Lekcja 7: Kliniczne aspekty chorób naczyń 2 | Clinical Aspects of Vascular Diseases 2

Lekcja 7: Kliniczne aspekty chorób naczyń 2 | Clinical Aspects of Vascular Diseases 2

Venous Thromboembolism (VTE)

Pathophysiology: VTE encompasses both deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT involves the formation of a blood clot in a deep vein, usually in the legs. PE occurs when a clot breaks free and travels to the lungs.

Clinical Presentation:

  • DVT: Swelling, pain, and redness in the affected leg.
  • PE: Sudden shortness of breath, chest pain, and coughing up blood.

Diagnostic Approaches:

  • D-Dimer Test: A blood test that helps to rule out the presence of an abnormal blood clot.
  • Ultrasound: To visualize clots in the deep veins.
  • CT Pulmonary Angiography: The gold standard for diagnosing PE.

Management Strategies:

  • Anticoagulation Therapy: Medications such as heparin, warfarin, or direct oral anticoagulants (DOACs) to prevent clot extension and new clot formation.
  • Thrombolytic Therapy: Used in severe cases to dissolve clots quickly.
  • Compression Stockings: To reduce the risk of post-thrombotic syndrome.

Varicose Veins

Pathophysiology: Varicose veins are enlarged, twisted veins that occur when valves in the veins become weakened or damaged, causing blood to pool.

Clinical Presentation:

  • Visible Veins: Swollen, blue or purple veins visible under the skin.
  • Pain and Discomfort: Aching, throbbing, or heaviness in the legs.
  • Swelling: Swelling in the lower legs and ankles.

Diagnostic Approaches:

  • Physical Examination: Visual inspection and palpation of the veins.
  • Duplex Ultrasound: To assess blood flow and check for valve function.

Management Strategies:

  • Lifestyle Modifications: Including weight management, exercise, and avoiding prolonged standing.
  • Compression Therapy: Wearing compression stockings to improve blood flow.
  • Procedures: Sclerotherapy, laser therapy, or vein stripping to remove or close off varicose veins.

Chronic Venous Insufficiency (CVI)

Pathophysiology: Chronic Venous Insufficiency (CVI) occurs when the veins in the legs are unable to effectively return blood to the heart, leading to pooling of blood in the lower extremities. This condition is primarily due to malfunctioning venous valves, which normally prevent backflow. When these valves are damaged or weakened, blood can flow backward, increasing pressure within the veins.

Clinical Presentation:

  • Edema: Swelling in the lower legs and ankles, especially after prolonged standing or sitting.
  • Pain and Heaviness: A dull ache or feeling of heaviness in the legs that often worsens by the end of the day.
  • Varicose Veins: Enlarged, twisted veins visible under the skin, often accompanied by a sense of fullness or discomfort.
  • Skin Changes: Darkening of the skin (hyperpigmentation), particularly around the ankles, and possible development of eczema or lipodermatosclerosis (hardening of the skin).
  • Venous Ulcers: Non-healing sores, usually around the ankles, which can become chronic and prone to infection.

Diagnostic Approaches:

  • Clinical Examination: Physical inspection for signs of varicose veins, skin changes, and ulcers.
  • Duplex Ultrasound: A non-invasive imaging technique that assesses blood flow and valve function, and can identify any venous reflux or obstruction.
  • Venography: An imaging test using contrast dye to visualize the veins in detail, often used when ultrasound findings are inconclusive.

Management Strategies:

  • Compression Therapy: Wearing compression stockings to improve venous return, reduce swelling, and alleviate discomfort.
  • Medications: Use of diuretics to manage edema and pentoxifylline to improve blood flow and reduce symptoms.
  • Lifestyle Modifications: Encouraging regular physical activity, leg elevation, weight management, and avoiding prolonged standing or sitting.