Artery And Vein Disease

Question 1

What is the most common vein pathology ?

Answer 1

Varicose veins

Question 2

What are the two classifications of lower limb venous system ?

Answer 2

Superficial and deep veins

Question 3

Where do deep veins reside in ?

Answer 3

Deep veins reside underneath the deep fascia with the major arteries

Question 4

Where are superficial veins located ?

Answer 4

In the subcutaneous tissue

Question 5

Describe the movement of blood between the superficial and deep veins

Answer 5

Blood in the lower limb moves from superficial veins to connecting perforating veins to deep veins to then the right side of the heart

Question 6

Describe the divisions of the veins in the lower limb

Answer 6

INFERIOR VENA CAVA ( ABDOMEN).

TO COMMON ILIAC VEIN.

TO EXTERNAL ILIAC VEIN

TO FEMORAL , DEEP FEMORAL AND LONG SAPHENOUS VEIN

THE FEMORAL VEIN DIVIDES INTO THE POPLITEAL VEIN WHICH DIVIDES INTO ANTERIOR TIBIAL , POSTERIOR TIBIAL AND PERONEAL. AND SHORT SAPHENOUS

Question 7

What are two important superficial veins located in the lower limb ?

Answer 7

Short and long saphenous

Question 8

Long saphenous vein lies posterior to …

Answer 8

Medial malleoulus

Question 9

What is the most common site of pathology for varicose veins ?

Answer 9

Saphenous veinss

Question 10

What is varicose veins ?

Answer 10

A vein that is tortuous m twisted or dilated. The superficial veins of the legs are most commonly affected , meaning varicose veins can be seen under the skin.

They appear blue
Visible to the naked eye 
Twisted 
Dilated 
Tortuous

Question 11

What are common risk factors that increase the risk of varicose veins ?

Answer 11

Pregnancy

Old age

Obesity

Having an occupation that involves a lot of standing

Question 12

What is the pathology behind varicose veins ?

Answer 12

1. Weakening of the wall of the vein will cause the veins to become dilated.
2. This causes the leaflets of the valves to be pulled apart.
3. This lets blood lead back through the valve by the downward pull of gravity.
4. This causes build of blood , increasing the pressure on the valves upstream ( closer to the feet).
5. This eventually causes a pool in the lower legs , forming varicose veins.

Question 13

Patients with varicose veins will often complain of what issues ?

Answer 13

Legs feeling heavy , tense and itchy.

Question 14

What are complications ofvaricose veins ?

Answer 14

1. Haemorrhaging of the veins because the varicose veins are thin and weakened making them more susceptible to damage.
2. Thrombophlebitis : this is inflammation of the vein by the formation of a small clot. This forms due to stasis of the blood in the veins. This can cause pain and swelling over the affected vein. This can also cause red blood cells to leak from thr affected vein into surrounding tissue - macrophages would then break down and oxidise the cells causing the oxidation of iron into FE3+. This causes the skin to be stained brown.
3. Venous hypertension
4. Oedema ( blood is under high pressure in varicose veins so fluid leaves into interstitial fluid)
5. Varicose eczema - fluid leaks from the vein under the high pressure causing inflammation which can cause uczema of the overlying skin. These patients are susceptible to developing ulcers.
6. Deep vein thrombosis which can lead to pulmonary embolism,
7. Venous ulceration.

8 lipodermatoscelorsis : inflammation and hardening of the subcutaneous fat.

Question 15

Why does venous hypertension result from varicose veins sometimes ?

Answer 15

The incompetence of the valves in the varicose veins means that the blood struggles to flow. This results in blood pooling at the bottom of the vein , building up the pressure in the vein which causes venous hypertension.

Question 16

What is another cause of venous hypertension - other than varicose veins ?

Answer 16

Calf-muscle pump failure - this is where the calf muscles are not being used properly - limited plantar flexion at the ankle joint during walking.

The soles and gastrocnemius muscles contribute to pushing blood against gravity towards the heart. When they contract , the valves open in perforating where they then push blood from superficial veins to deep veins.

Question 17

Who is at risk of calf-muscle pump failure ?

Answer 17

Immobility( elderly , obese , injured person where their calf muscles are not working properly)

Shuffling gait

Patients with deep vein Incompetence

Patients with superficial vein incompetence ( becomes deep vein to superficial vein )

Question 18

What are differences between arterial thrombosis and venous thrombosis ?

Answer 18

1. Arterial thrombosis most common cause is an atheroma. This is often platelet rich.
2. Venous thrombosis is often fibrin rich clot with very little platelet component. Often caused by stasis of blood , trauma , COCP , dehydration , oral contraceptive pill , pregnancy.

Question 19

What is a fatal consequence of DVT ?

Answer 19

Pulmonary embolism

Question 20

How does a pulmonary embolism form ?

Answer 20

1. There is a blood clot in a vein and breaks free from the vessel wall.
2. The embolus travels through the bloodstream and heart into the vessels of the lungs.
3. The embolus obstructs a vessel in the lung and deprived tissue of blood.

Question 21

Common causes of deep vein thrombosis

Answer 21

1. Stasis - no calf muscle pump ( this can be due to trauma , pregnancy , malignancy , before surgery , after surgery )

Question 22

Why do doctors promote mobility soon after surgery ?

Answer 22

To prevent a DVT from forming from the patient being immobile

Question 23

What is acute limb ischaemia ?

Answer 23

The sudden occlusion of an artery. This can occur due to an embolus or trauma. For example AF , popliteal artery aneurysm , sudden rupture of atherosclerotic plaque.

Question 24

What are the signs and symptoms of acute limb ischameia ?

Answer 24

THE 6 PS :

1. Pain
2. Paralysis
3. Paraesthesia
4. Pallor
5. Perishingly cold to touch
6. Pulseless

Question 25

Is acute limb ischaemia serious ?

Answer 25

VERy serious

Referral to vascular surgical unit needs to occur immediately.

Question 26

What is chronic peripheral arterial disease?

Answer 26

Arteries can become stenosed as a result of atherosclerosis. Stenosis of the arteries can reduce the flow of blood through the artery. Due to the stenosis , the patients can experience intermittent Claudication.

This is pain and cramping in the muscles of the leg when walking or exercising due to reduced oxygen delivery to the muscles.

Cramping pain in the leg is reduced by rest.

Question 27

What is critical ischaemia ?

Answer 27

If the stenosis of the peripheral artery is more severe , then patients can experience PAIN AT REST. this is critical ischameia.

This is heavy and tight pain the leg on,y relieved at night when they hang their legs of the bed.

If left untreated it can Lead to gangrene or ulceration.

Question 28

How to locate the stenosis of the peripheral artery ?

Answer 28

By checking for pulses in that limb. The main pulses are :

1. Femoral ( mid inguinal point )
2. Popliteal : deeep in the popliteal fossa
3. Dorsalis pedis : lateral to the extensor Hallucis longus tendon
4. Posterior tibial pulse : behind the medial malleoulus.