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2 CVS > 20 Peripheral Arterial and Venous Disease > Flashcards

20 Peripheral Arterial and Venous Disease Flashcards

• Venous anatomy and calf muscle pump function • Pathophysiology of peripheral venous disease - causes, signs and symptoms • Pathophysiology of peripheral arterial disease - causes, signs and symptoms • Lower limb pulses • Doppler ultrasound

1
Q

Where are the deep and superficial veins of the leg (and rest of body) located respectively?

A

DEEP= under deep fascia

SUPERFICIAL= in subcutaneous tissue (blood move superficial to deep)

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2
Q

What does the long saphenous vein run in front of?

A

Medial malleolus

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3
Q

Which muscles in the lower leg helps to push blood against gravity back towards the heart?

A

Soleus and gastrocnemius

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4
Q

What are varicose veins?

A

Tortuous/dilated vein

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5
Q

What is the pathophysiology of variscose veins?

A

The valves in veins= ineffective–>blood movement= slow/reversed–> walls of veins weaken–> varicosities develop–>valve cusps separate- become incompetent

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6
Q

Which veins commonly suffer from varicose vein pathology?

A

Saphenous veins

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7
Q

If a patients has a severe case of varicose veins, how might they present?

A

Heaviness, aching, muscle cramps, throbbing, thin+itchy skin along affected vein

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8
Q

What complications can arise from varicose veins?

A
  • Chronic venous insufficiency (associated with venous hypertension)
  • varicose eczema
  • skin pigmentation (haemosiderin staining)
  • lipodermatosclerosis (inflammation of fat layer under skin)
  • venous ulceration
  • oedema
  • haemorrhage
  • thrombophlebitis
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9
Q

What can cause venous eczema and ulceration?

A

Venous hypertension, pressure gradient between arterial and venous system=compromised

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10
Q

What are the symptoms associated with venous eczema and ulceration?

A

Skin= chronically itchy, red, swollen, tight- can cause lipdermatosclerosis. =v. Painful

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11
Q

What action should the lower limb be doing for the calf pump to function?

A

Plantar flexion

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12
Q

What is ‘deep vein incompetence’?

A

When retrograde flow occurs in veins=overwhelmed. Incompetent valve

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13
Q

Who is at high risk of having ‘calf muscle pump failure’?

A

immobile/injured/obese

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14
Q

How can we treat venous ulceration?

A

Ligation and vein stripping

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15
Q

What’s the most common cause of arterial thrombosis?

A

Atheroma (degeneration of the walls of the arteries caused by accumulated fatty deposits and scar tissue)

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16
Q

What are the risk factors for venous thrombosis?

A

Stasis, trauma, dehydration, pregnancy, inflammatory conditions, COCP

17
Q

What is Virchow’s triad?

A

Stasis, vessel wall damage, hyper-coagulability

18
Q

What is DVT?

A

Deep Vein Thrombosis- clotting of blood in deep vein

19
Q

How would a patient with DVT present?

A

Pain, swelling, redness, warmth, distended and visible superficial veins, oedema, pyrexia, asymmetry

20
Q

Why would having surgery increase your risk of developing DVT?

A

Stasis-trauma- prothrombotic state

21
Q

What prophylaxis for DVT is used following surgery?

A

Anticoagulant agents

22
Q

What is ‘Peripheral Arterial Disease’?

A

=narrowing of arteries (usually in legs)

23
Q

What is the pathophysiology of acute limb ischaemia?

A

Acute occlusion- minute/days-no collateral circulation develops

24
Q

What are the 2 most common causes of acute limb ischaemia?

A

1, Trauma

2, Embolism (also atrial fibrillation/ abdominal aortic aneurysm)

25
Q

=What are the 6Ps used to diagnose leg ischaemia?

A

1, Pain

2, Pulseless

3, Pallow

4, Perishing with cold

5, Paresthesia

6, Paralysis/reduced power

26
Q

If a patient has suspected limb ischaemia, what action should be taken?

A

Refer to vascular surgical unit immediately- imaging–> angioplasty/thromboectomy/intra-arterial thrombosis/amputation

27
Q

How does a patient with chronic peripheral arterial disease present?

A

Intermittent claudication (due to atherosclerosis) which= exercise induced

(pain goes away on rest)

28
Q

How would you know chronic ischaemia had reached critical ischaemia?

A

When=pain at rest

29
Q

If untreated what does critical ischaemia lead to?

A

Ulceration and gangrene

30
Q

What is the most common presentation of atheroma of the femoral artery?

A

Claudication in calf

31
Q

How do we determine where the stenoses have occurred in the lower limbs?

A

Where claudication presents and which pulses can be palpated.

32
Q

Which pulses can we palpate for in the lower limb and where can we find them?

A

Femoral, popliteal, dorsalis pedis, posterior tibial

33
Q

What is ‘Doppler ultra-sonography’?

A

Sonogram using ultrasound and Doppler effect- to measure real-time flow and velocity

34
Q

What is Doppler ultra-sonography used for?

A

In distal vessels, diagnosing peripheral arterial disease (stenosis causes flow and velocity changes)

2 CVS (16 decks)

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