CVS - Peripheral Arterial And Venous Disease

Question 1

Where is the long saphenous vein found in the ankle?

Answer 1

Anterior to the medial malleolus

Question 2

How does the venous pump system work?

Answer 2

Muscles in the legs contract and squeeze the veins, propelling blood towards the heart. Valves prevent backflow of blood

Question 3

What are varicose veins?

Answer 3

Tortuous, twisted or lengthened veins (usually in the legs)

Question 4

What causes varicose veins?

Answer 4

The vein wall is inherently weak, so that leads to dilatation and separation of valve cusps, so they become incompetent

Question 5

Give some symptoms of varicose veins

Answer 5

Heaviness, tension, aching, itching along the vein

Question 6

What is thrombophlebitis?

Answer 6

A venous thrombosis produces an inflammatory response, including pain

Question 7

Give some causes of calf muscle pump failure

Answer 7

• ‘failure’ of calf muscle contraction (obesity, immobility, reduced movement)
• deep vein incompetence
• volume overload

Question 8

What is Virchow’s triad?

Answer 8

Three things that lead to thrombosis:

• changes in lining of vessel wall (endothelial damage)
• changes in flow of blood (stasis)
• changes in constituents of blood (hypercoagulability)

Question 9

What is the difference between an arterial clot and a venous clot?

Answer 9

Arterial thrombosis is very platelet rich and uses extrinsic THEN intrinsic pathways.

Venous thrombi are fibrin rich and use the intrinsic THEN extrinsic pathway

Question 10

What are the five signs of an inflammatory response?

Answer 10

Calor, dolor, rubor, tumor, functio laesa

Question 11

What is a deep vein thrombosis?

Answer 11

A blood clot which develops within one of the deep veins in the body, usually in the leg

Question 12

Give some symptoms of DVT

Answer 12

Pain, swelling, skin discolouration, skin warmth

Question 13

Why is there an association between surgery and DVT?

Answer 13

• immobility prior to surgery and afterwards
• no calf muscle pump during surgery
• prothrombotic state following trauma of surgery

Question 14

What are the signs/symptoms of acute ischaemia?

Answer 14

• pain
• paralysis
• paraesthesia
• pallor
• perishing cold
• pulseless

Question 15

What is chronic peripheral arterial disease?

Answer 15

A build-up of fatty deposits in the arteries which restricts blood supply to leg muscles. Causes intermittent claudication, rest pain and ulceration/gangrene

Question 16

What is claudication?

Answer 16

Pain in the muscles of the lower limb brought on by walking/exercise

Question 17

What signs would be present in aortoiliac occlusion?

Answer 17

Bilateral buttock, thigh and calf claudication, absent lower limb pulses

Question 18

What signs would be present in common iliac occlusion?

Answer 18

Right buttock, thigh and calf claudication, absent right lower limb pulses

Question 19

What signs would be present in common femoral occlusion?

Answer 19

Right thigh and calf claudication, absent right lower limb pulses

Question 20

What signs would be found in a patient with superficial femoral artery occlusion

Answer 20

• right calf claudication

- femoral pulse present but absent popliteal and pedal pulses

Question 21

What is rest pain?

Answer 21

Pain in the foot that comes on when the patient goes to bed and is relieved by hanging the foot out of the bed - ischaemia is so severe that foot is ischaemic at rest