Chronic Venous Insufficiency Case 10 by Ade

7/30/2019 Chronic Venous Insufficiency Case 10 by Ade...

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Chronic Venous Insufficiency

By Ade


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Definisi

When your leg veins cannot pump enough

blood back to your heart, you have chronic

venous insufficiency (CVI).

VascularWeb


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Etiologi

When these valves are damaged, the

blood leaks and pools in the legs and feet.

The condition may also be caused by a

blockage in a vein from a clot (deep vein

thrombosis).

MedlinePlus Medical Encyclopedia


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Faktor resiko

Age

Being female (related to levels of thehormone progesterone)

Being tall

Genetic factors

Obesity

Pregnancy

Prolonged sitting or standing



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Diagnosis

First your physician asks you questions about

your current general health, past medical

history, and symptoms.

Your physician may measure the blood pressurein your legs and will examine the varicose veins.

To confirm a diagnosis of CVI, the physician

may order a duplex ultrasound test or

sometimes another test called a venogram.


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Tanda

Redness of legs and ankles

Skin color changes around the ankles

Superficial (on the surface) varicoseveins

Thickening of the skin on legs and

ankles Ulcers on the legs and ankles



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Duplex Ultrasound

Duplex ultrasound uses painless sound

waves higher than human hearing can

detect.

Duplex ultrasound allows your physician to

measure the speed of blood flow and to

see the structure of your leg veins.

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duplex ultrasound - a type of vascular ultrasound

procedure done to assess blood flow and the

structure of the leg veins. The term "duplex"

refers to the fact that two modes of ultrasoundare used - Doppler and B-mode. The B-mode

transducer (like a microphone) obtains an image

of the vessel being studied. The Doppler probe

within the transducer evaluates the velocity anddirection of blood flow in the vessel.


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Venogram

A venogram is an x-ray that also allows

your physician to see the anatomy of your

veins.

During this test, your physician injects a

dye, properly called contrast, which makes

the blood in your veins appear on an x-ray.

VascularWeb


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venogram - uses x-rays and intravenous

(IV) contrast dye to visualize the veins.

Contrast dye causes the blood vessels to

appear opaque on the x-ray image,allowing the physician to visualize the

blood vessels being evaluated.


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CEAP Classification of CVI

Class 0 No visible or palpable signs of venous disease (only symptoms)

Class 1

(a,s)

Telangiectasias or reticular veins

Class 2(a,s) Varicose veins

Class 3

(a,s)

Oedema

Class 4

(a,s)

Skin changes ascribed to venous disease (e.g. pigmentation,

venous eczema, lipo-dermatosclerosis)

Class 5

(a,s)

Skin changes as defined above with healed ulceration

Class 6

(a,s)

Skin changes as defined above with active ulceration

MedScape


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Penatalaksanaan

Compression stockings

Sclerotherapy

Ablation Vein stripping

Bypass

Valve repair

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Compression stockings

For mild cases of CVI, your physician mayrecommend compression stockings.Compression stockings are elastic

stockings that squeeze your veins andstop excess blood from flowing backward.In this way, compression stockings canoften also help heal skin sores and

prevent them from returning. You mayneed to wear compression stockings dailyfor the rest of your life.


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You can help avoid leg swelling and other

symptoms by occasionally raising your legs and

avoiding standing for long periods of time to

decrease the pressure in the veins. When youdo need to stand for a long period, you can flex

your leg muscles occasionally to keep the blood

flowing. You can also help lessen the symptoms

of CVI by maintaining your ideal body weight orlosing weight if you are overweight.


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Sclerotherapy

In sclerotherapy, your physician injects a

chemical into your affected veins. The

chemical scars your veins from the inside

out so your abnormal veins can then nolonger fill with blood. Blood that would

normally return to the heart through these

veins returns to the heart through otherveins. Your body will eventually absorb the

veins that received the injection.


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Ablation

Ablation uses a thin, flexible tube called a

catheter inserted into a varicose

vein. Tiny electrodes at the tip of the

catheter heat the walls of your varicosevein and destroy the vein tissue. As with

chemical sclerotherapy, your varicose vein

is then no longer able to carry blood, and itis eventually absorbed by your body.


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Vein stripping

To perform vein stripping, your physician first makes asmall incision in the groin area and usually anotherincision in your calf below the knee. Then your physiciandisconnects and ties off all veins associated with the

saphenous vein, the main superficial vein in your leg.Your physician then removes this vein from your leg. Aprocedure called ambulatory phlebectomy, or smallincision avulsion, can be done either alone or togetherwith vein stripping. Small incision avulsion allows your

physician to remove individual varicose vein clustersfrom the leg through tiny incisions.


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Bypass

For more extensive problems, your surgeon mayrecommend bypass surgery to treat CVI that occurs inthe upper thigh or pelvis. For example, your surgeon canconnect an artificial vein, called a graft, or a transplanted

vein to a vein not affected by CVI to help blood flow fromyour affected leg around the blocked vein. Most veinsurgery can be performed through small incisions.Usually bypass surgery is safe, although there is a smallrisk of DVT and infection at incision points. Your

physician will only recommend this procedure in themost serious instances.


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Valve repair

In valve repair, your surgeon shortens the

valves inside your vein to improve valve

function. After making a small incision into

your skin, your surgeon cuts into theaffected vein. Your surgeon then folds or

tucks the valve flaps. He or she may place

a fabric sleeve around the outside of youraffected vein to help press the walls of the

vein together to maintain valve function.


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Pencegahan

Primary prevention involves adequateanticoagulation after DVT and use ofcompression stockings for up to 2 yr

after DVT or lower extremity venoustrauma.

Lifestyle changes (eg, weight loss,regular exercise, reduction of dietaryNaCl) can decrease risk by decreasinglower extremity venous pressure.

Merck Manual of Patient Symptoms


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Terimakasih.

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Chronic Venous Insufficiency Case 10 by Ade