Peripheral Vascular Disease and Varicose Veins Flashcards
What are the risks for venous insufficiency?
Increased Abdominal pressure/obstruction leading to valve failure: Ascites Weight Pregnancy Pelvic Tumours
Valve Failure Increased pumping (calves in athletes), straining
What are the most common sites for atherosclerosis (to cause PVD)
Superficial Femoral Artery
What are the symptoms of Leriche’s?
Bilateral Buttock/Thigh Pain
Erectile Dysfunction
Where is the problem in Leriche’s?
Bifurcation of the aorta
What is Peripheral Vascular Disease?
Chronic Limb Ischaemia
Restriction of blood flow to a limb causing pain distally, for at least 2 weeks
Symptoms of Intermittant Claudication?
Pain on movement/exercise
Relieved at rest
Distal to proximal (normally calves)
Symptoms of Ischaemic Rest Pain?
Pain at rest
Worse at night/in bed
Have to dangle foot out of bed
What are varicose veins?
Abnormal, dilated, tortuous superficial veins which usually occur due to increased flow from the Deep veins which have failed somehow
What are the features of venous insufficiency?
Varicose Veins Varicose Eczema Thrombophlebitis Atrophy Blanche Lipodermatosclerosis
Investigations in Varicose Veins?
Trendelenbergs
What are the features of venous insufficiency?
Varicose Veins Varicose Eczema Thrombophlebitis Atrophy Blanche Lipodermatosclerosis Ulcers
Investigations in Varicose Veins?
Trendelenbergs
Tap Test
Cough Test
Investigations in PVD
Bloods - Cholesterol, Clotting, Glucose Treadmill Test - Do ABPI before and after (returns to normal slower) Buergers Test Duplex Scan/Doppler CT Angiogram ABPI
Treating PVD
Conservative: Weight loss, diet, exercise, education
Medical: statins, anti-hypertensives, anti-platelets, diabetes treatment
Surgical: PCI (if one) or bypass (multiple)
Amputation
Why do people get Intermittant Claudication
Increased O2 requirement
Arteries cannot supply enough
Anaerobic Metabolism
Substance P and lactate formed creating cramping pain
What are the stages of PVD?
1) Asymptomatic
2) Intermittant Claudication
3) Ischaemic Rest Pain
4) Critical Limb Ischaemia
What is the course of the superficial leg veins?
Small Saphenous - posterior to LM then to popliteal vein
Great Saphenous - ant to MM then posterior to MCondyle - adductor canal - femoral vein
What is the course of the deep veins?
Anterior/posterior tibial, fibular
Goes into popiteal vein - adductor canal - femoral + deep vein of thigh - external iliac - common iliac - IVC
What is the treatment for Varicose Veins?
Reassure
Education - raise legs, gentle exercise
Compression
Treat cause - ascites drain etc
Surgery - injection sclerotherapy, ligation, stripping leg
What are the symptoms of Varicose Veins?
Throbbing
Tiredness
Cosmetic Unhappiness
What are telectangasias?
Spider veins
Small, webs of venules
What are the types of varicose veins?
Trunk 70% - prominant, large
Reticular - multiple, red, grouped
Why are they more likely in women/pregnancy?
Progesterone relaxes Smooth muscle
Increased Abdo pressure for venous return
