PERIPHERAL VEINS

DISEASE

Dr Nora C Hutajulu SPJP,FIHA

 Veins
• Veins are capacitance vessels that contain
more than 70 % of total blood volume.
• The sub endothelial layer of vein is thin,and the
tunica media compromises fewer,smaller
bundles of smooth muscle cell intermixed with
reticular and elastic fibres.
• Whereas veins of the extremities posses intrinsic
vasomotor activity,transport of blood back to the
heart.
 Veins
• Veins of the extremities are classified as either
deep or superficial.
• In the lower extremity,where most peripheral
venous disorders occur,the deep veins generally
course along the arteries, whereas the
superficial veins are located subcutaneously.
• The superficial vessel drain into deeper veins via
a series of perforating connectors,ultimately
returning blood to the heart.
 HOW BLOOD CIRCULATES

• Arteries carry freshly oxygenated blood from the

heart to the rest of the body, starting in the central
trunk artery, the aorta, which leads from the heart's
main pumping chamber (the left ventricle).
From the aorta, the arteries branch and divide into
successively smaller vessels, and finally into tiny
arterioles and capillaries that deliver oxygen to the
body’s tissues.
• Arteries are thick-walled and muscular
• Arterial blood is scarlet,because it carries richly
oxygenated red cells
 HOW BLOOD CIRCULATES

• Veins carry blood that has left much of its oxygen

in the tissues back to the right side of the heart. It is
then pumped into the lungs to pick up more oxygen.

• Compared to the flow of arterial blood, which is

driven by the heart's powerful pumping, the flow of
venous blood is relatively slow, returning from the
lower body against the force of gravity. (A series of
one-way valves inside the veins helps keep the
blood from pooling or moving backward.)
 HOW BLOOD CIRCULATES

• The flow of blood from a cut vein is

slow and steady.
• Veins are thinner than arteries, and
they appear bluish, because the blood
they carry is low in oxygen.
• The veins, which send blood from
the limbs and other tissues back
to the heart, are also vulnerable
to a variety of disorders that can
cause blood clots to form or
inflammation to develop.
 Diseases of the Veins
• Varicose Veins
• Varicose veins are dilated, turtous superficial
vessels that often develop in the lower
extremities.
• Clinically apparent varicose veins occur in 10 –
20 % of general population.
• They affect women 2-3 times more frequently
than men, and roughly half of patiens have a
family history of this condition.
• Varicose veins
• Can occur in any vein in the body but are
most common in the saphenous veins of
the leg.
• They may also develop in the anorectal
area (hemorrhoids), in the lower
esophageal veins (esophageal varices),
and the spermatic cord (varicocele).
Extensive venous varicosities of the
right leg.
 Varicose veins
Causes :
Varicosity is thought to result from
intrinsic weakness of the vessel wall, or
increased intraluminal pressure from
standing too long or hormonal changes
during pregnancy,or from congenital
defects in the structure and fuction of the
valves that severely impair flow toward to
the heart , that dilate and relax veins.
 Varicose veins
Symptoms :
Sometimes asymptomatic ; sometimes
pain; dull ache or pressure sensation in
the leg after prolonged standing.
Can cause swelling and skin ulceration
that is particulary severe near the ankle.
Stasis of blood within varicose veins can
promote superficial vein thrombosis.
 Varicose veins
• Treatment :
Elevate the leg while supine ,avoiding
prolonged standing; wearing elastic or
support stockings,surgical removal for
patiens who are very symptomatic.
 Diseases of the Veins
• Venous thrombosis / thrombophlebitis.

= Thrombus within superficial or deep veins.and the

inflamatory response in the vessel that it incites.

• Causes:
- Sluggish movement of blood (stasis)
- Damage to the lining of the vein
- Inflammation of the vein (phlebitis)
- Abnormal tendency to form clots
(hypercoagulable state).
• Deep Vein Thrombosis
• The presence of a thrombus in a deep
vein.
• The incidence of deep vein thrombosis
increases with age.
• Deep vein thrombosis usually occurs in
the leg, regardless of cause.
 Deep Vein Thrombosis

• Etiology:
• Immobilization,
• Prolonged sitting (as may occur during long
drives or air travel), or
• Relatively sedentary existence can lead to
venous stasis and predisposes to thrombosis,
because the emptying of veins in the extremities
depends entirely on skeletal muscles that pump
blood and on one-way venous valves that inhibit
retrograde flow.
 Deep Vein Thrombosis

. Incompetent venous valves lead to deep

vein thrombosis.
• Thrombosis also damages the intima of
the vein; may lead to decreased local
production of antithrombotic factors (eg,
antithrombin III, prostacyclin).
 Deep Vein Thrombosis
• Any condition that increases the Hct increases
blood viscosity and results in a higher incidence
of clotting.
• Dehydration, pulmonary disorders, smoking,
and polycythemia are common causes of a high
Hct in the elderly.
• The two most common known hypercoagulable
states are hyperhomocysteinemia and protein C
resistance, which is genetically determined .
 Deep Vein Thrombosis
• Symptoms :
• Sometime asymptomatic;
• Generally, patients first note swelling when they
awaken.
• In ambulatory patients, swelling is maximal at
the ankle and lower leg, usually developing over
1 or 2 days. Pain may be present but is usually
not severe.
. Shortness of breath; coughing up blood-tinged
phlegm if clot moves to the lung (pulmonary
embolism); marked pain and swelling in one leg.
 Deep Vein Thrombosis
• Physical examination often reveals pitting
edema and a mild to moderate increase in
skin temperature over the calf or thigh.

• A gap always occurs between the level of

thrombosis and the location of edema.
 Deep Vein Thrombosis
• With popliteal and lower femoral vein
thrombosis, edema occurs only in the lower leg
and ankle.
• With thrombosis in the mid femoral vein area,
most or all of the leg is swollen.
• With upper femoral and external iliac vein
thrombosis, the thigh is also swollen.
. Calf vein thrombosis may produce no symptoms
or mild tenderness and mild edema.
• Deep vein thrombosis (DVT) and
pulmonary embolism represent different
manifestations of the same clinical entity,
which is referred to as venous
thromboembolism.
• A proximal DVT in the leg is one that is
located within the popliteal, femoral
(including the superficial femoral), or iliac
veins.
• A pulmonary embolism occurs when a segment
of a thrombus within the deep venous system
detaches from the vessel, travels to the lungs,
and lodges within the pulmonary arteries
• The pelvic and deep veins of the lower
extremities are the source of more than 70% of
all pulmonary emboli.
• The superior vena cava, upper extremity veins,
and right chambers of the heart are less
common sources.
 Deep Vein Thrombosis
• Diagnosis
• The “gold standard” for diagnosing deep-
vein thrombosis is contrast venography,
also called a venogram, a dye visible on
an X-ray is injected into the veins of the
feet; the patient is then tilted in various
positions to facilitate blood flow from the
lower veins to the heart, providing an X-
ray image of the vein network.
• Laboratory test : Serum D- Dimer level.
D-Dimer is a byproduct of fibrin
degradation.
• Impedance plethysmography,
. Doppler ultrasonography,
 Diagnostic Imaging /Venogram of
deep venous thrombosis
• A.Normal
• B.Extensive Thrombosis of deep calf vein
 Deep Vein Thrombosis

• Treatment
• Anticoagulant such as warfarin (Coumadin) and
heparin.
• In repeated cases,insertion of a filtering device
to prevent pulmonary embolism.
• Bedrest for 3 to 5 days with legs elevated.
• Elastic stockings worn below the knee.
. Anti-inflammatory drugs such as aspirin or
indomethacin (Indocin)
 Pulmonary embolism
• Causes : Deep-vein thrombosis moved to
lungs.
• Symptoms :
Some times chest pain that worsens upon
inhaling; sandpaper-like sound heard
through stethoscope; shortness of breath;
coughing up blood.
 Pulmonary embolism
• Angiogram Arteri Pulmonal.
 Pulmonary embolism
• .
• Treatment :
- Thrombolytic drugs such
urokinase (Abbokinase),
streptokinase (Kabikinase or
Streptase).
- Anticoagulants such as warfarin
(Coumadin) or heparin .
- In rare cases, surgery to remove
the clot.
 Superficial veins thrombophlebitis
• Much less serious than DVT(deep veins thrombosis)
does not lead to pulmonary embolism.
• Causes :
Infection or injury as a complication of indwelling
intravenous catheter.
• Symptoms :
Pain; redness; tenderness,and edema over the
involved vein.
. Treatment :
Anti-inflammatory drugs such as indomethacin
(Indocin); analgesics such as aspirin.
 Chronic venous Insufficiency
• Causes :
Complication following deep-vein thrombosis.

• Symptoms:
Swelling and discoloration of one or both legs.

• Treatment
Knee-length elastic stocking indefinitely to
prevent swelling.
Chronic venous Insufficiency
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