15. Peripheral arterial and venous disease Flashcards
Where are the deep and superficial veins located and which way does blood flow between them?
Deep: underneath the deep fascia with the major arteries
Superficial: located in the subcutaneous tissue
Blood flows from superficial to deep veins through perforating veins
What are the major superficial veins of the lower limb and which deep vein do they drain into?
Long Saphenous vein drains into common femoral vein
Short Saphenous vein drains into the popliteal vein
What are the major deep veins of the lower limb?
Common femoral vein superficial and deep femoral vein Popliteal vein anterior tibial vein posterior tibial vein peroneal vein
Where does the long spahenous vein pass relative to the malleoli?
Passes in front of the medial malleolus
What are perforating veins?
Connects superficial to deep veins
Describe the calf muscle pump and which muscles contribute to it.
Soleus and gastrocnemius muscles contribute to pushing blood against gravity back towards the heart. Every time the muscles contract, they squeeze the deep veins in the legs together and transport the blood further.
What is the function of the valves in the veins?
When open, the blood is pushed from superficial veins to perforating veins to deep.
Valves close to Prevent retrograde movement.
Perforating valves open again allowing filling from the superficial veins
how does the venous pressure in the foot change during exercise?
Venous pressure in the foot reduced during exercise as the increased activity of calf muscles means blood is pushed back up to the heart and is not pooling in the leg
What is the effect of long periods of standing or sitting on the venous return?
long periods of standing or sitting can result in the pooling of blood in the legs as there’s less force to push blood back to the heart.
What is peripheral venous disease?
Peripheral venous disease is a term that describes damage, defects or blockage in the veins that carry blood from the hands and feet to the heart
What are varicose veins and which veins are most commonly affected?
- Varicose veins are superficial veins that have become enlarged and twisted,
- Swollen and enlarged veins that usually occur on the legs and feet
- saphenous veins most commonly affected
What causes varicose veins and how does it affect blood flow through them?
Walls of veins weaken → varicosities develop and valve cusps separate, becoming incompetent
Can result in blood stasis or even retrograde flow due to ineffective valves
Don’t cause problems in their own right but can present
symptomatically
Veins tend to be tortuous, twisted
How might a patient describe symptoms of varicose vein?
Describe heaviness and aching, muscle cramps and throbbing.
Thin itchy skin, along affected veins
What are the complication of varicose veins?
Varicose veins near the surface of the skin can also rupture and bleed spontaneously or due to minor damage (haemorrhage).
Varicose eczema is an inflammatory skin disorder that can develop in those with varicose veins.
You can also develop superficial vein thrombophlebitis (this is an inflammatory condition of the veins due to a blood clot just below the surface of the skin). This causes a painful erythematous and this increases the risk of DVT.
What is chronic venous insufficiency?
Venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. CVI causes blood to “pool” or collect in these veins, and this pooling is called stasis and associated hypertension
What are the complications of CVI?
– reflux and or obstruction → venous hypertension
• oedema
• haemosiderin staining
• lipodermatosclerosis (inflammation and thickening of fat layer under the skin)
• venous ulceration
What is haemosiderin staining?
This is a dark purple discolouration if the lower legs caused by chronic venous disease. It occurs when iron from haemoglobin are released as a result of the breakdown of RBCs.
- leakage of RBCs from venules
- inflammatory response by macrophages
- oxidation occurs
- Fe2+ to Fe3+ (which is rust)
What are the symptoms of varicose eczema?
- itchy
- red and swollen
- dry and flaky
- scaly or crusty
What can varicose eczema lead to and how can it be differentiated from normal tissue?
Can lead to lipodermatosclerosis - which is hard to the touch
- c.f. other fatty tissues above or below
Where does ulceration due to CVI usually develop?
Around nodular areas
- typically the medial malleolus
Who is at risk of calf muscle pump failure?
Immobile, obese, injured etc.
What is deep vein and superficial vein incompetence?
Deep: retrograde flow in the deep veins
Superficial: retrograde flow from deep to superficial through perforating veins
