Peripheral Arterial and Venous Disease

Question 1

Where are the deep and superficial veins in the lower limb found

Answer 1

Deep - deep to the deep fasica

Superficial - found within subcutaneous tissue

Question 2

Name the deep veins of the lower limb

Answer 2

Popliteal vein

Femoral vein

External iliac vein

Question 3

Name the superficial veins of the lower limb

Answer 3

Short and long saphenous veins

Question 4

What are varicose veins and why do they form

Answer 4

Tortuous, twisted or lengthened veins

Dilatation of vein wall and separation of valve cusps causes them to become incompetent so blood flows backwards, causing the veins to enlarge

Due to inherent weakness of vein wall

Question 5

What are the symptoms of varicose veins

Answer 5

Varicose veins themselves

Heaviness

Tension

Aching

Itching

Question 6

What are the complications of varicose veins

Answer 6

Haemorrhage of the vein

Thrombophlebitis

Venous hypertension causes:

• Oedema
• Skin pigmentation
• Varicose eczema
• Lipodermatosclerosis
• Venous ulceration

Question 7

What is thrombophlebitis

Answer 7

Inflammation of a vein due to a thombus

The venous thrombus initiates an inflammatory response

Question 8

What causes haemosiderin staining

Answer 8

This is due to the venous hypertension

This causes RBCs to leave blood vessels and enter tissue fluid where they are taken up by macrophages and are oxidised

This causes oxidation of the iron in Hb causing the dark staining of the skin

Question 9

What is lipodermatosclerosis

Answer 9

Thickening of the fat in the skin, the fat thickens and hardens

Question 10

What causes venous ulceration

Answer 10

Venous hypertension

Question 11

What are the causes of muscle pump failure

Answer 11

Failure of calf muscle contraction - immobility, obesity (tend to shuffle so not using muscles), reduced hip, knee and/or ankle movement

Deep vein incompetence

Volume overload - superficial vein incompetence

Question 12

What are the likely reasons for arterial and venous thrombosis

Answer 12

Arterial - change in lining of vessel wall

Venous - changes in flow of blood

Question 13

How does arterial thombus formation differ from venous thrombus formation

Answer 13

Arterial needs platelets and activation of both pathways

Venous needs intrinsic pathway initially, then activation of the both pathways

Arterial thrombi are platelet rich, venous thrombi are fibrin rich

Question 14

Which type of prophylactics should be used to prevent the different types of thromi formation

Answer 14

For arterial thrombi, use anti-platelet

For venous thrombi, use anti-coagulant

Question 15

Where does a DVT commonly begin and what response does it produce

Answer 15

Commonly begins in deep calf veins

Produces an inflammatory response

Question 16

What are the signs and symptoms of DVT

Answer 16

Pain, cannot walk

Swelling

Blue-red skin discolouration

Calf tenderness

Muscle indurance

Distended, warm superficial veins

Oedema

Pyrexia

Question 17

How does hyperkalaemia cause patients to die

Answer 17

Causes cardiac asystole

Question 18

What are the commonest causes of acute limb ischaemia

Answer 18

Embolism

Trauma

Question 19

What are the signs and symptoms of acute ischaemia (6 P’s)

Answer 19

Pain

Paralysis

Paraesthesia

Pallor

Perishing cold

Pulseless

Question 20

What is claudication

Answer 20

Pain in muscles of the lower limb, elicited by walking/exercise

Question 21

What can chronic peripheral arterial disease cause

Answer 21

Intermittent claudication

Critical ischaemia - rest pain, ulceration/gangrene

Question 22

What are the features of claudication

Answer 22

Calf muscles most frequently affected, though proximal may be affected

Pain relieved by stopping exercise, even whilst standing up

Question 23

Where is the femoral pulse felt

Answer 23

Mid inguinal point

Question 24

Where is the dorsalis pedis pulse felt

Answer 24

Just lateral to extensor hallucis longus tendon

Question 25

Where is the posterior tibial pulse felt

Answer 25

Behind medial malleolus

Question 26

What are the features of aortoiliac occulsion

Answer 26

Bilateral buttock, thigh and calf claudication

Absent lower limb pulses

Question 27

What are the features of a right common iliac occulsion

Answer 27

Right buttock, thich and calf claudication

Absent right lower limb pulses

Question 28

What are the features of a right sided common femoral or external iliac occlusion

Answer 28

Right thigh and calf claudication

Absent right lower limb pulses

Question 29

What are the features of a right sided superficial femoral artery occlusion

Answer 29

Right calf claudication

Femoral pulse present, absent popliteal and pedal pulses

Question 30

What is critical ischaemia

Answer 30

Where there are multiple stenoses in vessels, resulting in little blood flow

There is rest gain and potential of ulceration and/or gangrene

Question 31

What is rest pain

Answer 31

Pain in the foot coming on when patient goes to bed and relieved by hanging the foot out of the bed

Ischaemia is so severe that at rest the foot skin, muscles and bones are ischaemic

Question 32

What are the consequences if rest pain is left untreated

Answer 32

Gangrene

Ulceration