CVS - Peripheral Arterial and Venous Disease

Question 1

Does doppler of peripheral vessels give flow?

Answer 1

No it gives velocity and direction

Can infer flow

Question 2

Which way is flow in veins in the leg?

Answer 2

Superficial to deep

Question 3

What are the veins called that flow goes from superficial to deep?

Answer 3

Perforators

Question 4

What is the one constant vein in the body? Where might you find it e.g. for venupuncture

Answer 4

Long saphenous vein?

Anterior to medial malleolus

Question 5

Is the short saphenous and long saphenous deep or superficial

Answer 5

Superficial

Question 6

How does blood flow from superficial to deep and up the leg?

Answer 6

When calves relaxed - blood pulled from superficial into deep.

When calves contract blood pushed towards heart

Question 7

How much does the calf pump reduce during exercise?

Answer 7

80%

Question 8

What is a varicose vein?

Answer 8

Tortuous twisted or lengthened veins

Question 9

What is the pathophys of varicose veins?

Answer 9

Vein wall is WEAK

Leads to dilation and separation of valves –> valved become incompetent

Question 10

What are four symptoms of varicose veins?

Answer 10

Heaviness
Aching
Itching
Tension

Question 11

What is itching in skin mediate by?

Answer 11

Nearly always histamine

Question 12

What are the complications of venous insufficiency (7)?

Answer 12

Vein - Haemorrhage, thrombophlebitis

Venous hypertension - oedema, pigmentation (haemosiderin), varicose eczema, lipodermatosclerosis (hard fat), venous ulceration

Question 13

Why do you get haemosiderin skin pigmentation in venous insufficiency?

Answer 13

Increased capillary permeability –> RBCs leak out

Question 14

Does venous thrombosis cause pain

Answer 14

Yes due to inflame response

Question 15

What in particular leads to venous ulceration?

Answer 15

Venous hypertension from calf muscle pump failure

Question 16

What are causes of calf muscle pump failure?

Answer 16

Immobility
Obesity
Superficial vein incompetence (retrograde flow)
Deep vein incompetence
Reduces hip/knee/ankle movement e.g. in fracture?

Question 17

What is virchows triad

Answer 17

Changes in vessel wall
Changes in blood flow
Changes in coagulability

Question 18

Which of the virchows is most relevant for arterial vs venous thrombosis?

Answer 18

Arterial - Vessel wall

Venous - flow of blood (stasis)

Question 19

Stasis + what = venous thrombosis?

Answer 19

E.g. surgery, contraceptive pill, dehydration, cancer

Question 20

What is the difference in thrombi components/pathways (intrinsic extrinsic) of arterial vs venous thrombi?

Answer 20

Arterial - platelets and both pathways

Venous - Fibrin intrinsic initially then both

Question 21

Does DVT produce an inflamm response? What are the signs?

Answer 21

Yes

Calor
Dolor
Function Laesa
Rubor
Tumor

Question 22

What are the signs/symptoms of DVT

Answer 22

Pain
Swelling
Blue-red skin colouration

Calf tenderness
Muscle induration
Skin warmth
Skin discolouration
Distended warm superficial veins
Oedema
Pyrexia

Question 23

What about surgery predisposes you to DVT?

Answer 23

Immobility

Hypercoaguable due to trauma of surgery

Question 24

Most common cause of acute limb ischaemia?

Answer 24

Emboli from heart, AAA or trauma

Question 25

How long have you got to reverse acute limb ischaemia?

Answer 25

6 hours

Question 26

What are the 6 Ps of acute limb ischaemia?

Answer 26

Pain
Pallor
Pulseless
Paralysis
Perishing cold
Paraesthesia

Question 27

What does a fixed mottled legs represent?

Answer 27

Patchy cyanosis –> Irreversible iscahemia –> amputate

Question 28

Why do you need to amputate?

Answer 28

Because K+ builds up and if leg reperfused will go to heart and cause cardiac arrest

Question 29

Where is most common cause of PVD causing claudication?

Answer 29

Superficial femoral artery

Question 30

Where is most common place to feel pain in claudication?

Answer 30

Calf

Question 31

Where might you feel a pulse to assess if there is one in PVD (4)?

Answer 31

Femoral
Popliteal
Dorsalis Pedis - just lateral to extensor hallucis longus
Posterior tibial - just behind medial malleolus

Question 32

What artery would you expect to see occlude if having buttock claudication?

Answer 32

Internal iliac

Question 33

Superficial femoral artery occlusion - where would you feel pulse/not feel pulse/ feel claudication?

Answer 33

Claudication - calf
Pulse in femoral artery present
Pulse in popliteal and pedal pulses

Question 34

What is rest pain? Why at night (3)?

Answer 34

Pain in foot at night at rest

Night because: decreased gravity lying down, decreased cardiac output at night, warmed foot=metabolic needs

Question 35

Why would you get ulcers over tibia in particular?

Answer 35

Blood supply isn’t great there anyway