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Presentation on theme: "DVT & VARICOSE VEINS."— Presentation transcript:




4 DVT It is the most common venous disorders result from incompetent valves in the veins and obstruction of venous return to the heart, usually as a result of thrombus.

5 ETIOLOGY Venous stasis Vessel wall injury Hypercoagulability

6 RISK FACTORS Older age Major surgery and orthopedic surgery Cancers
Immobilization Pregnancy and the postpartum period

7 Cont… Trauma and minor leg injury Previous VTE Oral contraceptives
Hormonal replacement therapy Central venous catheters Obesity Infection


Popliteal thrombosis Femoral thrombosis Iliac thrombosis

10 PATHOPHYSIOLOGY Clot formation Clot can enlarged and extend Venous valves are damaged(Inflammatory response) Postphlebitic syndrome

11 Cont… Muscle spasm and changes in intravascular pressure Developing thrombus to dislodge & moves towards heart and lungs Obstruct perfusion to the lung segments

12 Cont… Pulmonary arteries partially or totally obstructed by embolus Circulation of the lung segment affected Lung may undergo severe infarction with massive tissue destruction

13 Clinical manifestations
Calf thrombosis Calf tenderness Distal swelling Femoral thrombosis Tenderness & pain in distal thigh & popliteal regions Swelling Calf vein thrombosis

14 Cont… Iliofemoral thrombosis Massive swelling
Tenderness & pain in entire extremity Upper extremity thrombosis Swelling of affected extremity Dilated superficial veins Tenderness & pain Impaired mobility

15 Cont… Local warmth Mild fever
Possible venous cord in the popliteal area

History collection Physical examination Color flow duplex ultrasound imaging D- Dimer test

17 Cont…. Venography CT venography MR venography


19 Treatment Goals To prevent propagation of the clot
Prevent the development of new thrombi Prevent pulmonary emboli Limit venous valvular damage

20 Cont… Bed rest Leg elevation Compression stockings
Pharmacological measures Heparin Warfarin Thrombolytic therapy

21 Cont… Unfractionated heparin Initial-5000U OR 80U/kg - IV
Followed by maintain the APTT between 1.5 & 2.5 times the control. It given as 5 to 7 days

22 Cont…. LMWH Dosage – 250U/ kg every 12 hours. Eg; enoxaparin, dalteparin. Warfarin Dose of 5 mg per day

23 Cont… Thrombolytic therapy Eg;streptokinase, urokinase, recombinant tissue plasminogen(reteplase, alteplase)

24 Surgical management Thrombectomy- transvenous filtration device
Greenfield filter Bird’s nest filter Guidelines for safe practice

25 Green field filter

26 Bird’s nest filter


28 Varicose veins These are swollen,twisted and sometimes painful veins that have filled with an abnormal collection of blood.


30 Causes Hereditary Thrombophelebitis Risk factors Prolonged standing
Obesity & distended belly Pregnancy

31 Cont… Straining-chronic constipation, urinary retention, chronic cough. Prior surgery age

32 Pathophysiology Generally blood flow from the superficial veins to the deep veins To the large veins to the heart Venous blood flow work against gravity This is assisted by unidirectional intraluminal valves in the veins

33 Cont… Activity causes intermittent compression of the veins by muscles Pressure increases in the vein valves Incompetent valves Valve failure

34 Cont…. Veins become swollon and enlarged Become hard & tortuous Feeling of heaviness & pressure

35 Clinical manifestations
Aching ,heavy legs Appearance of spider veins Ankle swelling Brownish blue shiny skin discolouration Redness, dryness, itching of the affected area

36 Cont… Cramps while standing Bleeding during minor injuries
Hard swollon area Whitened irregular scar like patches in the ankles.

37 Diagnostic evaluation
History collection Physical examination Tourniquet test Doppler ultrasound MRI

38 TREATMENT Conservative Elevation of legs Regular exercises
Compression stockings Anti inflammatory medications

39 Cont…. Active Stripping - Removal of all or part of the saphenous vein . Endovascular laser surgery – uses a laser to destroy the veins. Radiofrequency ablation – heat to destroy the affected veins.

40 Cont… Ligation – it is usually involved in an incision at the groin .here they tied saphenous vein to the femoral vein just at the entrance of the incision.


42 Laser therapy

43 Ablation therapy

44 Non surgical Sclerotherapy - Injecting the chemical inside the vein . Sclerosant agent-polidocanal, sclerodex. Lasers – it is used in case of small veins with vacosity.

45 Sclerotherapy


47 Complications Varicose ulsers Severe bleeding Acute necrosis


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