CVS - Peripheral Arterial and Venous Disease Flashcards
Does doppler of peripheral vessels give flow?
No it gives velocity and direction
Can infer flow
Which way is flow in veins in the leg?
Superficial to deep
What are the veins called that flow goes from superficial to deep?
Perforators
What is the one constant vein in the body? Where might you find it e.g. for venupuncture
Long saphenous vein?
Anterior to medial malleolus
Is the short saphenous and long saphenous deep or superficial
Superficial
How does blood flow from superficial to deep and up the leg?
When calves relaxed - blood pulled from superficial into deep.
When calves contract blood pushed towards heart
How much does the calf pump reduce during exercise?
80%
What is a varicose vein?
Tortuous twisted or lengthened veins
What is the pathophys of varicose veins?
Vein wall is WEAK
Leads to dilation and separation of valves –> valved become incompetent
What are four symptoms of varicose veins?
Heaviness
Aching
Itching
Tension
What is itching in skin mediate by?
Nearly always histamine
What are the complications of venous insufficiency (7)?
Vein - Haemorrhage, thrombophlebitis
Venous hypertension - oedema, pigmentation (haemosiderin), varicose eczema, lipodermatosclerosis (hard fat), venous ulceration
Why do you get haemosiderin skin pigmentation in venous insufficiency?
Increased capillary permeability –> RBCs leak out
Does venous thrombosis cause pain
Yes due to inflame response
What in particular leads to venous ulceration?
Venous hypertension from calf muscle pump failure
What are causes of calf muscle pump failure?
Immobility
Obesity
Superficial vein incompetence (retrograde flow)
Deep vein incompetence
Reduces hip/knee/ankle movement e.g. in fracture?
What is virchows triad
Changes in vessel wall
Changes in blood flow
Changes in coagulability
Which of the virchows is most relevant for arterial vs venous thrombosis?
Arterial - Vessel wall
Venous - flow of blood (stasis)
Stasis + what = venous thrombosis?
E.g. surgery, contraceptive pill, dehydration, cancer
What is the difference in thrombi components/pathways (intrinsic extrinsic) of arterial vs venous thrombi?
Arterial - platelets and both pathways
Venous - Fibrin intrinsic initially then both
Does DVT produce an inflamm response? What are the signs?
Yes
Calor Dolor Function Laesa Rubor Tumor
What are the signs/symptoms of DVT
Pain
Swelling
Blue-red skin colouration
Calf tenderness Muscle induration Skin warmth Skin discolouration Distended warm superficial veins Oedema Pyrexia
What about surgery predisposes you to DVT?
Immobility
Hypercoaguable due to trauma of surgery
Most common cause of acute limb ischaemia?
Emboli from heart, AAA or trauma
How long have you got to reverse acute limb ischaemia?
6 hours
What are the 6 Ps of acute limb ischaemia?
Pain Pallor Pulseless Paralysis Perishing cold Paraesthesia
What does a fixed mottled legs represent?
Patchy cyanosis –> Irreversible iscahemia –> amputate
Why do you need to amputate?
Because K+ builds up and if leg reperfused will go to heart and cause cardiac arrest
Where is most common cause of PVD causing claudication?
Superficial femoral artery
Where is most common place to feel pain in claudication?
Calf
Where might you feel a pulse to assess if there is one in PVD (4)?
Femoral
Popliteal
Dorsalis Pedis - just lateral to extensor hallucis longus
Posterior tibial - just behind medial malleolus
What artery would you expect to see occlude if having buttock claudication?
Internal iliac
Superficial femoral artery occlusion - where would you feel pulse/not feel pulse/ feel claudication?
Claudication - calf
Pulse in femoral artery present
Pulse in popliteal and pedal pulses
What is rest pain? Why at night (3)?
Pain in foot at night at rest
Night because: decreased gravity lying down, decreased cardiac output at night, warmed foot=metabolic needs
Why would you get ulcers over tibia in particular?
Blood supply isn’t great there anyway
