1 Walden University
NURS 6501: Advanced Pathophysiology
March 26, 2017
Week 4 Assignment
Disorders of the Veins and Arteries 2
5ab5546b­c6c4­4666­8a49­1363cfe7beb1 Introduction
As an Advance Practice Nurse, one must be able to recognize signs and symptoms
that indicate an unbalance of the homeostasis of the body to correctly diagnose and treat a
disorder. The balance of the venous system is affected by many factors such as abnormal
clotting states or alterations in circulation. In this paper, I will discuss the
pathophysiology of Deep Venous Thrombosis (DVT) and Chronic Venous Insufficiency
(CVI) and describe how a venous thrombosis and arterial thrombosis are different. I will
explain how gender might impact the pathophysiology of CVI and DVT. I will also
explain how you would diagnose and prescribe treatment of these disorders for a patient
keeping in mind the selected factor of gender. And finally, I will present a mind map of
both DVT and CVI that includes the epidemiology, pathophysiology, risk factors, clinical
presentation, diagnosis and treatment of the disorders. Deep Venous Thrombosis
The clotting of blood in a deep vein of an extremity, usually in the calf or thigh, is
called a Deep Venous Thrombosis or DVT (Douketis, MD, 2017). DVT results when a
thrombus, or blood clot, releases from a vessel wall. Three major factors, called the triad
of Virchow, promote venous clots. These factors are stasis such as immobility, age, and
CHF; venous endothelial damage such as trauma and IV medications, and
hypercoagulable states caused from malignancy, oral contraceptives and hormone
replacement therapy (Laureate Education, 2012). Being pregnant, incurring a spinal cord
injury or undergoing orthopedic surgery or trauma is associated with the development of
a DVT (Huether & McCance, 2012). A DVT will often occur near a venous valve and is 3
the result of an accumulation of thrombin, fibrin, RBCs, and platelets (Douketis, MD,
2017). DVT will present with swelling and redness of the affected area, tenderness along
the distribution of veins in the calf or thigh and can sometimes be asymptomatic (Huether
& McCance, 2012). Calf discomfort caused by ankle dorsiflexion with the knee extended
(Homan’s sign) occasionally occurs when a lower leg DVT is present (Douketis, MD,
2017). Treatment of DVT focuses on prevention. Early ambulation, prophylactic use of
anticoagulants such heparin or warfarin, use of sequential compression devices (SCDs)
after surgery, and in some cases inferior vena cava filter may be indicated for the
treatment of DVT (Huether & McCance, 2012). Diagnosis of DVT is made with history
and physical examination, use of Doppler ultrasonography and serum d-Dimer labs to
confirm suspected diagnosis (Huether & McCance, 2012).
Chronic Venous Insufficiency
Veins channel blood flow from capillaries to all parts of the body and back to the
heart (Huether & McCance, 2012, p. 551). Chronic Venous Insufficiency is most
commonly caused by disruption to the valvular competence in the low-pressure
superficial venous system but may also be caused by valvular incompetence in the highpressure deep venous system, or in rare occurrences in both (Weiss, & Izaguirre-Anaribe,
2017). Also, CVI may be caused by a congenital absence of venous valves. CVI is
commonly found in patients that stand for extended periods of time, wear constricting
clothing, or cross their legs at the knees; these factors decreased pumping mechanisms
and increased the risk for venous distention (Huether & McCance, 2012. CVI is
commonly found in the lower extremities. (Durham, & Hebert, 2017) Patients suffering
from CVI will present with complaints of swelling, burning, cramping and aching of the 4
lower legs and complaints of restless legs or leg fatigue (Weiss, & Izaguirre-Anaribe,
2017). Treatment of CVI is usually conservative but effective. Noninvasive treatment
includes leg elevation, wearing compression stockings, and physical exercise.
Sometimes invasive treatment is necessary such as sclerotherapy, surgical ligation, vein
resection or vein stripping (Huether & McCance, 2012, p. 586). Diagnosis of CVI is one
with duplex ultrasonography, history, and physical examination, and a serum d-Dimer lab
test to rule out DVT (Huether & McCance, 2012).
How Arterial Thrombosis differ from Venous Thrombosis
Arterial thrombosis is a blood clot in an artery. Venous thrombosis is a blood
clot in a vein. With an arterial thrombosis, the blood flow from the heart to other organs
is obstructed causing serious side effects. Venous thrombosis disrupts blood flow of the
veins, usually in the lower extremities. Arterial thrombosis can affect many areas.
Blockage of arterial blood flow to the heart muscle results in a heart attack. Obstruction
of arterial blood flow to the brain results in a stroke A Transient Ischemic Attack (TIA) is
a temporary blockage of arterial blood flow to the brain (Arterial thrombosis - NHS
Choices, 2017). As stated previously, venous thrombosis is caused by stasis such as
immobility, age, and CHF; venous endothelial damage such as trauma and IV
medications, and hypercoagulable states caused from malignancy, oral contraceptives and
hormone replacement therapy (Laureate Education, 2012). Arterial thrombosis can be
caused by antiphospholipid antibodies that are reactive or part of an autoimmune
syndrome, atherosclerosis, heparin-induced thrombocytopenia, Bechet’s disease or an
aneurysm. Venous clots that migrate into arterial circulation cause paradoxical embolus
(Weinberg, 2017). 5
How Gender impacts DVT and CVI
The factor impacting DVT and CVI that I chose to explore is gender. There does
not appear to be a direct correlation of DVT to gender. However, hypercoagulability
caused by use of oral contraceptives and hormone replacement therapy and pregnancy are
risk factors that are directly related to the female gender (Huether & McCance, 2012).
CVI is 40 percent more prevalent in women than in men with varicose veins being 60
percent more prevalent in women (Durham, & Hebert, 2012). The increase prevalence in
women may be contributed to the fact that women often wear more restrictive clothing
and cross their legs at the knees more frequently than men.
Summary
DVT and CVI are serious disorders of the cardiovascular system impairing blood
flow of the veins. In this paper, I discussed the pathophysiology of Deep Venous
Thrombosis (DVT) and Chronic Venous Insufficiency (CVI) and described how a venous
thrombosis and arterial thrombosis are different. I explained how gender might impact
the pathophysiology of CVI and DVT. I also described how you would diagnose and
prescribe treatment of these disorders. And finally I presented a mind map of both DVT
and CVI that includes the epidemiology, pathophysiology, risk factors, clinical
presentation, diagnosis and treatment of the disorders. 6
Tenderness along
distribution of veins in
calf or thighs Sometimes
asymptomati
c redness Clinical
Presentation Orthopedic Surgery and spinal cord
injury Venous Stasis such as Immobility,
Age, CHF, obesity, long travel, and
hospitalization Swelling of legs Ultrasonography Venous Endothelial
damage such as
trauma or IV
medications Risk Factors Hx and Physical
Examination Diagnosis Malignancy, pregnancy, use of
oral contraception d-Dimer Lab results Deep Venous Thrombosis
DVT 1 per 1000
adults annually Higher incidence
in men than
women Epidemiology
25% higher
incidents in
African
Americans Endothelial
Injury Impaired
Venous return Pathophysiology
Inferior
Vena Cava
Filter 5-6 per 1000
adults annually
by age 80 Hypercoagulability Treatment - Prevention
Accumulation of clotting
factors and platelets in veins
Anticoagulants
Early
ambulation Thrombolytic
Therapy 7
Hyperpigmentation
of skin of feet and
ankles Restless leg
or leg
fatigue Clinical
Presentation Cramping, burning,
throbbing, and
heaviness Habitually standing for long
periods of time Risk Factors Hx and Physical
Examination Duplex Ulstrasound Female
gender, age
family history Age Edema of lower extremities Diagnosis Obesity, pregnancy,
DVT Chronic Venous
Insufficiency
CVI d-Dimer lab to R/O
DVT 17% prevalence in
men Increased venous
pressure and valve
failure 40%
prevalence in
women Pathophysiology Epidemiology
Peak incidence
occurs age 4049 for women
and age 70-79
for men Inadequate
venous return
over long
periods Elevating
legs Physical
exercise
Congenitally weak vein walls
dilate under normal pressures to
cause secondary valve failure 92 per 1000,000
hospital
admissions
caused by CVI Treatment - Prevention May result from the
congenital absence of
venous valves. Compression
stockings
Sclerotherapy or surgical
ligation, vein resection
and vein stripping 8
References:
Arterial thrombosis - NHS Choices. (2017). Nhs.uk. Retrieved 26 March 2017, from
http://www.nhs.uk/conditions/arterial-thrombosis/Pages/Introduction.aspx
Douketis, MD, J. (2017). Deep Venous Thrombosis (DVT) - Cardiovascular Disorders - MSD
Manual Professional Edition. MSD Manual Professional Edition. Retrieved 26 March
2017, from http://www.merckmanuals.com/professional/cardiovasculardisorders/peripheral-venous-disorders/deep-venous-thrombosis-dvt#v941044
Durham, MD, K., & Hebert, MD, A. (2012). Chronic Venous Insufficiency: Pathophysiology and
Treatment | Today's Wound Clinic. Todayswoundclinic.com. November 2012. Retrieved
24 March 2017, from http://www.todayswoundclinic.com/articles/chronic-venousinsufficiency-pathophysiology-and-treatment
Huether, S. E., & McCance, K. L. (2012). Understanding Pathophysiology, 5e (Huether,
understanding Pathophysiology) (5th ed.). Philadelphia, PA, United States: Elsevier
Health Sciences.
Laureate Education, Inc. (Executive Producer). (2012a). Alterations of cardiovascular functions
PPT lecture. Baltimore, MD: Author.
Weinberg, I. (2017). Arterial and Venous Thrombosis | Angiologist. Angiologist.com. Retrieved
25 March 2017, from http://www.angiologist.com/thrombosis-section/arterial-andvenous-thrombosis/
Weiss, R., & Izaguirre Anaribe, D. (2017). Venous Insufficiency. Emedicine.medscape.com.
Retrieved 24 March 2017, from http://emedicine.medscape.com/article/1085412overview

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