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
Where are the deep and superficial veins of the leg (and rest of body) located respectively?
DEEP= under deep fascia
SUPERFICIAL= in subcutaneous tissue (blood move superficial to deep)
What does the long saphenous vein run in front of?
Medial malleolus
Which muscles in the lower leg helps to push blood against gravity back towards the heart?
Soleus and gastrocnemius
What are varicose veins?
Tortuous/dilated vein
What is the pathophysiology of variscose veins?
The valves in veins= ineffective–>blood movement= slow/reversed–> walls of veins weaken–> varicosities develop–>valve cusps separate- become incompetent
Which veins commonly suffer from varicose vein pathology?
Saphenous veins
If a patients has a severe case of varicose veins, how might they present?
Heaviness, aching, muscle cramps, throbbing, thin+itchy skin along affected vein
What complications can arise from varicose veins?
- 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
What can cause venous eczema and ulceration?
Venous hypertension, pressure gradient between arterial and venous system=compromised
What are the symptoms associated with venous eczema and ulceration?
Skin= chronically itchy, red, swollen, tight- can cause lipdermatosclerosis. =v. Painful
What action should the lower limb be doing for the calf pump to function?
Plantar flexion
What is ‘deep vein incompetence’?
When retrograde flow occurs in veins=overwhelmed. Incompetent valve
Who is at high risk of having ‘calf muscle pump failure’?
immobile/injured/obese
How can we treat venous ulceration?
Ligation and vein stripping
What’s the most common cause of arterial thrombosis?
Atheroma (degeneration of the walls of the arteries caused by accumulated fatty deposits and scar tissue)
What are the risk factors for venous thrombosis?
Stasis, trauma, dehydration, pregnancy, inflammatory conditions, COCP
What is Virchow’s triad?
Stasis, vessel wall damage, hyper-coagulability
What is DVT?
Deep Vein Thrombosis- clotting of blood in deep vein
How would a patient with DVT present?
Pain, swelling, redness, warmth, distended and visible superficial veins, oedema, pyrexia, asymmetry
Why would having surgery increase your risk of developing DVT?
Stasis-trauma- prothrombotic state
What prophylaxis for DVT is used following surgery?
Anticoagulant agents
What is ‘Peripheral Arterial Disease’?
=narrowing of arteries (usually in legs)
What is the pathophysiology of acute limb ischaemia?
Acute occlusion- minute/days-no collateral circulation develops
What are the 2 most common causes of acute limb ischaemia?
1, Trauma
2, Embolism (also atrial fibrillation/ abdominal aortic aneurysm)
