Answers
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
Varicose veins affect almost one fifth of adults and are an abnormal dilatation of leg veins due to incompetent valves that prevent the backflow of bloods. Simple treatments include compression stockings and avoiding standing for long periods. Many varicose veins are idiopathic, but secondary causes include pregnancy, pelvic masses and previous iliofemoral DVT. Surgical treatment is usually only available on the NHS when varicose veins have a significant or adverse effect on the patient’s life through bleeding, eczema, phlebitis or ulceration. Cosmetic therapies include photodynamic therapy and foam sclerotherapy. Surgical treatments include vein stripping, saphenopopliteal ligation with multiple stab avulsions and newer technologies such as laser ablation. Recurrence is a common problem with surgical interventions, and care must be taken when consenting for surgery to include possibility of bleeding and saphenous nerve damage.
Blood flow
Peter R Hoskins, Kevin Martin, Abigail Thrush in Diagnostic Ultrasound, 2019
Veins transport blood back to the heart. To enable them to perform this function they have thin but strong bicuspid valves to prevent retrograde flow. There are typically a larger number of valves in the more distal veins. Venous flow back to the heart is enhanced by the influence of pressure changes generated by the cardiac cycle, respiration (Figure 8.18) and changes in posture as well as the action of the calf muscle pump. The flow and pressure in the central venous system are affected by changes in the volume of the right atrium which occur during the cardiac cycle. This pulsatile effect can be seen on Doppler spectra obtained from the proximal veins of the arm and neck due to their proximity to the chest. However, flow patterns in the lower limb veins and peripheral arm veins are not significantly affected by the cardiac cycle due to the compliance of the veins, leading to a damping of the pressure changes. The presence of valves and changes in intra-abdominal pressure during respiration also mask the effect of the cardiac cycle on venous flow in the distal veins.
The circulatory system
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella in Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Varicose veins are veins that have become distended over time due to the pooling of blood in the lower extremities. This condition occurs most frequently in individuals who spend long amounts of time standing (pharmacists for example) or who have impaired return of blood from the lower extremities. Pregnancy or obesity can also cause varicose veins due to an increase in intra-abdominal pressure. Veins are thin-walled vessels that are easily distended by the chronic pooling of blood in the lower extremities. Chronic distention of veins can reduce the effectiveness of the one-way venous valves that are present in the lumen to prevent the backflow of blood and lead to a condition termed valvular incompetence. Venous valves work in conjunction with skeletal muscle pumps in the legs to move blood back to the heart from the extremities. The most common manifestations of varicose veins are aching and edema. Their appearance through the skin is also unsightly. Treatment involves elevating the legs and the use of support stockings to prevent venous pooling. Surgical interventions may also be used to improve appearances and reduce discomfort.
Comprehensive overview of the venous disorder known as pelvic congestion syndrome
Published in Annals of Medicine, 2022
Kamil Bałabuszek, Michał Toborek, Radosław Pietura
Pelvic Venous Disorders manifests in many clinical presentations. Pelvic Congestion Syndrome is a common condition occurring worldwide, in which a significant proportion of cases remain undiagnosed and symptoms reported by women are often underestimated, due to poor knowledge of the condition. It is an important cause of chronic pelvic pain in female patients. It can also present with superficial varicose veins as the only symptom as well as in combination with pain. Symptoms can be non-specific and difficult to distinguish from other diseases. Certain diagnosis of the PCS is very challenging, due to its multiformity. Determining which patients suffer from symptoms associated with PCS is hard, but also extremely important to implement appropriate and targeted treatment. Future randomised trials on embolisation management are needed. A common treatment algorithm for trials based on an understanding of the mechanisms leading to symptoms would be particularly helpful in objectively evaluating outcomes.
Three-Dimensional in Vivo Anatomical Study of Female Iliac Vein Variations
Published in Journal of Investigative Surgery, 2022
Wenling Zhang, Chunlin Chen, Guidong Su, Hui Duan, Zhiqiang Li, Ping Shen, Jiaxin Fu, Ping Liu
The EIV joins the IIV in front of the sacroiliac joint to form the CIV. The bilateral CIV, accompanied by the common iliac artery, converges to the inferior vena cava on the right side of the 5th lumbar spine. Veins usually accompany arteries. April T. Bleich et al. [23] conducted an autopsy of 54 female cadavers and found that only 62.3% (66/106) of the posterior internal iliac arteries and anterior internal iliac arteries shared a common trunk, i.e., 37.7% of the posterior internal iliac arteries were independently issued by the common iliac artery. LePage PA et al. [24] dissected 79 specimens from 42 cadavers and found that 73% of the IIVs of the specimens flowed into the EIV system through a main trunk and that 27% of the IIVs flowed into the EIV system through two completely separated main trunks. Chong GO et al. [20] found that the incidence of main iliac vein separation was 18.3%. In this study, similar manifestations were found when IIV returned to CIV, with an incidence of approximately 34.20%. It was common to observe IIV dividing into two branches or simultaneous confluence with the EIV to form the CIV, while three branches were rare.
Pharmacological venous thromboembolism prophylaxis in elective cranial surgery: a systematic review of time of initiation, regimen and duration
Published in British Journal of Neurosurgery, 2022
Ian Tan, Anand S. Pandit, Shivani Joshi, Mehdi Khan, Zara Sayar, John-Paul Westwood, Hannah Cohen, Ahmed K. Toma
All studies included VTE and ICH as outcomes of interest. Wilhelmy et al.38 performed routine surveillance to detect postoperative ICH using computed tomography (CT) imaging, whereas the confirmation of ICH in all other studies either relied on the identification of clinical symptoms or were not specified. VTE was detected using clinical symptoms alone,37 or with further confirmation by imaging39; Wilhelmy et al.38 did not specify their method of measuring VTE occurrence. Whilst our review is focused on venous thromboembolism in the form of deep vein thrombosis and pulmonary embolism, Wilhelmy et al.38 also included patients who experienced non-venous thromboembolic events, including two patients who developed ischaemic stroke. None of the studies investigated the association between the interventions and mortality.