Intro to Lower Extremity Vessels Flashcards
What type of vein has a companion artery?
Deep veins
What type of vessel connects the deep and superficial venous system?
Perforating vein
What are examples of lower extremity superficial veins?
1.GSV
2. SSV
When does the external iliac become the common femoral artery?
At the inguinal ligament or groin crease
What does the common femoral artery divide into?
- Profunda femoris artery (deep femoral artery)
- Superficial femoral artery or femoral artery
When does the femoral artery turn into the popliteal artery?
At the knee crease and behind the knee
What does the popliteal artery bifurcate into?
- Tibio-peroneal trunk
- Anterior tibial
What does the tibio-peroneal trunk branch into?
- Posterior tibial artery
- Peroneal arteries
What does the anterior tibial artery become?
Dorsalis pedis artery
What does the posterior tibial artery become?
Medial and lateral plantar artery
Many of the collaterals that bypass the superficial femoral or popliteal artery occlusions arise from what artery?
Profunda femoris AKA deep femoral artery
What is the longest vein in the body?
Great saphenous vein (GSV)
What two veins drain into the common femoral vein?
- Femoral vein
- Deep femoral V.
What are the main superficial veins in the lower extremity system?
- Great saphenous vein (unites at CFV)
- Small saphenous vein (unites at popliteal V.)
Where does the GSV terminate?
GSV terminates into the common femoral vein at the sapheno-femoral junction
Does the SSV course anteriorly or posteriorly to the calf?
Posteriorly
Where does the SSV terminate?
SSV terminates into the popliteal vein at the sapheno-popliteal junction
What veins drain into the tibio-peroneal trunk?
- Posterior tibial V.
- Peroneal V.
What veins are included in the deep venous system?
- Femoral V and DFV
- Popliteal V
- Anterior tibial V
- Posterior tibial V
- Peroneal V
What vein does the peroneal vein join with?
Posterior tibial at the tibio-peroneal trunk
What does the anterior tibial vein drain into?
Popliteal vein
What does the common femoral vein drain into?
External iliac V.
The calf muscle pump aids in the return of blood from the legs against what type or force?
Force of gravity or hydrostatic pressure
How much pressure does the calf muscle generate upon contraction?
200 mmHg
Function of perforating veins?
Perforating veins in the superficial system can drain blood into the deep system but not the other way around
When is blood from the perforating veins of the superficial system drained into the deep system?
During relaxation
When are valves closed in perforating veins?
During contraction so blood cannot travel from the deep system to the superficial system
What determines primary varicose veins?
Incompetent valves with the ABSENCE of a DVT
What are primary varicose veins usually caused by and in what veins?
Incompetent valves in the common femoral V and GSV
What determines secondary varicose veins?
When varicose veins occur due to a chronic DVT where valves become destroyed over time
Valves in what system are incompetent with primary varicose veins?
Valves in the superficial venous system
Valves in what system are incompetent with secondary varicose veins?
Superficial
Perforating
Deep
Venous stasis ulcers occur due to what?
Persistent increased venous pressure
Varicose veins in pregnancy cause increased pressure + compliant veins = ?
A) venous distension + decreased blood return to the heart
B) venous distension + increased blood return to the heart
C) venous non-compliance + decreased blood return to the heart
D) venous non-compliance + increased blood return to the heart
A) venous distension + decreased blood return to the heart
What is the main purpose of deep veins?
To return blood to the heart
Why are thrombi likely to become dislodged in deep veins?
Since deep veins travel within the muscle, it is more likely the thrombus will become dislodged due to the movement of muscle with activity
Is a thrombus found in a deep vein or superficial vein usually largest?
Deep vein
Is a thrombus from a deep vein or superficial vein more life threatening to cause a pulmonary embolism?
Deep vein as it is responsible for returning blood directly to the heart and more potential for it to travel to the pulmonary artery
What is the main purpose of superficial veins?
To regulate body temperature as blood travels close to the body surface
When body temperature needs to be conserved, what happens to the superficial veins?
Contract to shunt blood away from the skin
What is the role of a perforator vein?
To move blood from the superficial to the deep system where blood is returned to the heart
What does VTE stand for?
Venous thrombo-embolism
What is known as the primary mechanism for the formation of venous thrombosis?
Virchow’s triad
What does Virchow’s triad consist of?
- Venous stasis
- Hypercoagulability
- Damaged vessel walls
DVT’s very commonly begin where?
Soleal sinus veins in the calf due to slower flow in that area
What are signs and symptoms of VTE
- Venous obstruction
- Inflammation
- Thrombus embolization
What symptoms are consistent with pulmonary embolism?
Tachycardiac
Tachypnea
Chest pain
What levels in the blood will be high in the presence of a clot?
D-dimer: a breakdown product of fibrin
What is D-dimer?
A breakdown product of fibrin that is present with a DVT
What position should the bed be for a lower extremity vein exam?
Reverse Trendelenburg
Which leg vein may be a bifid system?
Femoral vein
What veins are near the tibia?
Posterior Tibial Veins
What veins travel adjacent to the fibula?
Peroneal veins
One of the major storage areas for blood in the calf is a network of veins called?
Soleal sinus veins
What should spectral doppler look like in a normal vein?
Phasic with respiration
When a thrombus forms in a vein, what happens to the resistance and pressure?
They both increase
What should be suspected if continuous flow is seen and does not change with respiration?
A proximal thrombus
What disorder occurs with the compression of the left common iliac vein by the right common iliac artery, leading to restricted blood flow?
May-Thurner syndrome
What disorder is associated with marked swelling of the lower extremity, pain, pitting edema, and blanching, but no ischemia is present?
Phlegmasia alba dolens
What disorder is also known as milk leg or white leg?
Phlegmasia alba dolens
In what LEV disorder does massive swelling and cyanosis occur?
Phlegmasia cerulean dolens
What is the most common incidental finding in a LEV exam?
Hematoma
Popliteal fossa cysts are also known as?
Baker’s cysts
What does NOAC stand for?
New oral anti-coagulants
Patient presents with UNILATERAL pulsatile flow, what would this indicate?
AVF
Patient presents with BILATERAL pulsatile flow, what would this indicate?
Venous congestion
Patient presents with retrograde flow, what would this indicate?
Reflux - incompetent valves
T or F? Phlegmasia cerulean dolens is associated with pregnancy?
FALSE: Phlegmasia alba dolens is associated with pregnancy
What kind of waveform will appear with a proximal thrombus?
Non-phasic, Continuous flow
When does blood flow from the superficial system through the perforator veins and into the deep system in the calf?
a. During contraction
b. During relaxation
c. At rest
During relaxation
In secondary DVT, what veins act as collaterals?
Superficial veins
T or F? Pregnancy causes varicose veins?
FALSE: the increase in venous pressure and venous distension brings about predisposing factors
