This paper will discuss the pathophysiology of Deep Vein Thrombosis (DVT) and Chronic Venous Insufficiency (CVI). Also, the impact that age has on the pathophysiology, diagnosis, and treatment of the two disorders will be discussed. Finally, the pathophysiology and the treatment options for the two diseases will be will be compared, and a mind map will be presented to organize the information about the two diseases visually.
DVT and CVI
DVT results from the formation of clots in the deep veins of either arms or legs, but it is more common in the thighs, calf or pelvis. This causes a build-up of pressure in the veins, and the major complication of DVT is pulmonary embolism (PE), whose symptoms are a raising heartbeat, chest pains and difficulty breathing. DVT mostly develops in patients who have had long periods of hospitalization, (hence have limited movements), those who have undergone surgery, pregnant women as well as immobile persons (Huether & McCance, 2012). Many risk factors are associated with DVT which includes inflammatory bowel disease (IBD), pregnancy, use of tobacco, inherited blood disease, heart disease, and pregnancy. Symptoms that are associated with DVT include pain and swelling of the affected organ and prominently visible veins under the skin (Rosendaal, 2016). Chronic Venous Insufficiency (CVI) is a chronic condition associated with DVT, and varicose veins and symptoms include swelling of the legs and pain. Time is a significant factor, and the ultimate effect is progressive varicose veins, discoloration, and leg swelling. Ulcers may also occur near the ankles (Hamdan, 2012).
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Pathophysiology of DVT and CVI
DVT in the lower extremities results from an impairment of venous return, an injury or dysfunction to the to the endothelium as well as hypercoagulability. DVT in the upper extremities usually occurs in the upper part of the superior vena cava, and it results from injury to the endothelium due to injection drug use, insertion of catheter or pacemakers. Upper extremity DVT can also occur due to compression of the subclavian vein at the thoracic outlet or a hypercoagulable state. The primary cause of CVI is impaired blood circulation, i.e., improper valve functions which results in the backward flow of blood and hence venous pooling. CVI mainly develops when there are previous cases of blood clots and varicose veins (Huether & McCance, 2012).
Impacts of Age On the Pathophysiology, Diagnosis, And Treatment of DVT and CVI
DVT can occur in individuals of any age, but it is more common in the older people than in, the younger generation. More specifically, people with the age of over 70 years are affected by DVT, and more than 60% of DVT cases are from this age group. Also, the prevalence of CVI is also high among the much older people. Among the young people and the middle-aged, DVT mostly leads to PE. Studies show that PE causes one-third of the total deaths caused by DVT among the elderly. Frailty among the elderly has also been described as a risk factor for DVT (McPhee & Hammer, 2014).
Diagnosis of DVT can be very challenging, but diagnosis based on age can be determined in the elderly when the patient complains of pain and visible swelling. However, it is difficult to detect typical DVT symptoms among the elderly. Diagnosis for CVI, on the other hand, is usually visual, with more focus on the appearance of the skin on the lower limbs (symptoms looked for are ulcers, skin color change, hyperpigmentation, and edema). The standard method for diagnosis of CVI, however, is duplex ultrasound examination which detects venous backflow or vein incompressibility. DVT may be diagnosed using an X-Ray or magnetic resonance imaging depending on the age of the patient. The standard diagnostic procedure is contrast venography which is an invasive procedure that is not suitable for elderly patients (Watanabe, Ono, Sakakura, & Fujita, 2017).
There are limited treatment options for CVI, but currently, treatment is based on intensive skin care, compression stockings, and leg elevation. Depending on the age of the patient, surgical interventions are also an option. The standard treatment for DVT is anticoagulant medications such as heparin and warfarin. However, in the elderly patients, these drugs have adverse effects such as delirium. Therefore, direct oral anticoagulants (DOAC) are more commonly used in the treatment of seniors (Watanabe et al., 2017).
Conclusion
It's important to note that though the risk factors for DVT and CVI are similar, their pathophysiology, as well as diagnosis and treatment options, are entirely different. While DVT is caused mainly by blood clots in the deep veins, CVI is caused by impaired blood flow and improper valve function leading to venous backflow of blood and hence venous pooling ( McPhee & Hammer, 2014). Both disorders are differently treated where DVT is managed using anticoagulants or drugs that can dissolve the blood clots; while CVI is managed through palliative methods such as ulcer management and skin care as well as compression stockings and leg elevation
References
Hamdan, A. (2012). Management of Varicose Veins and Venous Insufficiency. JAMA , 308 (24), 2612. Retrieved from https://www.ncbi.nlm.nih.gov/m/pubmed/23268520/
Huether, S., & McCance, K. (2012). Understanding pathophysiology (Laureate custom Ed.). St. Louis, MO: Mosby
McPhee, S. J., & Hammer, G. D. (2014). Cardiovascular Disorders: Vascular Disease. In Pathophysiology of disease: An introduction to clinical medicine (7th ed., pp. 296-598). New York: McGraw Hill Education.
Watanabe, Y., Ono, K., Sakakura, K., & Fujita, H. (2017). Ambulant treatment for a very elderly patient with acute deep vein thrombosis in a rural area: A case report. Journal of Rural Medicine , 12 (2), 149-152. doi:10.2185/jrm.2946
Rosendaal, F. R. (2016). Causes of venous thrombosis. Thrombosis Journal , 14 (S1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5056464/
