Peripheral Arterial And Venous Disease

Question 1

Where are the Deep veins
Where are the Superficial veins

State the direction of blood flow between these 2 veins

Answer 1

Deep- Underneath deep fascia (With major arteries)
Superficial- In subcutaneous tissue

Blood moves from Superficial to Deep veins

Question 2

What is the calf muscle pump also called?
Which 2 muscles is it composed of?

What is the overall function?

When is Venous pressure in foot reduced?

Answer 2

Also called the Peripheral Heart

Soleus and Gastrocnemius contract to push blood against gravity towards heart

Reduced during exercise

Question 3

What happens when the Calf Muscle Pump contracts and relaxes

Answer 3

• Calf muscle pump contracts-> Blood pushed into and up the Deep veins through Perforating veins. Perforating valves close to prevent back flow into superficial veins
• Relaxes-> Perforating valves open to allow filling of Deep veins

Question 4

What are Varicose veins?
How do they develop?

Name 1 disease, where varicose veins are apparent

Answer 4

Varicose veins- Dilated, tortuous, lengthened veins, with ineffective valves, leading to slow/ reversed blood flow

Walls of vein weaken-> Varicosities develop and valve cusps separate, becoming incompetent

Peripheral Venous Disease

Question 5

Identify 5 symptoms of Varicose Veins

Answer 5

• Muscle cramps

Along affected vein;

• Heaviness
• Aching
• Throbbing
• Itching

Question 6

What are 2 complications of varicose veins resulting from the vein itself

Answer 6

• Haemorrhage
• Superficial Vein Thrombophlebitis
  ( Inflammatory process resulting in clot formation in a vein)

Question 7

What are 5 complications of varicose veins resulting from venous hypertension due to calf muscle pump failure

Answer 7

• Varicose eczema
• Oedema
• Skin pigmentation (Haemosiderin staining)
• Venous ulceration
• Lipodermatosclerosis

Question 8

what is Lipodermatosclerosis

Answer 8

Inflammation and thickening of fat layer under the skin

Question 9

What are 2 types of complications resulting from Varicose Veins

Answer 9

• Complications resulting from the vein itself

- Complications resulting from venous hypertension (Chronic Venous Insufficiency-> Reflux/ obstruction)

Question 10

What can calf muscle pump failure cause?

List 3 causes of Calf muscle pump failure

Answer 10

Venous hypertension

• Inadequate use of calf muscles (Immobility)
• Deep Vein Incompetence (Blood flows backwards, overwhelmed)
• Superficial Vein Incompetence (Blood flows into superficial veins, as opposed into deep) (Overflowing of calf muscle pump)

Question 11

How is calf muscle pump failure treated

Answer 11

Ligation/ Vein stripping

Breaking the circuit of vessels to prevent retrograde flow

Question 12

Compare Arterial and Venous thrombosis in terms of;

• Cause
• Platelt/ Fibrin rich?

Answer 12

Arterial;

• Atheroma
• Platelet rich

Venous;

• Stasis + another factor (Trauma/Chemo/Pregnancy etc.)
• Fibrin rich

Question 13

What is 1 fatal outcome of a DVT

Answer 13

Pulmonary Embolism

Question 14

List 2 causes of DVT

Answer 14

Stasis (Due to immobility);

• Before surgery
• During surgery
• After surgery

Trauma, (Prothrombic state due to);

• Malignancy
• Pregnancy

Question 15

What are 3 kinds of Peripheral Arterial Disease

Answer 15

• Acute Limb Ischaemia
• Chronic Peripheral Arterial Disease
• Critical Limb Ischaemia

Question 16

What is Collateral Circulation formation

Answer 16

Formation of new vessels around an occluded/ stenosed artery

Question 17

What is Acute Limb Ischaemia

List 2 causes

Answer 17

Normal-> impaired blood supply over minutes-days, with no collateral circulation development

Trauma
Embolism

Question 18

What are the signs of Acute Limb Ischaemia

Answer 18

6 Ps

• Pain (Initially)
• Pallor
• Perishing with cold
• Pulseless
• Parasthesia
• Paralysis or reduced power

Question 19

What are the 2 outcomes of acute limb ischaemia

Answer 19

• If not reversed in 6h, becomes permanent

- If not amputated, death (Hyperkalemia)

Question 20

What are 2 signs of Chronic Peripheral Arterial Disease?

What are 5 methods of management

Answer 20

• Intermittent claudication (Cramping pain induced by activity)
• Pain that goes away with rest

Management;

• Exercise
• Stop smoking
• Anti platelet drugs
• Angioplasty
• Bypass graft

Question 21

What are 3 signs of Critical limb ischaemia

Answer 21

• Pain at rest
• Gangrene
• Ulceration

Question 22

Describe the 4 locations in the lower limbs where pulses can be measured

Answer 22

• Femoral Pulse: At mid inguinal point (Midway between ASIS and Pubic Symphisis)
• Popliteal Pulse: Deep in popliteal fossa
• Posterior Tibial Pulse: Posterior to medial malleosus
• Dorsalis Pedis Pulse: Lateral to Extensor Hallucis Longus tendon

Question 23

How can Peripheral Arterial Disease be diagnosed

Explain how

Answer 23

Doppler Ultrasonography

Echoes produced from blood flow are detected and computed into flow direction and velocity

Question 24

What are the changes in blood flow at a stenosis

Answer 24

• Change in velocity at stenosis

- Turbulent flow beyond the stenosis

Question 25

What is the Ankle-Brachial Pressure Index (APBI)

What does an APBI below 0.9 indicate?

Answer 25

Ratio of BP in ankle to BP in upper arm (Brachium)

APBI below 0.9 indicates Peripheral Artery Disease

Question 26

To obtain an APBI, where must BPs be measured from

Answer 26

• Brachial artery
• Dorsalis Pedis Artery
• Posterior Tibial Artery