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<< Click here to get 22 Cardiology questions straight from my book, The Final Step >>=”thrombophlebitis”>Thrombophlebitis

• Phlebitis is an inflammation of vein.
• Thrombophlebitis is venous inflammation as a result of a blood clot
  • The most common cause of phlebitis.
  • Typically superficial following trauma

Deep venous thrombosis (DVT) vs superficial thrombophlebitis

Causes & Risk Factors

• Trauma
• Major surgery including hip and knee replacements
• Prolonged bed rest or immobilization
• Oral contraception
• Smoking
• Smoking + Oral contraception
• Cancer
• Pregnancy/post natal period
• Genetic clotting issues / family history

Clinical Presentation

• Skin is maybe, warm, swollen, and tender
• Calf pain

Physical Exam Findings

• Skin maybe red, warm, swollen, and tender
• Homans sign
  • pain and tenderness in the calf with passive dorsiflexion of the foot.
  • Studies of Homan’s sign suggest it is positive from 8 to 56% of people with proven deep venous thrombosis (DVT), but also positive in more than 50% of symptomatic people without DVT

Labs and Studies

• U/S doppler is the gold standard for diagnosis
• MRI and CT venography
• D-dimer – This is a blood test looking for fibrin degradation products. If it is negative there is no DVT however it can be positive for many reasons.

Treatment

• Prevention
  • Lifestyle modifications
  • Leg exercises
  • Compression stockings
  • Sequential compression devices
  • Frequent ambulation
  • Anticoagulation therapy
    • Warfarin
    • Lovenox
    • Heparin
• Superficial Thrombophlebitis
  • Heat
  • NSAIDs
  • Elevation of extremity
  • Anticoagulants?
• DVT
  • Medical
    • Heparin
    • Warfarin
  • Surgical
    • Filter for the inferior vena cava (concerned about PE)
    • Thrombolysis
    • Thrombectomy

Varicose Veins

Causes & Risk Factors

• Pregnancy
• Genetic predisposing factors
• Valvular incompetence
• Increased abdominal pressure
• Long periods of standing

Clinical Presentation

• Dilated tortuous veins (most commonly the long saphenous or its tributaries)
• May be painful and tender or asymptomatic
• Fatigue and aching of the lower extremities

Physical Exam Findings

• Dilated tortuous veins (most commonly the long saphenous or its tributaries)
• May be painful and tender or asymptomatic

Labs & Studies

• Doppler U/S may show incompetent valves

Treatment

• Behavioral changes
  • Avoid long periods of standing
  • Elevate legs when possible
  • Graduated elastic stockings
• Surgical
  • Vein stripping
  • Sclerotherapy

Chronic Venous Insufficiency

• Weakened vessel walls and incompetent valves generally in the lower extremities

Clinical Presentation

• Progressive edema beginning at the ankles and moving up
• Skin changes
  – Hyper-pigmentation
  – Shiny
  – Atrophic
  – Dermatitis
  – Painful ulcerations

Physical Exam Findings

• Progressive edema beginning at the ankles and moving up
• Skin changes
  – Hyper-pigmentation
  – Shiny
  – Atrophic
  – Dermatitis
  – Painful ulcerations

Labs & Studies

• U/S doppler

Treatment

• Behavioral changes
  • Avoid long periods of standing
  • Elevate legs when possible
  • Graduated elastic stockings
  • Heat
  • Ambulatory exercise

 

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