Show Menu

Venous Disorders Cheat Sheet by

Cheat sheet for venous disorders including clinical diagnosis and management.

Venous Anatomy

Blood from skin and SubQ tissue in legs flows into the superf­icial veins, then deep veins then to heart
Superf­icial Veins:
Great saphenous, lesser saphenous
Deep veins
Inferior vena cava -> right common iliac -> internal iliac and external iliac -> femoral -> popliteal -> peroneal -> anterior and posterior tibial
Leg muscles assist with return of blood (muscle pump action)
Venous valves prevent retrograde flow of blood

Venous Disease Classi­fic­ation

Venous Anatomy

History and Clinical Appearance

Medica­tions- side effects of swelling?
Previous history of DVT, congenital valve weakness, ulcers, edema, prolonged standing, trauma, vein stripping or other procedures
Chief Complaint
Sense of tiredness, fatigue, heaviness in feet, night leg cramps (relief by walking or massage)
Signs of Venous Insuff­iciency
Varicose veins, telang­iec­tasia, pitting edema, stasis dermat­itis, hemosi­derosis (brown iron complexes of hemosi­derin often deposited into the tissue due to increased hydros­tatic pressure forcing blood components to escape, brown staining results)
Chronic Insuff­iciency
Atrophie blanche, lipode­rma­tos­cle­rosis, venous ulcers
Testing for Venous Disease
Brodie­-Tr­end­ele­nburg test, hand held doppler constant sound, photocell or air plethy­smo­graphy, ambulatory venous pressure testing, venography
Venous stasis can occur from:
-secondary to obstru­ction or insuff­iciency
-throm­bop­hle­bitis may block venous drainage
-valve damage contribute to incomp­etence
-veins may be compressed due to tumour or fibrosis

Venous Disorders

Superf­icial Thromb­oph­elbitis
Occurs when there is inflam­mation and thrombus within the superf­icial vein
Can occur following an infection, trauma, hyperc­­oa­g­u­lable stagtes, oral contra­­ce­p­t­ives, procoa­­gulant factors
Risk factors: prior history of superf­icial phlebitis, DVT, PE, recent surgery or pregnancy, prolonged immobi­liz­ation, malignancy
Signs and Symptoms: Redness and warmth associated with vein, pain over vein, diffuse leg pain, edema, fever
Differ­entials: Baker's cyst, soft tissue injury, cellul­itis, MSK pain, lympha­ngitis, neuritis, ruptured head of gastroc
Treatment: prevent progre­ssion into deep venous system, NSAIDs (for pain), antico­agu­lan­ts(­hep­arin), increase ambula­tion, gradient compre­ssion stocki­ngs­(30­-40­mmHg)
Deep Vein Thrombosis
Develo­pment of thrombus in the deep veins
Want to detect early to prevent fatal PE
If thrombus partially or completely blocks the flow of blood through the vein, blood begins to pool and build up venous hypert­ension
Risk Factors: Similar to superf­icial thromb­oph­elbitis but also includes age >60, hyperc­oag­ulable states, obesity, history of DVT
Symptoms: Common site is the calf (post tib and peroneal veins), silent in 50% cases, progre­ssive pulling sensation at back of leg, pain increases with ambula­tion, slight fever, swelling occurs distal to site of thrombus, distension of superf­icial veins, increase in temp distal to clot,
Causes: Virchow's triad
Prevention: Heparin, NSAIDs, gradient compre­ssion hose, increased ambulation
Treatment: if suspected refer to emerg! Bed rest x 1 week with legs elevated which stabilizes clot, elastic stocking to reduce swelling and protect superf­icial veins, 3-6 months limitation of prolonged standing, medica­tions (fibro­nolytic agents, antico­agu­lants, antibi­otics)
Pulmonary Embolism
Embolus is a blockage in the blood flow to the lungs by blood clot or fat, air or tumor. Very dangerous when thrombus is torn from attach­ment. May cause pulmonary infarction
Risk Factors: same as DVT
Symptoms: Sudden, chest pain, shortness of breath, coughing, dizziness, fainting, anxiet­y/s­wea­ting. MEDICAL EMERGENCY
Treatment: Thromb­oly­tics, vein filter (prevents emboli from reaching lungs
Chronic Venous Insuff­iciency
Venous hypert­ension caused by chronic venous reflux as a result of structural or functional abnorm­alities of veins
Leads to: Edema, protein exudation and deposition to skin, fibrosis and lipode­rma­tos­cle­rosis, stasis dermat­itis, tissue hypoxia, leg ulcers
Venous Ulcer
Seen in lower third of leg (lateral or medial aspect), surrou­nding skin has signs of CVI, shallow ulcer, moist granul­ating base, sloping edges, cyanotic discol­our­ation
Treatment: reduce venous hypert­ension by walking regimens, limb elevation, local wound care (manage moisture)
Virchow's Triad: 1. Stasis of blood 2. Increased blood coagul­ability 3. Vessel wall injury (alter­ation to vein wall)
Causes of Thrombi Formation: Old age, estrogen use, pregnancy, obesity, malignancy

Venous Disorder Management

Elevation: Avoid high heels as they reduce venous emptying as muscle pump not activate. Raise feet above heart 15-30 mins several times/day. Place 2-3" block under legs
Exercise: Emphasize ankle planta­rfl­exion , activate muscle venous pump. 30-60mins of PA
Medica­tions: NSAIDs, vitamin C/E for symptom relief. Pentox­ify­lline may change course of disease
Compre­ssion Therapy:
Benefits: Reduce diameter of veins, increase flow velocity, decrease chance of thromb­osis, improve lymphatic flow
Types: Elastic (stocking or bandag­ing), inelastic (garments or short stretch bandages), pneumatic compre­ssion
Class 1: 20-30mmHg for aching, swelling. telang­iec­tasia, varicose veins (to start/­asy­mpt­omatic)
Class 2: 30-40mmHg for sympto­matic varicose veins, CVI, post ulcer
Class 3: 40-50mmHg for CVI, post ulcer
Class 4: 50-60mmHg for CVI, post ulcer, severe CVI not controlled by class 3
Sclero­therapy: remove oblite­ration of abnormal vessel that carry retrograde flow.
Other: Saphen­ofe­moral bypass, prosthetic graft, valvular recons­tru­ction
Vein Stripping: strip varicose veins (only option for saphenous vein)
*Elevating legs is contra­ind­icated in CHF, gastro­eso­phageal reflux, pulmonary disease and sleep apnea patients
*Compr­ession therapy is contra­ind­icated in patients with an ABI of 0.5 and below


No comments yet. Add yours below!

Add a Comment

Your Comment

Please enter your name.

    Please enter your email address

      Please enter your Comment.

          Related Cheat Sheets

          More Cheat Sheets by happyfeet2020

          Hemostasis Cheat Sheet
          Fungal Infections Cheat Sheet