Lower Limb Vascular Disease

Question 1

Define claudication

Answer 1

Pain in the muscles of the lower limb, induced by walking or exercise

Question 2

What is the pathophysiology of claudication?

Answer 2

Atheroma formation causes a reduced blood flow to the muscles therefore giving rise to ischaemia. This stimulate anaerobic metabolism, producing lactate and substance P.

Question 3

Which arteries are commonly affected and give rise to claudication?

Answer 3

Superficial femoral artery (80%)
Aorto-iliac arteries (15%)
Calf arteries (5%)

Question 4

What is a major risk factor towards further complications with peripheral vascular disease?

Answer 4

Continuing smoking

Question 5

Differential for pain on walking

Answer 5

Spinal stenosis (pain when going downhill)
Muscular strain
Musculo-ligamentous strain

Question 6

Treatment for peripheral vascular disease

Answer 6

Correct CVS risk factors 
Exercise rehabilitation
Percutaneous transluminal angioplasty
Surgical bypass
Aspirin 75mg OD
Statins

Question 7

Describe critical limb ischaemia

Answer 7

Blood supply is not adequate even when resting
Classically - pain in toes
Causes: ulcers and gangrene

History - pain in leg at night which is relieved by hanging the limb out of bed

Question 8

Describe Buergers Test

Answer 8

Lift the leg up to 45 degrees and hold or 1-2 minutes. A white leg indicates arterial insufficiency. On hanging the leg off the bed, it will first go blue (deoxygenated blood) which then becomes red due to reactive hyperaemia.

Question 9

Where are deep veins on the leg?

Answer 9

Located between deep fascia of lower limb. Accompany the major arteries.

Question 10

Give the path of the deep veins of the leg

Answer 10

Posterior and anterior tibial vein
Popliteal vein
Femoral vein
External iliac vein

Question 11

Where do you find superficial veins?

Answer 11

In the subcutaneous tissue. Drain into the deep veins

Question 12

What are the two main superficial veins?

Answer 12

Great saphenous vein

Small saphenous vein

Question 13

Describe the path of the great saphenous vein

Answer 13

Dorsal venous arch
Anterior to medial malleolus
Posterior to the medial condyle of the knee
Along anterior thigh
Through saphenous opening of fascia lata
Forms saphenous arch
Drains into the femoral vein at the saphenofemoral junction

Question 14

Describe the path of the small saphenous vein

Answer 14

Dorsal venous arch 
Posterior to lateral malleolus
Travels with sural nerve 
Passes through the heads of the gastrocnemius
Drains into the popliteal vein

Question 15

Define a varicose vein

Answer 15

Dilated, tortuous veins. Classed as:
Trunk
Telangiectasia
Reticular

Question 16

What are the symptoms of varicose veins?

Answer 16

Heaviness
Itching
Aching
Tension

Question 17

Give some complications of varicose veins

Answer 17

Thromboplebitis
Haemmorhage

Venous hypertension causing:

• oedema
• skin pigmantation
• varicose eczema
• Atrophie blanche
• lipodermatosclerosis
• venous ulceration

Question 18

What things would you ask about in the history of someone with varicose veins?

Answer 18

Symptoms
Concerns
History of DVT
History of skin changes
CVS risk factors
On the Pill or HRT