Peripheral Venous And Arterial Disease

Question 1

What are the 2 types of veins in the lower limb?

Answer 1

Superficial veins
Deeps veins

Question 2

Where are the superficial veins located in the lower limbs?

Answer 2

In subcutaneous tissue

Question 3

Where are the deep veins in the lower limb?

Answer 3

Underneath deep fascia next to bone or through muscle

Question 4

How does blood move between superficial and deep veins?

Answer 4

Moves from superficial to deep

Question 5

What are the superficial veins of the lower limb from proximal to distal on the anterior side?

Answer 5

Femoral vein
Branches to the long saphenous vein which runs down the medial side

Question 6

What landmark can be used to identify the long saphenous vein?

Answer 6

In front of the medial malleolus

Question 7

What are the superficial veins of the owner limb on the posterior side running from proximal to distal

Answer 7

Popliteal vein emerges from the popliteal fossa
Branches to form short saphenous

Question 8

What are the deep veins of the lower lim from proximal to distal?

Answer 8

Inferior vena cava
Branches to L/R common iliac
Branches to External Iliacs
Branches to femoral veins (Deep and superficial deep veins)
Femoral becomes popliteal in popliteal fossa
Popliteal branches to fibular vein and tibial vein
Tibial vein branches to Anterior tibial and posterior tibial vein

Question 9

What muscles make up the calf muscle pump?

Answer 9

Soleus and Gastrocnemius

Question 10

How does blood flow from superficial to deep veins in the lower limb?

Answer 10

Perforating veins

Question 11

What deep vein does the short saphenous vein drain into?

Answer 11

Popliteal vein

Question 12

What deep vein does the long saphenous drain into?

Answer 12

Femoral vein

Question 13

What features of the lower limb help blood return against gravity?

Answer 13

Valves of veins preventing backflow
Gastrocnemius and Soleus contracting squeezes blood upwards

Question 14

What is Varicose veins?

Answer 14

Where the walls of the veins are weakened leading to valves being ineffective

Causes blood to be slow or moving wrong way due to veins becoming tortuous and twisted

Question 15

What are the symptoms of Varicose veins?

Answer 15

Heaviness, aching, muscle cramps and throbbing

Along affected veins:
-leg cramps
-Ankle swelling
-Varicose eczema
-Haemorrhage from damaged veins

Question 16

What are the risk factors for Varicose veins?

Answer 16

Age
Family history
Female
Number of birth
Occupation (standing a lot)

Question 17

What is Superficial vein thrombophlebitis?
What does it usually follow from?

Answer 17

Inflammatory processes resulting from a clot in vein

Usually follows varicose veins and increases risk of DVT

Question 18

What is Lipodermatosclerosis?

Answer 18

Inflammation and thickening/hardening of fat under the skin

Question 19

What is chronic venous insufficiency?

Answer 19

Happens when the leg veins don’t allow blood flow back to the heart

Question 20

How does chronic venous hypertension cause Haemosiderin staining?

Answer 20

Red cells forced out into intersitial space in surrounding tissues
Macrophages break down the red cells and their haemoglobin in the tissue
This leads to Haemosiderin remaining in the skin staining it a rusty brown

Question 21

How does Venous eczema present?

Answer 21

Chronic
Itchy red
Swollen tight
Can lead to lipodermatosclerosis
Hard to touch

Question 22

How do venous ulcers present?

Answer 22

Chronic
Painful
Develop around hard Nodular areas like medial malleolius

Question 23

What movement in walking at the ankle is important in the calf pump?

Answer 23

Plantar Flexion

Question 24

Why does lack of action of the calf pump cause venous hypertension?

Answer 24

Blood pools in the lower limbs

Question 25

Who is at risk of venous hypertension?

Answer 25

Immobile patients Parkinson’s patients

Question 26

Why do patients with Parkinson’s have an increased risk of venous hypertension?

Answer 26

The adopt a Parkinsonian gait where they shuffle along Not using Plantarflexion and Dorsiflexion properly to use the calf pump q

Question 26

Why do patients with Parkinson’s have an increased risk of venous hypertension?

Answer 26

The adopt a Parkinsonian gait where they shuffle along Not using Plantarflexion and Dorsiflexion properly to use the calf pump

Question 27

What happens to the perforator valve in superficial vein incompetence?

Answer 27

It bulges allowing blood to flow from deep to superficial

Question 28

What are the 3 conditions of Virchow’s triad that lead to a thrombotic state if at least 2 are present?

Answer 28

Stasis Vessel wall damage Hypercoagulability

Question 29

What is an atheroma?

Answer 29

When fatty material accumulates in the arteries causing their degeneration

Question 30

What are the levels of platelets in arterial thrombosis?

Answer 30

Platelet rich, platelets activated, aggregation, plaques form

Question 31

What usually leads to venous thrombosis?

Answer 31

Stasis and usually something else

Question 32

What are the levels of platelets in venous thrombosis?

Answer 32

Little platelet component and fibrin rich

Question 33

What is Deep Vein Thrombosis (DVT)?

Answer 33

Clotting of blood in a deep vein

Question 34

What usually leads to DVT?

Answer 34

Impaired venous return (stasis) and hypercoagulabilty

Question 35

What are usually the signs/symptoms of DVT?

Answer 35

Pyrexia with NO other obvious cause Calf tenderness and warmth Pain Swelling Redness

Question 36

What is the primary concern with Deep Vein Thrombosis leading to?

Answer 36

Pulmonary embolism

Question 37

Who is at an increased risk of DVT?

Answer 37

Immobile people People before and after surgery Pregnancy Malignancy Trauma

Question 37

Who is at an increased risk of DVT?

Answer 37

Immobile people People before and after surgery Pregnancy Malignancy Trauma

Question 38

How can the risks of DVT be reduced?

Answer 38

Mobility after surgery (preventing static state) Physcial activity Gradient stockings/compression socks

Question 39

What is the importance of collateral circulation?

Answer 39

Limit incidence of acute ischaemia because it provides multiple pathways to the tissues

Question 40

What are anastomoses?

Answer 40

Formation of branches between existing vessels to bypass a blockage

Question 41

When do anastomoses normally form?

Answer 41

Adaptive response to stenosis of a major vessel over a long time

Question 42

What is Acute limb ischaemia? Why does the ischamie occur?

Answer 42

Acute/quick occlusion of arteries supplying the limbs Ischaemia occurs since no time for collateral circulation to develop

Question 43

What are the 6Ps for the presentation of Acute limb ischaemia?

Answer 43

Pain Pallor (mottling dark colour) Perishingly cold Pulseless Parasthesia (numbing) Paralysis

Question 44

Why do patients with acute limb ischaemia have hyperkalaemia?

Answer 44

Apoptosis of cells leads to the release of the K+ into the blood

Question 45

How is Acute limb ischaemia treated?

Answer 45

Surgery Angioplasty Thrombectomy Amputation

Question 46

What is Claudication?

Answer 46

Cramping pain in the leg induced by exercise

Question 47

What causes Claudication?

Answer 47

Atherosclerosis

Question 48

What happens to the oxygen supply to the heart in stable angina?

Answer 48

The oxygen demand of the heart is greater than the amount that can be supplied due to it being hard to increase supply in atherosclerotic arteries

Question 49

How is claudication treated?

Answer 49

Exercise Smoking cessation Antiplatelet drugs Angioplasty Bypass graft

Question 50

What is angioplasty?

Answer 50

A balloon stent catheterised in artery pushing it open Mesh keeps artery open

Question 51

What is the Ankle-brachial pressure index (ABPI)?

Answer 51

The systolic pressure of the ankle (Dorsalis pedis and posterior tibial) DIVIDED BY Systolic pressure of the brachial artery

Question 52

What value of Ankle-brachial pressure index indicates presence of peripheral artery disease?

Answer 52

ABPI < 0.8

Question 53

How can you determine where the stenosis is which is causing the claudication?

Answer 53

Palpate pulses to determine where the occlusion is Point of occlusion determines where claudication is experienced

Question 54

Intermittent claudication can lead to critical ischaemia, what makes this pain worse and what relieves it?

Answer 54

Claudication is made worse by exercise but if it leads to critical ischaemia it can have Pain at Rest Hanging foot out of bed helps it (uses gravity to help perfuse the limb/foot)

Question 55

How do you treat critical limb ischaemia?

Answer 55

Angioplasty Thrombectomy Intra-arterial thrombolysis Amputation

Question 56

What is Thrombectomy?

Answer 56

Removing occlusion

Question 57

Where can the femoral pulse be palpated?

Answer 57

Mid Inguinal point Midway between ASIS and pubic symphysis

Question 58

Where can the popliteal pulse be palpated?

Answer 58

Deep in popliteal fossa

Question 59

Where can the Dorsalis pedis pulse be palpated?

Answer 59

Lateral to extensor hallucinations longus (essentially between big toe and toe 2)

Question 60

Where can thee posterior tibial pulse be palpated?

Answer 60

Just behind and slightly below the medial malleolus

Question 61

What is the use of Doppler ultrasonography?

Answer 61

Using ultra sound and the Doppler effect to measure real time flow and velocity

Question 62

How does Doppler ultrasonography work?

Answer 62

Echoes produced from turbulent blood detected and computer works out its flow direction and velocity

Question 63

How is velocity of blood affected through a stenosed vessel?

Answer 63

Increased velocity