peripheral venous and arterial disease

Question 1

what is the relationship between superfiical and deep veins of the lower limb?

Answer 1

blood drains from superficial veins into deep veins
involves opening and closing of valves

Question 2

where are superficial veins located?

Answer 2

within subcatenous tissue

Question 3

where are deep veins located?

Answer 3

underneath deep fascia

Question 4

what is the calf muscle pump?

Answer 4

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

Question 5

what is varicose veins?

Answer 5

twisted or tortous veins
common in the saphenous veins

Question 6

what causes varicose veins?

Answer 6

walls of vessles weakend = valves become incompotent = veins tortous and twisted

Question 7

how do patients with varicose veins present?

Answer 7

ALONG AFFECTED VEINS:
* leg cramps
* superficial vein thrombophlebits (inflammation resulting from a clot)
* varicose eczema

Question 8

what are risk factors for varicose veins?

Answer 8

• age
• female sex
• family history

Question 9

what is chronic venous insufficiency and how does it present?

Answer 9

more advanced disease which presents with:
* lipodermatosclerosis (thickening of fat layer under skin)
* venous ulceraton
* brawny oedema (brawny colour due to haemosiderin from RBC)

Question 10

what is venous eczema?

Answer 10

eczema: chronic disease, itchy, red, swollen and tight
ulcers: chronic, painful, develops around hard nodules (e.g. medial malleolus)

Question 11

who is at increased risk of calf pump failure?

Answer 11

obese
immobile
parkinsons disease

Question 12

what does calf pump failure cause?

Answer 12

Deep vein incompetence:
* results in retrograde flow = system overwhelmes

Superficial vein incompetence:
* deep to superficial blood flow

Question 13

how is calf pump failure treated?

Answer 13

ligate superficial veins
remove superficial veins

Question 14

what is the difference between arterial and venous thrombosis?

Answer 14

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

Question 15

how does deep vein thrombosis present?

Answer 15

• pain
• swelling
• redness
• calf tenderness + warmth

Question 16

what is the Wells score?

Answer 16

determines how likely someone is to develop DVT so you can work to prevent it

Question 17

what can cause DVT?

Answer 17

surgery - calf muscle pump isnt used before or after surgery
trauma
malignancy
pregnancy
long haul flights

Question 18

how does our body normally prevent peripheral arterial disease?

Answer 18

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

Question 19

what is acute limb ischaemia and what causes it?

Answer 19

occurs very quicly - so no collateral circulation set up
atrial fib, rupture of atherosclerotic plaque

Question 20

how does acute limb ischaemia present?

Answer 20

6 P’s
1. pain
2. pallor
3. perishingly cold
4. paraesthesia
5. pulselessness
6. paralysis

Question 21

how does chronic peripheral arterial disease present?

Answer 21

intermittent claudication (cramping pain induced by exercise)
pain relieved by rest

Question 22

how is chronic peripheral arterial disease managed?

Answer 22

• smoking cessation
• antiplatelet durgs
• angioplasty
• bypass graft

Question 23

how is peripheral arterial disease diagnosed?

Answer 23

ankle brachial pressure index (ABPI)
ankle systolic BP / brachial systolic BP
ABPI <0.8 = peripheral arterial disease

Question 24

what can claudication cause if left untreated?

Answer 24

ischaemia
dry gangrene

Question 25

what is critical limb ischaemia?

Answer 25

progression of chronic peripheral arterial disease

Question 26

how does critical limb ischaemia present?

Answer 26

rest pain
lowering foot out of bed relieves pain

Question 27

what does critical limb ischaemia lead to if left untreated?

Answer 27

ulceration
gangrene

Question 28

how is critical limb ischaemia treated?

Answer 28

analgesia
imaging
angioplasty

Question 29

1. where do you palpate for femoral pulse?
2. where do you palpate for popliteal pulse?
3. where do you palpate for dorsalis pedis pulse?
4. where do you palpate for posterior tibial pulse?

Answer 29

1. mid point between ASIS and pubic symphesis
2. deep in popliteal fossa
3. lateral to extensor hallucis longus tendon
4. just behind medial malleolus