Peripheral Vascular Disease

Question 1

Calf pain on walking with absent pulses is a sign of…

Answer 1

Claudication

Question 2

Arteries of the leg:

Question 3

Veins of the leg:

Question 4

What is the path of the great saphenous vein?

Answer 4

The great saphenous vein runs up the medial side of your leg from the foot all the way up to the groin.

Joins the deep venous system at the sapheno femoral junction.

Note: Small saphenous vein runs up the back of the calf joining the popliteal vein at the saphenopopliteal junction.

Question 5

What is important at the saphenous junctions?

Answer 5

Significant because they are the sites of two important valvular systems. When the valves become floppy or incompetent it enables blood to flow the wrong way in the vein back down the leg.

• This increases the venous pressure in turn causes dysfunction of other valves, resulting in increased pressure and increased dilitation of the veins.
• Results in exudation of fluid which causes the skin changes and problems seen with venous disease.

Question 6

Summary of the importance of the saphenous junctions:

Answer 6

You can get valvular incompetence which results in venous hypertension.

Question 7

Examination of peripheral vascular disease:

Answer 7

1. Look for varicosities and decide whether they belong to the short saphenous vein (posterior lateral below the knee) or the great saphenous vein (medial).
2. Ulcers around the medial malleolus are suggestive of venous disease. There may also be atrophy and loss of skin elasticity (lipodermatosclerosis).
3. Brown haemosiderin deposits result from venous hypertension.
   4.

Question 8

Warm varicose veins may indicate…

Answer 8

Infection

Question 9

Firm but tender varicosities suggest what…

Answer 9

Thrombosis

Question 10

Bruits (a murmur) over a varicosity indicates what?

Answer 10

Arteriovenous malformation

Question 11

How can peripheral vascular disease present?

Answer 11

• Intermittent claudication
• Critical limb ischemia:
  
  • Ulcer
  • Rest pain
  • Gangrene
  • Sepsis
• Acute limb ischemia
  
  • 6P’s
  • Limb loss

Question 12

Acute Limb Ischemia vs Critical limb ischemia

Answer 12

Acute = due to emboli

Chronic critical limb ischemia = due to atherosclerotic plaques which cause gradual reduction in blood flow resulting in long term chronic symptoms.

(Arterial pathologies)

Question 13

What investigations are carried out in PVD?

Answer 13

1. Inspect for varicosities and skin changes.
2. Palpate varicosities.
3. Auscultation of varicosities
4. Doppler test (A Doppler ultrasound is a test that uses high-frequency sound waves to measure the amount of blood flow through your arteries and veins, usually those that supply blood to your arms and legs. Vascular flow studies, also known as blood flow studies, can detect abnormal flow within an artery or blood vessel.)

Question 14

Treatment of PVD:

Answer 14

1. Control risk factors e.g stop smoking, control diabetes, active, antiplatelet therapy, statins and BP control.
2. Angioplasty - wire and balloon through a stenosis - insert stent to maintain the artery as being open.
3. Bypass (anatomic / extra-anatomic).mic

Question 15

Extra-anatomic bypass options.

Answer 15

Question 16

Valvular incompetence in PVD classically occurs where?

Answer 16

Saphenofemoral junction

Saphenopopliteal junction

Question 17

These are the clinical manifestation of

Answer 17

PVD

Question 18

What is shown here?

Answer 18

Saphenous varix - a dilation of the saphenous vein at its junction with the femoral vein in the groin. Saphena varix is a common surgical problem. Patient can present with a groin swelling due to saphena varix.

Question 19

Cellulitis

Answer 19

Common, potentially serious bacterial skin infection. The affected skin appears swollen and red and is typically painful and warm to the touch. Cellulitis usually affects the skin on the lower legs, but it can occur in the face, arms and other areas.

• can be associated with PVD

Question 20

Treatment of varicose veins:

Answer 20

Compression stocking

Leave alone

If skin symptoms are starting to develop and accompany varicose veins - treatment is thermal ablation.

Thermal ablation is gold standard.

Question 21

Main causes of ulcers?

Answer 21

Ischemia

Granulation

Infection

Question 22

Ulcer location indicates pathology >

Answer 22

Question 23

Arterial vs Venous ulcers

Treatment?

Answer 23

Compression socks

Question 24

The underlying pathophysiology of PVD is…

Answer 24

Atherosclerosis

Question 25

Critical limb ischemia

Answer 25

Critical Limb Ischemia (CLI) is a severe obstruction of the arteries which markedly reduces blood flow to the extremities (hands, feet, and legs) and has progressed to the point of severe pain and even skin ulcers or sores. The pain caused by CLI can wake up an individual at night.

Question 26

Different types of Ulcer - Features

Answer 26