Peripheral Arterial and Venous Disease Flashcards
Where are the deep and superficial veins in the lower limb found
Deep - deep to the deep fasica
Superficial - found within subcutaneous tissue
Name the deep veins of the lower limb
Popliteal vein
Femoral vein
External iliac vein
Name the superficial veins of the lower limb
Short and long saphenous veins
What are varicose veins and why do they form
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
What are the symptoms of varicose veins
Varicose veins themselves
Heaviness
Tension
Aching
Itching
What are the complications of varicose veins
Haemorrhage of the vein
Thrombophlebitis
Venous hypertension causes:
- Oedema
- Skin pigmentation
- Varicose eczema
- Lipodermatosclerosis
- Venous ulceration
What is thrombophlebitis
Inflammation of a vein due to a thombus
The venous thrombus initiates an inflammatory response
What causes haemosiderin staining
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
What is lipodermatosclerosis
Thickening of the fat in the skin, the fat thickens and hardens
What causes venous ulceration
Venous hypertension
What are the causes of muscle pump failure
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
What are the likely reasons for arterial and venous thrombosis
Arterial - change in lining of vessel wall
Venous - changes in flow of blood
How does arterial thombus formation differ from venous thrombus formation
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
Which type of prophylactics should be used to prevent the different types of thromi formation
For arterial thrombi, use anti-platelet
For venous thrombi, use anti-coagulant
Where does a DVT commonly begin and what response does it produce
Commonly begins in deep calf veins
Produces an inflammatory response
What are the signs and symptoms of DVT
Pain, cannot walk
Swelling
Blue-red skin discolouration
Calf tenderness
Muscle indurance
Distended, warm superficial veins
Oedema
Pyrexia
How does hyperkalaemia cause patients to die
Causes cardiac asystole
What are the commonest causes of acute limb ischaemia
Embolism
Trauma
What are the signs and symptoms of acute ischaemia (6 P’s)
Pain
Paralysis
Paraesthesia
Pallor
Perishing cold
Pulseless
What is claudication
Pain in muscles of the lower limb, elicited by walking/exercise
What can chronic peripheral arterial disease cause
Intermittent claudication
Critical ischaemia - rest pain, ulceration/gangrene
What are the features of claudication
Calf muscles most frequently affected, though proximal may be affected
Pain relieved by stopping exercise, even whilst standing up
Where is the femoral pulse felt
Mid inguinal point
Where is the dorsalis pedis pulse felt
Just lateral to extensor hallucis longus tendon
Where is the posterior tibial pulse felt
Behind medial malleolus
What are the features of aortoiliac occulsion
Bilateral buttock, thigh and calf claudication
Absent lower limb pulses
What are the features of a right common iliac occulsion
Right buttock, thich and calf claudication
Absent right lower limb pulses
What are the features of a right sided common femoral or external iliac occlusion
Right thigh and calf claudication
Absent right lower limb pulses
What are the features of a right sided superficial femoral artery occlusion
Right calf claudication
Femoral pulse present, absent popliteal and pedal pulses
What is critical ischaemia
Where there are multiple stenoses in vessels, resulting in little blood flow
There is rest gain and potential of ulceration and/or gangrene
What is rest pain
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
What are the consequences if rest pain is left untreated
Gangrene
Ulceration
