Wagner’s Last Lecture – Part 1: Veins:

• Vein probs
o Varicose veins
o Deep vein thrombosis
o Chronic venous insufficiency
• Venous death
o Before learning about probs, you should know something about veins and how they func
• Veins must carry blood to the heart against the force of gravity
• The flow of blood is maintained by 2 factors
 A system on one-way valves in veins
 Calf muscle pumping action
• Important veins in legs
o Femoral
o Popliteal
o Lesser saphenous - post
o Greater saphenous - medial
• Drains medial aspect of foot and leg
• Empties into deep sys at femoral
o Short saphenous
• Drains lateral
• Empties into deep at popliteal - enters into deep system sooner - superficial
thrombosis can convert into deep vein thrombosis more easily - can cause death
• 3 types of veins
o Superficial
o Communicating - carry blood btw deep and sup
o Deep - in muscle carry 90% of blood back to heart
• Plexus in leg
o Planter plexus into post tibial V
o Calf plexus into popliteal V
o Adductor plexus into femoral V
• Plexus in pelvis
o All empty into deep sys
• On left - left ovarian into left renal
o Plexuses:
• Perirectal
• Periuterine
• Perivesicular
o CC- left testicular sagging (see Dr. Duenk's lect for details)
• Boys drop pants and check tonight
• Drainage
o Sup femoral
• Pop
• Ant tib
• Post tib
• Plantar
o Deep femoral
• Adductor mm
o Hypogastric
• Uterine
• Rectal
• Etc.
• Ultimate drainage is iliac to IVC
• Other heart in body
 o When you are walking get soleus pump effect - allows for return of blood from lower
extremities
• Interstital pressure of relaxed muscle is 30mm, it rises up to 400 for contracted muscle - moves
blood towards heart
• Varicose vein
o Incompetent valve - leads to back flow, swelling, and pooling of blood in lower leg
o Ladies - After 3rd month of pregnancy put on elastic stockings to prevent varicose veins -
do if you want nice legs after pregnancy
• Venous statis disease
o Results from deep vein throm which leaves scarred, unclosable valves, which leads to
pooling in lower 1/3 of leg - ultimately develop ulcers
o Normal
• When muscle relaxes, valve relaxes and holds blood in place
• When mm contracts, valve opens and blood moves
o Abnormal
• Blood presses on vein wall causing it to twist - ropy vein
• An ulcer forms if skin is broken - fluid comes out, and damages surrounding tissue
 Flares up - not pretty
 Difficult to treat
• Varicose vein treatment
o Bandages
o Exercise
o Diet
o Sclerotherapy - injection of veins to close them off
o Surgical management - vein stripping, ie removes veins (greater saph) - first must be sure
that deep circulation is adequate
• Do complete physcial to make sure various symptoms are working well
• Causes of venous thrombosis- (Virchow's triad) - KNOW UNTIL YOU DIE
o Intimal injury (damage to vessel wall)
o Inc coagulability of the blood
o Stasis of the venous circulation
• Ladies - knee highs are like tying a tourniquet around leg - damage saphenous vein,
causes stasis of superficial system
 Thus long stockings of no stockings
• Hospital bed postiongs
o Legs slightly elevated STRAIGHT - DO NOT BEND KNEES
• Bending knees causes stasis - leads to pooling blood in ankles or pelvis
 Bad:

• Deep venous thrombosis - DVT

o Causes
• Pregnancy
• Obesity
• Cancer
• Inmobility
• Injury
• Cardiac disease
• Surgical procedures
o Testing - to see where it is
• Doppler - flat line in abnormal doppler
 o Thrombosis reduces near by arterial flow
• Can lead to complete shut off of arterial flow
o Sequence - 4 stages
• Area of injury - vein wall
• Platelet - platelet thrombus
• Larger platelet structure (?) - layered thrombus
• Clot over platelet - propagating thrombus
o If clot is bigger than pulmonary vessels and it gets knocked out of vein, can travel and block
pulmonary vessels in lungs and causes death
• Pulmonary embolism
 Testing: - If time
• Chest x-ray
• Angiogram
 Symptoms
• Aphrehension
• Shortness of breath
• Sweating
• Chest pain
• Fainting
• Cough with bloody sputum
• Rapid oulse
 SEEK EMERGENCY MEDICAL CARE
 Treatment
• Anticoagulants
• O2
• If recurring, put on tephlon clip - clip below renal vessels to prevent
further embolization of clot
• Thromobolytic drugs to dissolve clot until better (may be for life)
• Place filter in inf Vena cava below renal vessels - prevent emboli
getting to lungs
• Dress sensibly
o Arterial disease - wear seasonly appropriate clothes, frostbite more common when
circulation is poor
• Loose clothes - prolonged pressure can cause sores
o Venous disease - stockings to provide support when awake
• Elephantaitis
o Clogging of lymphatics - legs look like elephant legs (very swollen)
• In creases of leg can get irritation/infection - thus be careful with hygiene of skin of
leg
• Wheel chair bound