Peripheral artery and vein disease

Question 1

Where does the long saphenous vein always run?

Answer 1

out of femoral vein, down medial aspect of leg and then INFRONT OF THE MEDIAL MALLEOLUS

Question 2

Describe how blood is returned from the legs to the heart?

Answer 2

vein runs within muscle belly
as muscle contracts pressure increases due to tight fascia
increase in pressure pushes blood upwards to heart

Question 3

What is a varicose vein?

Answer 3

a vein which is tortuous, twisted or lengthened

Question 4

How do varicose veins occur?

Answer 4

The vein wall in inherently weak which leads to dilatation and seperation of valve cusps and so they become incompetant

Question 5

What are the symptoms of a varicose vein?

Answer 5

heaviness, tension, aching and itching along the vein itself

Question 6

What are the complications of a varicose vein due to the vein itself? (2)

Answer 6

• bleeding

- thrombophlebitis

Question 7

What is thrombophlebitis

Answer 7

• 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

Question 8

What are the complications of a varicose vein due to the venous hypertension? (5)

Answer 8

• oedema
• skin pigmentation
• varicose eczema
• lipodermatosclerosis
• venous ulceration

Question 9

What is lipodermatosclerosis?

Answer 9

fat in the skin becomes hard as a result of the veinous insufficiency. exactly how and why is unknown

Question 10

What is the difference in arterial and venous thrombus formation?

Answer 10

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

Question 11

If symptoms present, what are the signs and symptoms of DVT?

Answer 11

• pain
• swelling
• blue/ red skin colour
• tenderness
• warmth
• warm, distended superficial arteries
• oedema
• pyrexia

Question 12

What are the main causes of acute peripheral artery disease?

Answer 12

• thrombus

- trauma

Question 13

What is the consequence of acute peripheral artery disease?

Answer 13

limb ischaemia and eventually death

Question 14

What are the 6 signs of acute limb ischaemia?

Answer 14

• pain
• pallor (pale)
• paralysis
• paraesthesia
• perishing cold
• pulseless

Question 15

Why can limb ischaemia sometimes look red (sunset foot)

Answer 15

vasodilation to try and get rid of ischaemia

Question 16

Describe the progression of acute ischaemia

Answer 16

• 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

Question 17

Define claudication

Answer 17

pain in the muscles elicited by walking/ exersize

Question 18

Where can the dorsalis pedis pulse be felt?

Answer 18

lateral to the extensor halicus longus tendon

Question 19

Where can the posterior tibial artery be felt?

Answer 19

posterior to the medial malleous

Question 20

Describe the possible progressions of chronic peripheral arterial disease

Answer 20

- collateral cirulation grows 
or 
- intermittant claudication 
- rest pain 
- then necorsis/ ulceration/ gangrene

Question 21

Describe the presentation of someone with rest pain

Answer 21

pain in FOOT that comes on usually when pt goes to bed and is releived by hanging the foot out of bed

Question 22

Why does rest pain most commonly come on when the pt goes to bed?

Answer 22

• lie down- less gravity pushing blood down
• warm up- higher metabolic rate/ demand
• lower cardiac output at night

Question 23

What causes pain in an ischaemic limb?

Answer 23

• more lactate produced, lower pH, this stimulates pain receptors (nociceptors)
• substance P (a neuropeptide) is released locally which increases sensitivity of pain receptors

Question 24

What is the burgers test?

Answer 24

Elevating the foot to see what angle you can get it up to before it becomes white- suggests ischaemia starting