Disorders of the Veins and Arteries
Nurs 6501
Disorders of the Veins and Arteries
The vascular system comprises of veins, arteries, and capillaries. Diseases of the vascular system are common and can be serious. Two types of diseases are chronic venous insufficiency (CVI) and deep vein thrombosis (DVT). More than 2.5 million individuals suffer from chronic venous insufficiency and approximately 187,000 new cases of DVT are diagnosed each year. The purpose of this paper is to discuss CVI and DVT, discuss similarities and differences of these two diseases, and explain a patient factor might impact the pathophysiology of these two diseases. Mind maps of both diseases must be constructed as well.
Pathophysiology of CVI and DVT
Both CVI and DVT occur in the veins with the most common veins affected are those in the lower extremities. Nurse Practitioner must understand the venous anatomy and physiology of the lower extremities under normal conditions in order to comprehend the causative pathology of both CVI and DVT. Located in the superficial and deep veins are bicuspid valves that prevents blood to reflux toward the feet while an individual is standing or in an upright position. These veins open and close approximately every 20 minutes due to pressure. Venous valves are vulnerable to initiation and formation of thrombus and subsequent further damage that leads to CVI (Durham & Hebert, 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap).
Chronic Venous Insufficiency. CVI occurs when the veins are incompetent allowing blood to leak backward. CVI occurs over a long period of time due to prolonged standing, pregnancy, female gender, trauma, surgery, and genetics (Durham & Hebert, 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap). When the veins and valves are weakened to the point where it is difficult for the blood to flow up to the heart, blood pressure in the veins stays elevated for long periods of time, leading to CVI (Cleveland Clinic, 2015 – Research Paper Writing Help Service). The stasis causes white blood cells and platelets to be trapped which leads to inflammation reaction in vessels and tissue leading to fibrosclerotic remodeling of the skin and the ulceration (Huether & McCance, 2017, pg. 598).
Deep Vein Thrombosis. DVT is an embolus that has occluded a vessel. Typically DVTs are formed in the soleus sinusoids and cusps of the valves of the calf veins. Hypoxia of the endothelium leads to expressing adhesion molecules that attract leukocytes. Leukocytes transfer tissue factor that complex with activated factor VII causing a coagulation cascade via the extrinsic pathway resulting in clot formation. Thrombi can form in both arteries and veins, but both have different pathophysiology and different outcomes. The differences between venous and arterial thrombi are the mechanism, location, and composition. Arterial thrombi are located in the arteries and left chambers of the heart, composed of mainly of platelets, and typically occur from a rupture of atherosclerotic plaques. Venous thrombi are located in venous sinusoids of muscles and valves in veins, composed mainly of fibrin, and typically are a combination of factors from Virchow’s triad (hypercoagulability, stasis, and endothelial damage) (Wong & Chaudhry, 2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). Treatment for both are different as well. Arterial thrombi would be treated with antiplatelet agents whereas venous thrombi are treated with anticoagulants.
Risk Factors and Disorders of Veins and Arteries
There are numerous risk factors for both DVT and CVI such as age, gender, behavioral, and genetics. Vascular changes in women increase due to pregnancy and use of birth control pills. A risk factor for CVI is a DVT. A risk factor that is common with both CVI and DVT is obesity. Obesity was once not thought of as a major risk factor, studies now show that being overweight increases the likelihood of developing vein diseases and the severity is increased in comparison to normal weight individuals. Diagnosing CVI or DVT in an obese individual must start with an in-depth history and physical. An individual with a family history of a bleeding disorder is predisposed to the development of DVTs. If a DVT is suspected, an ultrasound and D-timer lab will be obtained. A decrease in resolution of the ultrasound is seen in the obese patient. False negative results due to edematous extremities is also seen in obese individuals. An alternative to ultrasound would be to obtain a computed tomography venogram. Once a diagnosis is made, starting an anticoagulant, change in diet, and weight loss would be ordered. If the individual does loss weight, their inflammation will decrease and improve blood chemistry which decreases the risk of clotting. With that being said, this does not guarantee the chance of developing another DVT.
CVI is diagnosed using an ultrasound as well. A complete history and physical should be obtained as well. Treatment for a CVI starts with prevention. It is important to counsel individuals with risk factors on preventive measures such as change in diet, compression stockings, and lower extremity exercises. Obesity can increase the risk of developing skin infections due to poor venous stasis and must be treated with antibiotics. If the individual has a history of DVT, treatment with anticoagulation will be started. For the obese patient, discuss the importance of good hygiene will help decrease skin infections as well. There are non-surgical and surgical options are available for both DVT and CVI, which should be consider if non invasive treatments are not improving the clot or insufficiency.
Conclusion
Diseases of the veins and arteries are quite different conditions but share common risk factors. Both DVT and CVI are at times mistaken for signs of other conditions due to their symptoms which make for difficulty in diagnosing. Obesity can affect the pathophysiology of both DVT and CVI. Recognizing the symptoms and differentiate between DVT and CVI is beneficial in proper treatment.
References
Cleveland Clinic. (2015 – Research Paper Writing Help Service). Chronic venous insufficiency (CVI). Retrieved from https://my.clevelandclinic.org/health/diseases/16872-chronic-venous-insufficiency-cvi
Durham, K. C. & Hebert, A. A. (2014: 2024 – Essay Writing Service. Custom Essay Services Cheap). Chronic venous insufficiency: Pathophysiology and treatment. Today’s Wound Clinic, 6(9). Retrieved from https://essays.homeworkacetutors.com/write-my-essay/todayswoundclinic.com articles/chronic-venous-insufficiency-pathophysiology-and-treatment
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Wong, E. & Chaudhry, S. (2008 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). Venous thromboembolism (VTE). New England Journal of Medicine, 358(10), 1037-1052. Retrieved from https://essays.homeworkacetutors.com/write-my-essay/pathophys.org/vte/#Etiology
