Pathophysiology
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Pathophysiology
Chronic venous insufficiency (CVI) is the disorder that happens when the venous valves or wall do not work efficiently in the leg veins. It creates difficulty for the blood to flow into the veins of the. CVI is impaired venous return that results in skin changes, discomfort, and edema. Deep vein thrombosis (DVT) is the preventable cause of mortality and morbidity. The symptoms of DVT include swelling and pain in legs and venous ulcer in some of the cases. The causes of the DVT include; hypercoagulability, stasis or low blood flow, and vessel wall damage. To diagnose CVI duplex ultra sound and measure of blood pressure in legs are taken while to diagnose DVT ultra sound along with physical and history assessment is used. About forty percent of Americans face issue of CVI ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"mOu7MODm","properties":{"formattedCitation":"(Quist-Paulsen et al., 2010)","plainCitation":"(Quist-Paulsen et al., 2010)","noteIndex":0},"citationItems":[{"id":656,"uris":["http://zotero.org/users/local/mlRB1JqV/items/XTJQZLF2"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/XTJQZLF2"],"itemData":{"id":656,"type":"article-journal","title":"Arterial cardiovascular risk factors and venous thrombosis: results from a population-based, prospective study (the HUNT 2)","container-title":"Haematologica","page":"119-125","volume":"95","issue":"1","source":"PubMed","abstract":"BACKGROUND: An explanation for the increased risk of myocardial infarction and stroke in patients with venous thrombosis is lacking. The objective of this study was to investigate whether risk factors for arterial cardiovascular disease also increase the risk of venous thrombosis.\nDESIGN AND METHODS: Cases who had a first venous thrombosis (n=515) and matched controls (n=1,505) were identified from a population-based, nested, case-cohort study (the HUNT 2 study) comprising 71% (n=66,140) of the adult residents of Nord-Trøndelag County in Norway.\nRESULTS: The age- and sex-adjusted odds ratio of venous thrombosis for subjects with concentrations of C-reactive protein in the highest quintile was 1.6 (95% confidence interval: 1.2-2.2) compared to subjects with C-reactive protein in the lowest quintile. This association was strongest in subjects who experienced venous thrombosis within a year after blood sampling with a three-fold increased risk of participants in the highest versus the lowest quintile. Having first degree relatives who had a myocardial infarction before the age of 60 years was positively associated with venous thrombosis compared to not having a positive family history [odds ratio 1.3 (95% confidence interval: 1.1-1.6)]. Subjects with blood pressure in the highest quintile had half the risk of developing venous thrombosis compared to subjects whose blood pressure was in the lowest quintile. There were no associations between the risk of venous thrombosis and total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, triglycerides, glucose or smoking. We confirmed the positive association between obesity and venous thrombosis.\nCONCLUSIONS: C-reactive protein and a family history of myocardial infarction were positively associated with subsequent venous thrombosis. Blood pressure was inversely correlated to venous thrombosis. These findings should be confirmed by further investigations.","DOI":"10.3324/haematol.2009.011866","ISSN":"1592-8721","note":"PMID: 19713225\nPMCID: PMC2805742","title-short":"Arterial cardiovascular risk factors and venous thrombosis","journalAbbreviation":"Haematologica","language":"eng","author":[{"family":"Quist-Paulsen","given":"Petter"},{"family":"Naess","given":"Inger Anne"},{"family":"Cannegieter","given":"Suzanne C."},{"family":"Romundstad","given":"Pål R."},{"family":"Christiansen","given":"Sverre C."},{"family":"Rosendaal","given":"Frits R."},{"family":"Hammerstrøm","given":"Jens"}],"issued":{"date-parts":[["2010",1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Quist-Paulsen et al., 2010). On the other hand, one out of thousands American face DVT issue where number of cases remain undiagnosed. The treatment of the DVT include heparin, warfarin, and elevate legs whereas patient with CVI should take treatment according to their nature and severity of disease.
Venous thrombosis is the blood clot known as thrombus that develops within a vain. Thrombosis is the term that is used to define the blood clotting within a blood vessel. Arterial thrombosis is also defines the blood clotting but occurs in an artery. The common type of the venous thrombosis is deep vein thrombosis (DVT) while common type of arterial thrombosis is the chronics venous insufficiency (CVT). Both types of blood clotting occur in legs but with different symptoms and complications. Venous thrombosis is kind of inflammatory reaction where white blood cells are crucial for the resolution of venous clots ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ZYYNxDYr","properties":{"formattedCitation":"(Eberhardt Robert T. & Raffetto Joseph D., 2014)","plainCitation":"(Eberhardt Robert T. & Raffetto Joseph D., 2014)","noteIndex":0},"citationItems":[{"id":654,"uris":["http://zotero.org/users/local/mlRB1JqV/items/PWCRRLKM"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/PWCRRLKM"],"itemData":{"id":654,"type":"article-journal","title":"Chronic Venous Insufficiency","container-title":"Circulation","page":"333-346","volume":"130","issue":"4","source":"ahajournals.org (Atypon)","DOI":"10.1161/CIRCULATIONAHA.113.006898","journalAbbreviation":"Circulation","author":[{"literal":"Eberhardt Robert T."},{"literal":"Raffetto Joseph D."}],"issued":{"date-parts":[["2014",7,22]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Eberhardt Robert T. &Raffetto Joseph D., 2014). In case of arterial thrombosis blockage occur with the artery which make difficult for blood to circulate freely. If the piece of blood clot breaks into the pieces it enters into the lungs through right side of the heart which can create more complication in patient’s health. On the other hand arterial thrombosis makes artery narrow and hard which create difficulties for heart to work property. If the disorder gets diagnosed on time that is from artery clotting can be removed however breakage of clotting into pieces is difficult to be treated.
The factor which causes chronics venous insufficiency is the arterial thrombosis which damages the valve. The formation of clotting occurs when patient is not regular with his physical activities. Lack of exercise and flexibility in the muscles make artery harder and blood circulation get effected. When the blood does not find its way to circulate it transform into clotting which results in blocking with the artery. In addition history assessment is crucial that impact the pathophysiology of CVI ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Rtbnn1ya","properties":{"formattedCitation":"(Min et al., 2016)","plainCitation":"(Min et al., 2016)","noteIndex":0},"citationItems":[{"id":661,"uris":["http://zotero.org/users/local/mlRB1JqV/items/8EQD72T5"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/8EQD72T5"],"itemData":{"id":661,"type":"article-journal","title":"Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines","container-title":"Vascular Specialist International","page":"77-104","volume":"32","issue":"3","source":"PubMed Central","abstract":"Lower extremity deep vein thrombosis is a serious medical condition that can result in death or major disability due to pulmonary embolism or post-thrombotic syndrome. Appropriate diagnosis and treatment are required to improve symptoms and salvage the affected limb. Early thrombus clearance rapidly resolves symptoms related to venous obstruction, restores valve function and reduces the incidence of post-thrombotic syndrome. Recently, endovascular treatment has been established as a standard method for early thrombus removal. However, there are a variety of views regarding the indications and procedures among medical institutions and operators. Therefore, we intend to provide evidence-based guidelines for diagnosis and treatment of lower extremity deep vein thrombosis by multidisciplinary consensus. These guidelines are the result of a close collaboration between interventional radiologists and vascular surgeons. The goals of these guidelines are to improve treatment, to serve as a guide to the clinician, and consequently to contribute to public health care.","DOI":"10.5758/vsi.2016.32.3.77","ISSN":"2288-7970","note":"PMID: 27699156\nPMCID: PMC5045251","title-short":"Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis","journalAbbreviation":"Vasc Specialist Int","author":[{"family":"Min","given":"Seung-Kee"},{"family":"Kim","given":"Young Hwan"},{"family":"Joh","given":"Jin Hyun"},{"family":"Kang","given":"Jin Mo"},{"family":"Park","given":"Ui Jun"},{"family":"Kim","given":"Hyung-Kee"},{"family":"Chang","given":"Jeong-Hwan"},{"family":"Park","given":"Sang Jun"},{"family":"Kim","given":"Jang Yong"},{"family":"Bae","given":"Jae Ik"},{"family":"Choi","given":"Sun Young"},{"family":"Kim","given":"Chang Won"},{"family":"Park","given":"Sung Il"},{"family":"Yim","given":"Nam Yeol"},{"family":"Jeon","given":"Yong Sun"},{"family":"Yoon","given":"Hyun-Ki"},{"family":"Park","given":"Ki Hyuk"}],"issued":{"date-parts":[["2016",9]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Min et al., 2016). If the patient had heath issue related to the blood pressure it might narrow the case and treatment of the patient. For the patient of the deep vein thrombosis the factor causing it is venous thrombosis which makes vein narrow and hard. The health and background assessment play vital role to understand the case of the patient because sometimes the issue can be genetically transferred which requires different treatment. In addition, symptoms like pain and extremely redness should not be neglected by the patient.
The patient can identified the issue when he feels a constant pain and dark skin area in legs. He should make an immediate treatment and checkup is required as soon as he noticed the issue. To diagnose the CVI measuring blood pressure and duplex ultra sound is necessary. These two methods are significant to know the details of CVI. In addition if the artery is not allowing the blood circulation it mean patient has CVI. Treatment is different for every patient according to the condition of the leg or disease ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"V2W9ZSwt","properties":{"formattedCitation":"(Patel & Surowiec, 2019)","plainCitation":"(Patel & Surowiec, 2019)","noteIndex":0},"citationItems":[{"id":658,"uris":["http://zotero.org/users/local/mlRB1JqV/items/SC2PRZEI"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/SC2PRZEI"],"itemData":{"id":658,"type":"chapter","title":"Venous Insufficiency","container-title":"StatPearls","publisher":"StatPearls Publishing","publisher-place":"Treasure Island (FL)","source":"PubMed","event-place":"Treasure Island (FL)","abstract":"Chronic venous insufficiency (CVI) typically refers to lower extremity edema, skin trophic changes, and discomfort secondary to venous hypertension. Chronic venous insufficiency is a prevalent disease process. Disability-related to chronic venous insufficiency attributes to diminished quality of life and loss of work productivity. In most cases, the cause is incompetent valves. Each year approximately 150,000 new patients are diagnosed with chronic venous insufficiency, and nearly $500 million is used in the care of these patients. The CEAP classification (clinical, etiology, anatomy, and pathophysiology) has been developed to guide decision-making in chronic venous insufficiency evaluation and treatment. The system has shown to predict the patient quality of life and severity of their symptoms.[1][2][3]","URL":"http://www.ncbi.nlm.nih.gov/books/NBK430975/","call-number":"NBK430975","note":"PMID: 28613694","language":"eng","author":[{"family":"Patel","given":"Shivik K."},{"family":"Surowiec","given":"Scott M."}],"issued":{"date-parts":[["2019"]]},"accessed":{"date-parts":[["2019",6,19]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Patel &Surowiec, 2019). On the other hand, for the patient of DVT ultra sound, health assessment, and history is crucial to diagnose the disease. If the patient facing issue of redness and pain in that area then there is the maximum chances that he has DVT. For the treatment proper exercise and therapy is useful. The other treatments for the DVT patients include Heparin and elevate legs.
Mind Maps
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00Physical and history
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00Deep Venous Thrombosis
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00Various cases remain undiagnosed
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00Annual incident of about one in thousands people
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00Arteries circulate oxygen rich blood to the body
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00Chronic Venous Insufficiency
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00Backflow of blood
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References
ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Eberhardt Robert T., & Raffetto Joseph D. (2014). Chronic Venous Insufficiency. Circulation, 130(4), 333–346. https://doi.org/10.1161/CIRCULATIONAHA.113.006898
Min, S.-K., Kim, Y. H., Joh, J. H., Kang, J. M., Park, U. J., Kim, H.-K., … Park, K. H. (2016). Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines. Vascular Specialist International, 32(3), 77–104. https://doi.org/10.5758/vsi.2016.32.3.77
Patel, S. K., & Surowiec, S. M. (2019). Venous Insufficiency. In StatPearls. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK430975/
Quist-Paulsen, P., Naess, I. A., Cannegieter, S. C., Romundstad, P. R., Christiansen, S. C., Rosendaal, F. R., & Hammerstrøm, J. (2010). Arterial cardiovascular risk factors and venous thrombosis: Results from a population-based, prospective study (the HUNT 2). Haematologica, 95(1), 119–125. https://doi.org/10.3324/haematol.2009.011866
