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The balance of the blood circulatory system can be disturbed by a number of internal and external factors, which lead to significant alterations in blood flow and clotting states, posing a considerable threat to patients. Despite being similar, these conditions often require different treatments. It is a responsibility of an Advanced Practice Nurse to recognize signs of various vascular disorders to be able to approach them correctly.
Chronic Venous Insufficiency vs. Deep Venous Thrombosis
Chronic Venous Insufficiency (CVI) is impaired venous return, which occurs in hypertensive patients owing to valvular incompetence and makes venous blood escape from its normal course, refluxing back down the veins. The risk factors of the disease include surgery, gender, genetics, pregnancy, obesity, and working conditions (prolonged standing). There are numerous mechanisms that may lead to the damaging of valves (Tibbs, 2013). Secondary valve failure can come as a result of a direct injury, superficial phlebitis, weak veins dilating under normal hydrostatic pressure, or congenital abnormalities–it is highly important to identify the cause to address the condition.
In order to fully comprehend the pathophysiology of the disease, it is necessary to understand the anatomy of the lower extremities in their normal state. When the patient stands upright, the systems of superficial and deep veins in the lower extremities must ensure that the blood is directed to the heart, preventing its reflux back to the feet with the help of perforating valves (Eberhardt & Raffetto, 2014). This function is distorted when the patient suffers from CVI.
With the development of CVI, the interruption of the normal blood flow through the extremity results in hypoxia and acidosis since the demands of the cells cannot be satisfied. Leukocyte trapping triggers the release of adhesion molecules leading to inflammation, which is responsible for ulceration or dermatitis. If these consequences are not addressed in due time, colonization of bacteria will create a non-healing wound. Patients often stay unaware of their condition until they notice dilated veins in their legs, swelling, itching, achiness, or tiredness (Gujja, Wiley, & Krishnan, 2014).
Unlike CVI, Deep Venous Thrombosis (DVT) is caused by the clotting of blood in a deep vein (usually in a thigh or a calf). The condition emerges when a blood clot or a thrombus is released from a wall of a vessel. There are three key factors that may lead to clotting (referred to as the triad of Virchow): 1) age; 2) immobility; 3) CHF. Other risks include traumas, hypercoagulable states (due to oral contraceptives or hormone therapy), pregnancy, IV medications, diabetes, metabolic syndrome, spinal cord injury, obesity, hypertension, and orthopedic surgery (Iverson & Gomez, 2013).
The condition happens to owe to the accumulation of fibrin, thrombin, platelet, and RBCs and presents itself with redness and the swelling of the affected area and tenderness along with the distribution of veins; however, in some patients, it may be totally asymptomatic (as compared to CVI) (Darwood & Smith, 2013). Ankle dorsiflexion with the knee extended may cause discomfort.
Although there is an increasing body of evidence that proves the likelihood of DVT and arterial thrombosis since they share their symptoms and risk factors, these diseases are still different in their nature. A vein carries blood to the heart under lower pressure while an artery carries blood away from it under higher pressure. This implies that with DVT, there is a danger that a clot will travel up to the heart into the lungs, causing a pulmonary embolism (Tibbs, 2013). With arterial thrombosis, blockages usually hinder the flow of blood to certain organs.
Despite the fact that some researchers believe that the occurrence of CVI and DVT is not related to gender, there are still differences in these conditions in men and women. While it is typical of women to develop CVI, DVT is more common in men. However, oral contraception and pregnancy increase women’s chances to have DVT. This is accounted for by the fact that hormones raise the risk of clotting. According to the recent statistics, the condition occurs in 14% of men and 9% of women. CVI, on the contrary, is met in 25% of women and 15% of men (Tibbs, 2013). Both diseases can be identified with the help of venogram and Duplex ultrasonography.
Thus, in treating women, who are more likely to suffer from CVI, the primary goal is to prevent reflux and venous hypertension, which can be done with the help of compression stockings or leg elevation. Laser therapy can also be used in some cases. On the contrary, since men are more often subject to DVT, the typical treatment will be the prevention of embolization (Kearon & Akl, 2014). Oral anticoagulants following heparin are the best option in this case.
Mind Map: CVI
Mind Map: DVT
Darwood, R. J., & Smith, F. C. (2013). Deep Vein Thrombosis. Surgery (Oxford), 31(5), 206-210.
Eberhardt, R. T., & Raffetto, J. D. (2014). Chronic Venous Insufficiency. Circulation, 130(4), 333-346.
Gujja, K., Wiley, J., & Krishnan, P. (2014). Chronic Venous Insufficiency. Interventional Cardiology Clinics, 3(4), 593-605.
Iverson, R. E., & Gomez, J. L. (2013). Deep Venous Thrombosis. Clinics in Plastic Surgery, 40(3), 389-398.
Kearon, C., & Akl, E. A. (2014). Duration of anticoagulant therapy for Deep Vein Thrombosis and pulmonary embolism. Blood, 123(12), 1794-1801.
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Tibbs, D. J. (2013). Varicose veins and related disorders. Oxford, UK: Butterworth-Heinemann.