peripheral venous and arterial disease Flashcards
what is the relationship between superfiical and deep veins of the lower limb?
blood drains from superficial veins into deep veins
involves opening and closing of valves
where are superficial veins located?
within subcatenous tissue
where are deep veins located?
underneath deep fascia
what is the calf muscle pump?
gastrocnemius and soleus contract and increase pressure in the deep veins
this allows for blood to pump against gravity back to the heart
valves close which prevents back flow of blood
what is varicose veins?
twisted or tortous veins
common in the saphenous veins
what causes varicose veins?
walls of vessles weakend = valves become incompotent = veins tortous and twisted
how do patients with varicose veins present?
ALONG AFFECTED VEINS:
* leg cramps
* superficial vein thrombophlebits (inflammation resulting from a clot)
* varicose eczema
what are risk factors for varicose veins?
- age
- female sex
- family history
what is chronic venous insufficiency and how does it present?
more advanced disease which presents with:
* lipodermatosclerosis (thickening of fat layer under skin)
* venous ulceraton
* brawny oedema (brawny colour due to haemosiderin from RBC)
what is venous eczema?
eczema: chronic disease, itchy, red, swollen and tight
ulcers: chronic, painful, develops around hard nodules (e.g. medial malleolus)
who is at increased risk of calf pump failure?
obese
immobile
parkinsons disease
what does calf pump failure cause?
Deep vein incompetence:
* results in retrograde flow = system overwhelmes
Superficial vein incompetence:
* deep to superficial blood flow
how is calf pump failure treated?
ligate superficial veins
remove superficial veins
what is the difference between arterial and venous thrombosis?
arterial = platelet rich, activated platelets, caused by atheroma, white in appearance
venous = fibrin rich, low platelet count, red in appearance, caused by trauma or pregnancy
how does deep vein thrombosis present?
- pain
- swelling
- redness
- calf tenderness + warmth
what is the Wells score?
determines how likely someone is to develop DVT so you can work to prevent it
what can cause DVT?
surgery - calf muscle pump isnt used before or after surgery
trauma
malignancy
pregnancy
long haul flights
how does our body normally prevent peripheral arterial disease?
collateral circulation
major arteries have anastamoses which means if there is a blockage in one vessel it wont completely cut of blood supply to region
an adaptive response to prolonged occlusion of a blood vessel
what is acute limb ischaemia and what causes it?
occurs very quicly - so no collateral circulation set up
atrial fib, rupture of atherosclerotic plaque
how does acute limb ischaemia present?
6 P’s
1. pain
2. pallor
3. perishingly cold
4. paraesthesia
5. pulselessness
6. paralysis
how does chronic peripheral arterial disease present?
intermittent claudication (cramping pain induced by exercise)
pain relieved by rest
how is chronic peripheral arterial disease managed?
- smoking cessation
- antiplatelet durgs
- angioplasty
- bypass graft
how is peripheral arterial disease diagnosed?
ankle brachial pressure index (ABPI)
ankle systolic BP / brachial systolic BP
ABPI <0.8 = peripheral arterial disease
what can claudication cause if left untreated?
ischaemia
dry gangrene
