Peripheral Arterial and Venous Diseases Flashcards
lower limb anatomy
- veins deep and superficial
- deep veins runs deep fascia with major arteries and deep veins are connected via perforating
movement of heart through the veins normally
superficial veins throughout the perforating veins to deep then sent back to the right side of heart
important veins in vd
- femoral
- long saphenous
- politeal
is femoral vein deep or superficial?
nah deep
is saphenous vein deep or superficial and what else it ?
superficial at popliteal vein connects to the saphenous vein and longest vein in the body
whats the division of the veins from the external iliac
image
what an imprint site of locating a specific vein?
- long saph runs infront of medial malleolus
calf muscle function
- soleus and gastrocnemius muscle contribute to pushing blood against gravity towards the heart
- valves open and b pushes through these deep veins , valves close to prevent retrograde movement
during exercise what happens to venous pressure
decreases b blood isn’t polling at the feet , if it pools for too long their vp drop too low and get to hypotension
varicose
varicose - damage to valves (d walls of veins weakening; varicosities develop and valve cusps separate becoming incompetent) of vessel wallso ineffevie movement of b and stasis , most common in saphenous veins hence why easy to view in les, more common in women
symptomatic development and complication
- throbbing, itchy -haemorrhage (during hot showers, vasodilation, d damage to veins , veinodilation, haemmoraghe, can be fixed if they bring their legs up) - superficial vein thrombophlebitis (inflammatory process resulting in clot in vein) -chronic venous insufficiency; reflex or obstruction c venous hypertension and oedema -haemosidirin staining (venous pressure high b pours out the iron is leaked out -lipidermatosclerosis ; inflam. ad thickening of fat layer under skin -venous ulceration; damage to the skin damage
differential diagnosis of venous ulcers from arterial and diabetic ulcers
- itching , throbbing and irregular and shallow and red is VENOUS - arterial ulcers are more pale, with defined edge - deep, red, plantar part of foot is Diabetic ulcer
whats CVI and what does it development into?
-chronic venous insufficiency -b pushed out of the capillaries into the interstitum and so c lymphatic compromised function d the chronic venous leakage - 50% get DVT
why does calf muscle pump fail
- b muscle not being used properly, plantar flexion o ankle at joint
who’s most at risk of DV incompetence
-elderly/injured/obese/waiting for hip and knee replacement/parkinson 9since they shuffle and don’t flex) b more idle
retrograde flow?
-pooling of b
superficial vein incp
-valve damage so b moves from deep to superficial, so sup is overwhelmed - this increases risk of venous ulcers
whats does pooling increase risk of
ulcers - treatment is = ligating that perforating vein
arterial thrmbosis ?
- platelet rich - activated- aggregate - plug hole
venous thrombosis
- stasis and other factor -fibrin rich - virchows triad
DVT
-commomly calf -impaired vein return and hypercoaguabilty - - combined oral contraceptive pill ^ risk d changes in coagulability
post surgery pyrexia for no reason?
- then post surgical DVT
what scoring system do you use
Well’s score
economy class syndrome and risk factors od DVT
- DVT more common in people who dot move or long-haul flights so economy class - stasis patients before and after -trauma increase hypercoagulity not even major surgery -cancers and pregnancy
treatments
- anticoagulants -movement -ted stocking
what can DVT c
pulmonary embolism
peripheral arterial disease common routes
knee , shoulder hip
whats an adaptive response to stenosis of major vessel over a period of months or years
collateral circulation
phyisiological design to limit incidence of ischaemia when we end or flex a joint?
collateral circulation
acute limb ischaemia
- occlusion d trauma or embolism -happens in matte of minutes or days -6 Ps
leg ischameia Ps
-pain -pallor -pulseless -parasethia -paralysis or reduced power (d to occlusion) -perishing with cold
treatments of AVD
- angioplasty/thrombectomy/intra-ateraial thrombolysis
what happens in ischamic leg
- necrosis then hyperkalemia wc damage the heart and c asystole and death
necrosis what should you think of
hyperkalemai
chronic pAD how does it present
- claudificaion (pain induced on exercise) -caused by arthero. -oxugen supply and demand ratio is imbalanced and so get angina
management of CPAD
- exercise, smoking, antiplatelet drugs, angioplasty , bypass grafts
critical ischameia and rest pain
- rest pain ; b supply so bad its painful even at rest; unstable angina
- REST PAIN: even at rest pain but patients say its really painful at bed but releive the pain by hanging foot out of bed, this is because they are inducing gravity to stimulate gravity to get b into lower limbs
treatment for critical isachemia
- imaging
- angioplasty/thrombectomy/intra-arterial thrmoblysis or amputation
pathology of claudification
1) first mild where one 1 vessel occluded then more adn more and more
- most common is atheroma borught about the atheroschelrosis of the superficial femoral artery , pateitn presents with calf muscle claudification , untreated becomes critical ischamea
- then stenonsis can c infarctionadn necrosis (coagulative) , then dry gangrene and ulcers
palpitations of lower limb
- femoral - mid lingual point midway been ASIS and pubic symphysis
- popliteal pulse - deep in popliteal fossa
- dorsalis pedis pulse - just lateral to extensor hallucis longus tendon (ask patient to flex big toe and go lateral to the tendon)
- posterior tibial pulse - just behind the medial malleolus
doppler ulstrasound
- used in diagnosis
- measures flow and velocity w Is dirubed in occlusion
- used in echo to demonstrate movement
- also used in ankle-brachial pressure index
ankle brachial pressure index
- measure in brachial artery and ankle (looking at the doralis pedis artery and posterior tibial artery ) and divide it and systolic brachial if <0.9 theres an issue
what are the risk factors for PAD
- PVD ; ^ cholesertol, uncontrolled hypertension, smoking, diabetes
what are risk factors for PVD
pregnancy (hence the ted stocking), oral contraceptive being female
Buerger’s disease
- occurs the b vessels of hands and feet become inflamed and clots form, they block b flow(veins and arteries) - d smoking
Raynauds disease
- spasm of the arteries in the fingers, toes sometimes nose and ears, Brough about by stress and cold c ischaemia to those areas -treatment is keep warm
most common cause of PAD
atheroschelorsis ( build up of fatty plaque on the artery wall ; this is different to arterioschelrosis wc is hardening of artery walls)
T/F PVD occurs due to thickening of the valves in the veins
false , occurs due to overstretched valves wc become incompentent and allow for retrograde flow and so pooling of blood
with PAD whats important about tempreature
- prevent the foot from getting too cold or else it will undergo vasoconstriction wc impedes b flow further
-superficial vein thrombophlebitis (inflammatory response that cause b clot to form in vein) - patients present with painful erythematous
arterial
venous
diabetic
vascular arterial examination
- consent
- ASK IF PAIN OR DISCOMFORT
- remove clothes and banadges
- suppine position, patient at 45 degree angle or flat
- lookat patient hands for temp , cyanosis, tabacoo,radial pulse to rule out AFib
- pulse in both arms
- scar for surgey
- sources of external bleeding, look for pallor, ischaemia, erythema , gangree, hair loss hard skin(chronic ischaemia), swelling
- feel skin with back of hand to assess tempreture and palpate the knee thigh and leg and ask about painand look at their face
- slightly left to mid line use 2 hands to palpate the abdominal aorta
- palpate the femoral, popliteal, dorsalis and tibial
- assess capilaary refil time by pressing on the toe for 3 seconds and seeing how long it takes for reperfusiion to return to it >3 is abnormal
- bones abnoamrlaies can c occlusion adn stenosis
- assessneural impingement by checking motor funtion and sensation (e/f knee and hip adn dorsflexion adn plantar)
- Buerger’s test
- doppler ultrassound
buerger’s test
- patient in supine postion as to raise leg flexed
- even raised the leg should be pink , but with positive they go pallor and when leg returned it goes blue then red
