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3. Mondays > 304 Vascular arterial, venous, and IR > Flashcards

304 Vascular arterial, venous, and IR Flashcards

1
Q

What are the 2 venous muscles pumps int he body?

A

Muscles in the calf and diaphragm

They contract and create a pressure that pushes venous blood around the body

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2
Q

What are the different causes of venous insufficiency?

A

-Immobility
-Calf muscle pump failure
-Deep venous occlusion
-Superficial venous reflux
–Deep venous reflux
-Obesity
-Dependency

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3
Q

What is the cause of venous hypertension?

A

Venous insufficiency

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4
Q

What is Gaiter area?

A

The area below the knee and above the ankle where venous ulcers are most likely to happen

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5
Q

What are spider veins?

A

AKA Telangiectasia varicose veins

Small clusters of blue or red veins that sometimes appear on your face or legs; they’re harmless and, unlike trunk varicose veins, do not bulge underneath the surface of the skin

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6
Q

What is the definition of a varicose vein?

A

A vein that has permanently lost its vascular efficiency so remains continuously dilated under pressure

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7
Q

What is ovarian vein incompetence?

A

Otherwise unexplained pelvic pain in pre-menopausal women

Affects back, pelvis and upper thigh

Equivalent to a varicocele in men

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8
Q

What is a varicocele?

A

Abnormally dilated veins in the scrotum

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9
Q

What is the CEAP classification used for?

A

Classification of Varicose veins

C = Clinical
* C0 – no visible venous disease
* C1 - reticular veins and thread veins
* C2 - varicose veins
* C3 – oedema
* C4 – skin changes
* C5 - healed ulceration
* C6 - active ulceration
E = Etiology (primary vs secondary)
A = Anatomy (location eg. Deep)
P = Pathophysiology (reflux, obstruction)

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10
Q

What is the Aberdeen vein score?

A

Quantifies the effect of venous disease on the quality of life

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11
Q

What are the symptoms of varicose veins?

A

Heaviness or tension
Feeling of swelling
Aching
Restless legs
Cramps
Itching
Tingling

Women experience more of these symptoms compared to men

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12
Q

What are some complications fo varicose veins?

A

Phlebitis 20%
Bleeding 3%
Skin changes 25%
Ulceration 5-10%

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13
Q

What is Phlebitis?

A

AKA superficial thrombophlebitis

An inflammatory response to an embolus
No infected

Treated with LMW Heparin

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14
Q

What is the SPJ/SFJ?

A

SPJ: saphenopopliteal junction
SPJ: Sapheno-femoral junction

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15
Q

How does the SPJ/SFJ relate to varicose veins?

A

Varicose veins have been linked to great saphenous vein reflux and in particular, with reflux at the saphenofemoral junction (SFJ)

It can be checked by asking the patient to sit down and then lie down to see is the veins are visible

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16
Q

Why would there be a bruit over the SFJ in varicose vein disease?

A

A bruit indicates turbulent blood flow which may suggest an underlying arteriovenous malformation

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17
Q

What is the treatment for varicose veins?

A

Conservative measures

Or Invasive treatments
– Surgery
– Catheter (heat based) therapy
– Sclerotherapy
- Conventional sclerotherapy
- US guided foam sclerotherapy
» Cyanoacrylate glue

18
Q

What are some conservative treatments for varicose veins?

A

Leg elevation
Exercise
Weight loss
Compression stockings

19
Q

What are TED stockings?

A

Thrombo-embolus deterrent stockings

20
Q

What is the maximum dose of lignocaine?

A

7mgs/kg

21
Q

What is a phlebectomy?

A

Removal of veins

22
Q

What is sclerotherapy?

A

The treatment of varicose blood vessels by the injection of an irritant which causes inflammation, coagulation of blood, and narrowing of the blood vessel wall.

23
Q

What is the aetiology of DVT?

A

Virchow’s triad

  1. Changes to flow
    Eg. immobility, paralysis, extrinsic vessel compression
  2. Changes to blood coagulation
    Eg. Thrombophilia, severe dehydration, malignancy, sepsis, drugs like COCP, COVID
  3. Changes to blood vessel wall
    Eg. deep vessel injection, trauma
24
Q

How is a DVT diagnosed?

A

-Clinical features
* History
* Clinical features
* Wells score
-D-dimer testing
-Duplex US scanning

25
Q

How does COVID-19 contribute to vascular disease?

A
  • Significantly increased risk of thrombosis
    – Likely due to direct endothelial cell infection
  • Platelet aggregation and activation
  • Increased arterial and venous thrombosis
    – Increased risk of Stroke, critical limb and mesenteric
    ischaemia
    – Patients are prothrombotic.
    – Benefit in continuing statin therapy.
    – Digital manifestations of mild or asymptomatic
  • Covid fingers or covid toes (chilblains)
26
Q

What are chilblains?

A

Small, itchy swellings on the skin that occur as a reaction to cold temperatures

Occur mostly on fingers and toes

27
Q

What is the management of DVT?

A

Manage the DVT itself
– Anticoagulation
* Heparin/LMWH
* DOAC eg Rivaroxaban/ Apixiban.
* Warfarin (monitoring required)

– Compression hosiery
* 2 weeks minimum.
* Longer if still symptomatic.
* Ensure sufficient arterial supply and healthy enough skin

28
Q

What is post-thrombotic syndrome?

A

A combination of patient reported
symptoms and objective findings
such a swelling and skin changes in
patients following DVT of the upper
or lower extremity.

  • 20 -50% of patients after
    symptomatic DVT .
  • 5 -10% will suffer severe PTS with
    features of advanced chronic venous insufficiency

*Impact on QoL can be devastating.
– Severe pain and ulceration in
young patients

29
Q

What is the pathophysiology of post-thrombotic syndrome?

A

Obstruction at key points
* Reflux: loss of valvular integrity.
* Ambulatory venous hypertension.
* Triggering of inflammation: PAIN.
* Reduced calf perfusion with tissue
hypoxia.
* Increased tissue permeability:
Oedema
* Progressive pump dysfunction

The quicker the clot resolution, the
less collateral damage

30
Q

What is a venous infarction?

A

A medical emergency that occurs due to obstruction of the venous system by thrombus or external compression

Pulses palpable initially because blood is pumped in but had nowhere to go causing:
Swelling (often severe), Tenderness (compartment syndrome), and discoloration/ cyanosis

31
Q

What is Phlegmasia alba dolens and Phlegmasia caerulea dolens?

A

Uncommon conditions that result from acute, massive venous thromboembolism

Associated with DVT of the lower extremity and have high associated morbidity and mortality

32
Q

What are the Pulmonary complications of DVT?

A

Pulmonary embolism
Chronic pulmonary hypertension

33
Q

What are the symptoms of DVT?

A

Shortness of breath
Pleuritic chest pain
Collapse
Sudden death

34
Q

What is the definition of relative ischaeima?

A

Insufficient perfusion to permit full function but is okay at rest

35
Q

What is Claudication?

A

The equivalent of leg angina

Absolute: critical ischaemia with gangrene and pain at rest

36
Q

What are the 6 P’s of limb ischaemia?

A

Pale
Painful
Pulseless
Perishingly cold ‘Poikilothermic’

Paraesthetic
Paralysed

Lower 2 are neurological an develop in late stage

37
Q

What are some causes of acute limb ischaemia?

A

Embolic
-AF, endocarditis, proximal aneurysm

Thrombotic
-Rupture of an atherosclerotic plaque

Aneurysm
-Eg Popliteal thrombosis

Trauma
-Fracture / Dislocation
-Knife, Gunshot wound
-IV drug use
-Iatrogenic

38
Q

What is the treatment for acute limb ischaemia?

A

Heparin 5000 iu IV
LMWH (Fragmin) s/c
Analgesia
Foot down

39
Q

What does TLC stand for?

A

Tender loving care

40
Q

What is the Seldinger technique?

A

A procedure to obtain safe access to blood vessels

It allows for insertion of a catheter
Used in angioplasty

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