Peripheral artery and vein disease Flashcards
Where does the long saphenous vein always run?
out of femoral vein, down medial aspect of leg and then INFRONT OF THE MEDIAL MALLEOLUS
Describe how blood is returned from the legs to the heart?
vein runs within muscle belly
as muscle contracts pressure increases due to tight fascia
increase in pressure pushes blood upwards to heart
What is a varicose vein?
a vein which is tortuous, twisted or lengthened
How do varicose veins occur?
The vein wall in inherently weak which leads to dilatation and seperation of valve cusps and so they become incompetant
What are the symptoms of a varicose vein?
heaviness, tension, aching and itching along the vein itself
What are the complications of a varicose vein due to the vein itself? (2)
- bleeding
- thrombophlebitis
What is thrombophlebitis
- blood clots (usually in varicose vein due to stasis)
- produces inflammatory response
- pain, redness ect along course of vein, may get haemosiderin staining due to RBC leaking out and macrophages converting ferrous iron to ferric iron
What are the complications of a varicose vein due to the venous hypertension? (5)
- oedema
- skin pigmentation
- varicose eczema
- lipodermatosclerosis
- venous ulceration
What is lipodermatosclerosis?
fat in the skin becomes hard as a result of the veinous insufficiency. exactly how and why is unknown
What is the difference in arterial and venous thrombus formation?
Arterial thrombus involve platelets first, then extrisnic and intrinsic pathways as they need to be able to be formed under high pressure. clotting generally occurs here due to vessel wall defects.
Venous thrombus tend to be due to flow of blood defects, and rely on intrinsic pathway then extrinsic pathways.
Both involve vessel constriction
If symptoms present, what are the signs and symptoms of DVT?
- pain
- swelling
- blue/ red skin colour
- tenderness
- warmth
- warm, distended superficial arteries
- oedema
- pyrexia
What are the main causes of acute peripheral artery disease?
- thrombus
- trauma
What is the consequence of acute peripheral artery disease?
limb ischaemia and eventually death
What are the 6 signs of acute limb ischaemia?
- pain
- pallor (pale)
- paralysis
- paraesthesia
- perishing cold
- pulseless
Why can limb ischaemia sometimes look red (sunset foot)
vasodilation to try and get rid of ischaemia
Describe the progression of acute ischaemia
- pale foot
- moveable mottling (goes blue due to stasis of deoxygenated blood, but will blanch)
- fixed mottling- no more blanching, leg is dead. cut it off
Define claudication
pain in the muscles elicited by walking/ exersize
Where can the dorsalis pedis pulse be felt?
lateral to the extensor halicus longus tendon
Where can the posterior tibial artery be felt?
posterior to the medial malleous
Describe the possible progressions of chronic peripheral arterial disease
- collateral cirulation grows or - intermittant claudication - rest pain - then necorsis/ ulceration/ gangrene
Describe the presentation of someone with rest pain
pain in FOOT that comes on usually when pt goes to bed and is releived by hanging the foot out of bed
Why does rest pain most commonly come on when the pt goes to bed?
- lie down- less gravity pushing blood down
- warm up- higher metabolic rate/ demand
- lower cardiac output at night
What causes pain in an ischaemic limb?
- more lactate produced, lower pH, this stimulates pain receptors (nociceptors)
- substance P (a neuropeptide) is released locally which increases sensitivity of pain receptors
What is the burgers test?
Elevating the foot to see what angle you can get it up to before it becomes white- suggests ischaemia starting
