insufisiensi vena kronik ka jadeh

8/10/2019 Insufisiensi Vena Kronik Ka Jadeh

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INSUFISIENSI VENAKRONIK

disusun oleh:Intan Maulinar

Pembimbing:

dr. Yopie A. Habibie, Sp.BTKV


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Epidemiologi

5-30% pada populasi dewasaWanita : pria = 3 : 1


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Anatomi


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Etiologi

Insufisiensi vena kronik yang kongenital ( present since birth )

Terdapat kelainan dimana katup yang seharusnya terbentuk di suatusegmen ternyata tidak terbentuk sama sekali (aplasia, avalvulia), ataupembentukannya tidak sempurna (displasia), berbagai malformasi vena,dan kelainan lainnya.

Insufisiensi vena kronik yang primer ( undetermined etiology )

Kelemahan intrinsik dari dinding katup, yaitu terjadi daun katup yang terlalupanjang (elongasi) atau daun katup menyebabkan dinding vena menjaditerlalu lentur tanpa sebab yang diketahui. Keadaan daun katup yangpanjang melambai (floppy, rebundant) sehingga penutupan tidak sempurnayang mengakibatkan terjadinya katup tidak dapat menahan aliran balik,sehingga aliran vena menjadi retrograd atau refluks.

Insufisiensi vena kronik yang sekunder ( associated with post-thrombotic,

traumatic )


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Faktor Resiko

Penambahan Usia

Jenis Kelamin

Family history of venous disease

Berdiri terlalu lama

Increased body mass indexSmoking

Inaktivitas fisik

Lower extremity trauma

Prior venous thrombosis (superficial or deep)

Hereditary conditions

High estrogen states

Pregnancy 2.
http://howmanyarethere.net/wp-content/uploads/2012/10/healthy_pregnancy_image.jpghttp://www.trauma.org/archive/cases/images/classic013b.jpghttp://www.osteoarthritisblog.com/category/about-knee-osteoarthritis/page/2/http://www.medimanage.com/my-worries/articles/have-digestion-problems-heres-why.aspxhttp://uhaweb.hartford.edu/IKEACHUMB/


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Patofisiologi

Refluks

CVI merupakan akibat dari disfungsi katup-katup vena yangmenyebabkan aliran darah vena yang anterograd untukmengalir dalam dua arah, yaitu secara antegrad dan

retrograde, sehingga terjadi refluks darah dalam pembuluhdarah (vena).

Hal ini menyebabkan vena tidak saja menerima darah yangdipompa dari ventrikel kiri, tetapi juga aliran darah daridalam pembuluh darah yang gagal dipompa ke atrium kanan(atau dari aliran vena yang tidak efisien)

Pembuluh darah vena berfungsi mengalirkan darah dariseluruh tubuh kembali ke jantung. Untuk mencapai jantung,darah pada vena tungkai harus mengalir ke arah atas. Otot

otot tungkai harus berkontraksi untuk memeras darah padavena tersebut. Vena memiliki katu satu arah untuk


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CVI terjadi jika katup ini mengalami kerusakan sehingga darah yang dipompa kembali ke arahbawah dan tertumpuk sehingga tekanan dalamvena meningkat. Kerusakan katup dapat terjadiakibat proses penuaan, duduk atau berdiridalam jangka waktu lama, atau penurunanmobilitas tungkai.ObstruksiSumbatan pada vena profunda tungkai ( deepvein thrombosis , DVT), dapat akut maupunkronis

Kombinasi


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Manifestasi Klinis

ASYMPTOMATICSUPERFICIAL VENOUS DILATATION

Telangiectasis (intradermal)

Reticular veins (subdermal)


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VARICOSE VEINS (subcutaneous)


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Leg edema


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Skin changesHyperpigmentation


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Skin changesStasis dermatitis


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Skin changesCorona phlebectatica

a. venous cups (veins)

b. telangiectasisc. reticular veins

d. stasis spots(capillaries)


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Lipodermatosclerosisa form of panniculitis just above the ankles


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Venous stasis ulceration


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CLASSIFICATION OF VEINDISEASECEAP an international consensus conference initiated the Clinical-Etiology-Anatomy-

Pathophysiology classification.

C 0 no evidence of venous disease.C 1 telangiectasias/reticular veins.C 2 varicose veins.C 3 edema associated with vein disease.C 4a pigmentation or eczema.C 4b lipodermatosclerosis.

C 5 healed venous ulcer.C 6 active venous ulcer.E c congenitalE p primary venous disease.E s secondary venous disorder.E n not specified.

A s superficial veins. A d deep veins. A p perforating veins. A n not specified.P r venous reflux.P o venous obstruction.P n not specified.


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Diagnosis

AnamnesisPemeriksaan fisikInspection dan palpation may reveal visualevidence for CVI Pemeriksaan penunjang


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Pemeriksaan Penunjang

Venous Duplex Imaging Photoplethysmography (PPG) Air Plethysmography (APG)


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VENOUS DOPPLER ULTRASOUNDEvaluate for deep and superficial venousthrombosis.Evaluate for incompetent veins withsignificant reflux disease.Evaluate for incompetent perforatingveins and tributaries.


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Tata Laksana


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LEG ELEVATION heart level for 30 minutes 3-4 timesdaily improves micro-circulation reduces edema, andpromotes healing of venous ulcers.

EXERCISE daily walking and simple ankle flexionexercises.

Conservative Management


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Compression therapy Compression bandages elastic or non-elastic

with single or multi-layers.


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Compression stockings


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CLASS PRESSURE LEVEL OF

SUPPORT

INDICATION CEAP

OTC 40 mmHg Extra firm Lymphedema. NA


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MANAGEMENT OF CVI SKINCARE

Skin cleansing wash with a mild non-soapcleanser (e.g. Dove, Olay, Caress).Emollients provides a film of oil to lubricate

the skin (e.g. Vaseline, Lubriderm, Aveeno).Barrier preparations physically blockchemical irritants and moisture (e.g. Zinc

oxide, Vaseline ).Topical corticosteroids often used to treatstasis dermatitis.


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MANAGEMENT OF CVI -MEDICATIONS

Pentoxifylline more effective for complete or partialulcer healing.Stanozolol an anabolic steroid that stimulatesfibrinolysis and improves lipodermatosclerosis andpossibly ulcer healing.Escin (horseshoe chestnut) 50mg twice daily reducesleg volume and edema. It stimulates the release of Fseries prostaglandins which induce venoconstriction,decreasing the permeability of vessel walls to lowmolecular proteins, water, and electrolytes.


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MANAGEMENT OF CVI VENOUSSTASIS ULCERS

Surgical debridement used to removedevitalized tissue.Enzymatic agents used to break downnecrotic tissue (e.g. Santyl).Growth factors synthesized by many celltypes such as platelets, neutrophils, andepithelial cells (e.g. Regranex).

Bioengineered tissue

used for a variety ofnon-healing ulcers (e.g. Apligraf, Dermagraft).Skin grafting an option for non-healing ulcers.


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MANAGEMENT OF CVI VENOUSSTASIS ULCERS

Dressings depend upon the ulcer characteristics,frequency of dressing changes, and cost.-Occlusive dressings may be fully occlusive(impermeable to gases and liquids) or semi-impermeable (impermeable to liquids and partiallypermeable to gases and water vapor).It stimulates collagen synthesis, angiogenesis, andspeeds reepithelialization.-Low adherent gauze dressings frequent changes butinexpensive.-Hydrogels and alginate dressings are highly absorbentto handle heavily exudative ulcers, while hydrocolloidscan help with wound debridement and skin protection.-Silver can be incorporated if the ulcer is infected.


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MANAGEMENT OF CVI -SCLEROTHERAPY

Chemical irritants injected to close unwantedveins. Preparations include liquid and foam. It isused primarily in the treatment of

telangiectasias, reticular veins, and smallvaricose veins.These substances cause endothelial damage bytheir actions as either osmotic or detergentagents. Osmotic agents achieve their effect bydehydrating endothelial cells through osmosis.Detergents are surface active agents whichdamage the endothelium by interfering with cellmembrane lipids. 8.


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MANAGEMENT OF CVI -SCLEROTHERAPY

DETERGENT AGENTS- Sodium tetradecyl sulfate- Polidocanol

OSMOTIC AGENTS- Hypertonic saline- Glycerin


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MANAGEMENT OF CVI ABLATIONTHERAPY

Indications patients with persistentsigns/symptoms of venous disease after aminimum of 3 months of medical therapy (e.g.compression) and documented reflux (e.g.>0.5 seconds of reflux GSV).

Absolute contraindications acute DVT orphlebitis and pregnancy.


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MANAGEMENT OF CVI RADIOFREQUENCY ENDOVENOUS

ABLATION THERAPY

Radiofrequency devices generate a high

frequency alternating current for which theenergy heats the adjacent vein walls to theprobe which alters the protein structure of thevein effecting its closure.Superficial veins include Great SaphenousVein, Small Saphenous, and incompetentperforator veins.

MANAGEMENT OF CVI


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MANAGEMENT OF CVI ENDOVENOUS LASER ABLATIONTHERAPY

Lasers emit a single, coherent wavelength of light.Laser therapy of venous structures is based uponthe concept of selective photothermolysis (ie,selective thermal confinement of light induceddamage). Vein wall injury is mediated directly byabsorption of photon energy by the vein wall andindirectly by thermal convection from steambubbles, and from heated blood.Superficial veins include Great Saphenous Vein,

Small Saphenous Vein, incompetent perforator


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Surgical Treatment

- Vein ligation/stripping- Phlebectomy- Valve reconstruction- Open or endoscopic perforator ligation.


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