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VENOUS DISEASE
VENOUS DISEASE
Dr. Juwanto SpPD-KKV Divisi Kardiovaskular Bagian Ilmu Penyakit Dalam FK UR
Dr. Juwanto SpPD-KKV
Divisi Kardiovaskular Bagian Ilmu
Penyakit Dalam FK UR
Introduction
Introduction
 Venous disease are common conditions of the American population  Varicose veins are estimated 27
Venous disease are common conditions
of the American population
Varicose veins are estimated 27 %
Chronic venous insufficiency are 1-3 %
Venous Thromboembolism ( VTE )
Varicose veins refer to any dilated
totuous elongated vein
Introduction
Introduction
 Varicocities can be divided into three categories :
Varicocities can be divided into three
categories :
1.Trunk vein varicocities Enlargement of the greater and the lesser saphenous systems 2.Reticular veins
1.Trunk vein varicocities
Enlargement of the greater and the lesser
saphenous systems
2.Reticular veins

Subcutaneous veins arising from tributaries of trunk vein

Introduction  Varicocities can be divided into three categories : 1.Trunk vein varicocities Enlargement of the
3.Telangiectasias / spider vein Small intradermal varicosities
3.Telangiectasias / spider vein
Small intradermal varicosities
CLINICAL FEATURE
CLINICAL FEATURE
 Demographics – Age ; CVI increases with age – Gender ;Women have three to four-fold
Demographics
– Age ; CVI increases with age
– Gender ;Women have three to four-fold
higher risk for varicose veins than men
– Race ; Whites at greater risk than
Hispanics, who are at greater risk than
Asians
– Obesity ; Obesity increases the risk for
varicosities in women
CLINICAL FEATURE
CLINICAL FEATURE
 History of Present Illness  Symtoms of venous desease are pain, swelling, and cutanous changes
History of Present Illness
Symtoms of venous desease are pain,
swelling, and cutanous changes
Clinical risk factors for acute venous
thromboembolism ;
Strong risk ( OR> 10 ) ;
– knee or hip replacement; Major trauma;
fracture hip or knee ; spinal cord injury
CLINICAL FEATURE
CLINICAL FEATURE
 Moderate risk ( OR 2-9 ) ; – Abdominal and thoracic surgery – Arthroscopic surgery
Moderate risk ( OR 2-9 ) ;
– Abdominal and thoracic surgery
– Arthroscopic surgery
– CHF
– Chemotherapy
– Hormone replacement therapy
– Thrombophilia
CLINICAL FEATURE  Low risk ( Odds ratio < 2 ) – Age – Bed rest
CLINICAL FEATURE
Low risk ( Odds ratio < 2 )
– Age
– Bed rest > 3 days
– Obesity
– Varicose vein
– Prolonged car or airplane travel
– Pregnancy
Past Medical and Surgical History
Past Medical and Surgical History
 A History of DVT  A History of malignancy  Paralysis due to spinal cord
A History of DVT
A History of malignancy
Paralysis due to spinal cord injury
Pregnancy increases the risk of VTE
Medication such as estrogen
Thrombophilia and hypercoagulable
DEEP VENOUS THROMBOSIS (DVT)
DEEP VENOUS THROMBOSIS (DVT)
 General Consideration – The deep veins of the lower extremities and pelvis are most frequently
General Consideration
– The deep veins of the lower extremities
and pelvis are most frequently involved.
– The process begins 80 % of the calf, the
popliteal and femoral veins 10 %.
– DVT develop up to 2 weeks
posteperatively.
Clinical Findings
Clinical Findings
 Approximately half of patient with DVT have no symtoms or signs in the extremity in
Approximately half of patient with DVT
have no symtoms or signs in the
extremity in the early stages.
The patient may suffer a pulmonary
embolism, presumably from the leg
veins, without symtoms or
demonstrable abnormalities in the
extemities.
Symtoms and signs
Symtoms and signs
 The patient may complain of a dull ache, a tight feeling, or frank pain in
The patient may complain of a dull
ache, a tight feeling, or frank pain in
the calf or, in more extensive cases,
the whole leg, especially when
walking.
Leg pain and leg swelling
The skin may be cyanotic
Signs
Signs
 Leg swelling  Localized tenderness along the distribution of the DVT  Dilated supeficial veins
Leg swelling
Localized tenderness along the
distribution of the DVT
Dilated supeficial veins
Redness and warmth
Phlegmasia alba dolens and cerula
dolens
Differential Diagnosis
Differential Diagnosis
 Hematoma, muscle injury  Cellulitis  Ruptured Baker’s cyst  Arthritis of the knee or
Hematoma, muscle injury
Cellulitis
Ruptured Baker’s cyst
Arthritis of the knee or the ankle joint
Swelling following recent hip or knee
surgery
Superficial phlebitis