Peripheral Venous And Arterial Disease Flashcards
What are the 2 types of veins in the lower limb?
Superficial veins
Deeps veins
Where are the superficial veins located in the lower limbs?
In subcutaneous tissue
Where are the deep veins in the lower limb?
Underneath deep fascia next to bone or through muscle
How does blood move between superficial and deep veins?
Moves from superficial to deep
What are the superficial veins of the lower limb from proximal to distal on the anterior side?
Femoral vein
Branches to the long saphenous vein which runs down the medial side
What landmark can be used to identify the long saphenous vein?
In front of the medial malleolus
What are the superficial veins of the owner limb on the posterior side running from proximal to distal
Popliteal vein emerges from the popliteal fossa
Branches to form short saphenous
What are the deep veins of the lower lim from proximal to distal?
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
What muscles make up the calf muscle pump?
Soleus and Gastrocnemius
How does blood flow from superficial to deep veins in the lower limb?
Perforating veins
What deep vein does the short saphenous vein drain into?
Popliteal vein
What deep vein does the long saphenous drain into?
Femoral vein
What features of the lower limb help blood return against gravity?
Valves of veins preventing backflow
Gastrocnemius and Soleus contracting squeezes blood upwards
What is Varicose veins?
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
What are the symptoms of Varicose veins?
Heaviness, aching, muscle cramps and throbbing
Along affected veins:
-leg cramps
-Ankle swelling
-Varicose eczema
-Haemorrhage from damaged veins
What are the risk factors for Varicose veins?
Age
Family history
Female
Number of birth
Occupation (standing a lot)
What is Superficial vein thrombophlebitis?
What does it usually follow from?
Inflammatory processes resulting from a clot in vein
Usually follows varicose veins and increases risk of DVT
What is Lipodermatosclerosis?
Inflammation and thickening/hardening of fat under the skin
What is chronic venous insufficiency?
Happens when the leg veins don’t allow blood flow back to the heart
How does chronic venous hypertension cause Haemosiderin staining?
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
How does Venous eczema present?
Chronic
Itchy red
Swollen tight
Can lead to lipodermatosclerosis
Hard to touch
How do venous ulcers present?
Chronic
Painful
Develop around hard Nodular areas like medial malleolius
What movement in walking at the ankle is important in the calf pump?
Plantar Flexion
Why does lack of action of the calf pump cause venous hypertension?
Blood pools in the lower limbs
Who is at risk of venous hypertension?
Immobile patients
Parkinson’s patients
Why do patients with Parkinson’s have an increased risk of venous hypertension?
The adopt a Parkinsonian gait where they shuffle along
Not using Plantarflexion and Dorsiflexion properly to use the calf pump q
Why do patients with Parkinson’s have an increased risk of venous hypertension?
The adopt a Parkinsonian gait where they shuffle along
Not using Plantarflexion and Dorsiflexion properly to use the calf pump
What happens to the perforator valve in superficial vein incompetence?
It bulges allowing blood to flow from deep to superficial
What are the 3 conditions of Virchow’s triad that lead to a thrombotic state if at least 2 are present?
Stasis
Vessel wall damage
Hypercoagulability
What is an atheroma?
When fatty material accumulates in the arteries causing their degeneration
What are the levels of platelets in arterial thrombosis?
Platelet rich, platelets activated, aggregation, plaques form
What usually leads to venous thrombosis?
Stasis and usually something else
What are the levels of platelets in venous thrombosis?
Little platelet component and fibrin rich
What is Deep Vein Thrombosis (DVT)?
Clotting of blood in a deep vein
What usually leads to DVT?
Impaired venous return (stasis) and hypercoagulabilty
What are usually the signs/symptoms of DVT?
Pyrexia with NO other obvious cause
Calf tenderness and warmth
Pain
Swelling
Redness
What is the primary concern with Deep Vein Thrombosis leading to?
Pulmonary embolism
Who is at an increased risk of DVT?
Immobile people
People before and after surgery
Pregnancy
Malignancy
Trauma
Who is at an increased risk of DVT?
Immobile people
People before and after surgery
Pregnancy
Malignancy
Trauma
How can the risks of DVT be reduced?
Mobility after surgery (preventing static state)
Physcial activity
Gradient stockings/compression socks
What is the importance of collateral circulation?
Limit incidence of acute ischaemia because it provides multiple pathways to the tissues
What are anastomoses?
Formation of branches between existing vessels to bypass a blockage
When do anastomoses normally form?
Adaptive response to stenosis of a major vessel over a long time
What is Acute limb ischaemia?
Why does the ischamie occur?
Acute/quick occlusion of arteries supplying the limbs
Ischaemia occurs since no time for collateral circulation to develop
What are the 6Ps for the presentation of Acute limb ischaemia?
Pain
Pallor (mottling dark colour)
Perishingly cold
Pulseless
Parasthesia (numbing)
Paralysis
Why do patients with acute limb ischaemia have hyperkalaemia?
Apoptosis of cells leads to the release of the K+ into the blood
How is Acute limb ischaemia treated?
Surgery
Angioplasty
Thrombectomy
Amputation
What is Claudication?
Cramping pain in the leg induced by exercise
What causes Claudication?
Atherosclerosis
What happens to the oxygen supply to the heart in stable angina?
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
How is claudication treated?
Exercise
Smoking cessation
Antiplatelet drugs
Angioplasty
Bypass graft
What is angioplasty?
A balloon stent catheterised in artery pushing it open
Mesh keeps artery open
What is the Ankle-brachial pressure index (ABPI)?
The systolic pressure of the ankle (Dorsalis pedis and posterior tibial)
DIVIDED BY
Systolic pressure of the brachial artery
What value of Ankle-brachial pressure index indicates presence of peripheral artery disease?
ABPI < 0.8
How can you determine where the stenosis is which is causing the claudication?
Palpate pulses to determine where the occlusion is
Point of occlusion determines where claudication is experienced
Intermittent claudication can lead to critical ischaemia, what makes this pain worse and what relieves it?
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)
How do you treat critical limb ischaemia?
Angioplasty
Thrombectomy
Intra-arterial thrombolysis
Amputation
What is Thrombectomy?
Removing occlusion
Where can the femoral pulse be palpated?
Mid Inguinal point
Midway between ASIS and pubic symphysis
Where can the popliteal pulse be palpated?
Deep in popliteal fossa
Where can the Dorsalis pedis pulse be palpated?
Lateral to extensor hallucinations longus (essentially between big toe and toe 2)
Where can thee posterior tibial pulse be palpated?
Just behind and slightly below the medial malleolus
What is the use of Doppler ultrasonography?
Using ultra sound and the Doppler effect to measure real time flow and velocity
How does Doppler ultrasonography work?
Echoes produced from turbulent blood detected and computer works out its flow direction and velocity
How is velocity of blood affected through a stenosed vessel?
Increased velocity
