower extremities and pelvis are most frequently involved. The process begins 80 % of the calf, the popliteal and femoral veins 10 %. DVT develop up to 2 weeks posteperatively.

Clinical Findings

Approximately half of patient with DVT have no symtoms or signs in the extremity in the early stages. The patient may suffer a pulmonary embolism, presumably from the leg veins, without symtoms or demonstrable abnormalities in the extemities.

Symtoms and signs

The patient may complain of a dull ache, a tight feeling, or frank pain in the calf or, in more extensive cases, the whole leg, especially when walking. Leg pain and leg swelling The skin may be cyanotic

Signs

Leg swelling Localized tenderness along the distribution of the DVT Dilated supeficial veins Redness and warmth Phlegmasia alba dolens and cerula dolens

Differential Diagnosis

Hematoma, muscle injury Cellulitis Ruptured Bakers cyst Arthritis of the knee or the ankle joint Swelling following recent hip or knee surgery Superficial phlebitis