Peripheral artery and venous disease Flashcards
which way in the legs does the blood run (superficial/deep)
superficiial to deep
how is blood pumped up to the heart?
the calf muscle pump
very tight fasicia around the calf muscles–>large increase in pressure on contraction
define varicose veins
tortuous, twisted or lengthened veins
describe the pathophysiology of varicose veins
wall of veins is inheritiantly weak
cusps of valves separate–>incompetency of valves
Four symptoms of varicose veins?
heaviness, itching, aching, tension
ALONG THE VEIN ITSELF
2 complications that are as a result of the varicose vein itself?
haemorrhage and thrombophlebitis
define thrombophlebitis
inflammation of the vessell wall
pain
5 complications due to venous hypertension
oedema, skin pigmentation (Due to haemosiderin staining), varicose eczema, lipodermatosclerosis, venous ulceration
why do you get venous hypertension in varicose veins?
the calf muscle pump has stopped working
Causes of venous hypertension?
immobility
obesity
(Both associated with calf muscle contraction failure
deep vein incompetence
superficial vein incompetence
Explain how superficial vein incompetence can lead to venous hypertension
You get an incompetent valve at the junction of the superficial to deep vein
so when the calf muscle pump contracts, some blood goes from deep to superficial
so taken back to the calf muscle pump system
so you get a dilatation of this system–>calf muscle pump failure
how would you treat superficial vein incompetence?
Separate the superficial vein from the deep vein
What is virchows triad?
three things thrombosis can be due to:
changes in the vessel wall
changes in blood flow
changes in blood constituents
what is arterial thrombosis mostly due to (Virchows triad)
changes in the vessel wall
what venous thrombosis most often due to? (Virchows triad)
changes in blood flow
With venous thrombosis, as we said it was due to some change in the blood flow. Also need a provacateur. Give 4 examples of provocateurs
cancer
trauma
dehydration
oral contraceptive pill
compare artterial and venous thrombus
Arterial: involves platelets (platelet rich
the extrinsic pathway of clotting first, then the intrinsic
Venous: Doesn’t involve platelts in a major way
intrinsic then extrinsic
fibrin rich clot
Why do you get pain when you get a DVT?
it induces an inflammatory response
Give some symptoms of DVT
oedema pain skin discolouration pyrexia skin warmth swelling
Why is surgery related to DVT formation. what is the dreaded consequence?
surgery- immobility and a form a trauma so go into a prothrombotic state
what is common around joints (Blood supply wise)
collateral circulation
Why can collateral circulation not form in acute limb ischaemia?
normal blood supply–>greatly impaird blood supply in mins
not enough time to form
Two causes of acute limb ischaemia? Two consequences (untreated and treated)
embolism or trauma
amputation
if not, patient can die of hyperkalaemia as dead cells release K+
6 symptoms of acute limb ischaemia?
Pain Paralysis Parasthesia Pallor Perishingly cold Pulseless
What colour does the leg go initially? At what stage is it ‘too late’ in acute limb ischaemioa
white
When you get fixed mottling of the leg (No blanching so no flow of blood what so ever)
Define intermittent claudication
pain on walk due to ischamemia
m ost commmon in the calf
Describe the deep venous supply to the leg (proximal to distal
external iliac vein–>femoral vein–>popliteal vein
Two superficial veins in the leg?
long saphenous and short saphenous veins
where does the long saphenous vein always pass?
anterior to the medial malleolus
describe the arterial supply to the leg (proximal to distal)
common iliac artery
internal and external iliac arteries
common femoral artery–>superficial femoral artery and the profunda femoris artery
popliteal artery–>anterior tibial artery, posterior tibial artery and peroneal artery
Anterior tibial artery–>dorsalis pedis
Three pulses and where each can be felt?
femoral pulse- the med inguinal point popliteal pulse- popliteal fossa pedal pulses (The dorsal pedalis and the posterior tibial arteries- foot
what claudication and what pulses would you get with Aorto iliac occlusion
billateral buttock pain, thigh pain, calf claudication
no pulses in lower leg
what claudication and what pulses would you get with common iliac occlusion
unilateral buttock, thigh and calf claudication
no pulses
what claudication and what pulses would you get with common femoral occlusion
right thigh and calf claudication
no pulses in right lower limb
what claudication and what pulses would you get with superficial femoral artery occlusion
right calf claudication
femoral pulse present
popliteal and pedal pulses not
Define rest pain. When do you get rest pain in the foot? how is the pain relieved? If untreated what will it progress to?
at rest you are unable to meet the cell’s basic metabolic demands
when you go to bed
hang your foot out of the bed
ulceration and gangrene
