Peripheral venous and arterial disease Flashcards
describe the lower limb venous anatomy.
- superficial and deep veins.
- superficial located in subcutaneous tissue.
- deep veins underneath deep fascia with major arteries.
MOVEMENT SUPERFICIAL TO DEEP.
give some examples of superficial and deep veins.
- superficial : great and short saphenous vein.
- deep : popliteal, femoral, anterior/ posterior tibial, peroneal vein.
why is the calf muscle called ‘the peripheral heart’ ?
- because the soleus and gastronemius contribute to push blood against gravity back towards heart.
- contain valves to prevent retrograde movement when closed.
- perforating valves open again to allow filling from superficial veins and venous pressure in foot reduced during exercise.
*faints due to pooling of blood at gravity.
what is the peripheral venous disease varicose veins?
- ineffective valves and slow blood movement/ reversed saphenous veins causes walls of veins to weaken and varicosities to develop and valve cusps tO separate.
- veins tend to be tortuous and twisted.
*risk factors : age, familial history, female, occupation and standing, number of births.
what is the symptomatic presentation of varicose veins?
- heaviness and aching, muscle cramps and throbbing.
- leg cramps, ankle swelling, haemorrhage.
- increased risk of DVT.
Why might someone develop chronic venous insufficiency? any other complications?
- due to reflux and or obstruction leading to venous hypertension. ( harder for venous return )
- lipodermatosclerosis ( fat layer under skin inflamed and thickened ).
- haemosiderin staining.
- venous ulceration.
why might venous eczema and ulceration occur?
- as a result of venous pooling and hypertension causing leaking of material into interstitium, irritation leads to chronic, painful ulcers in hard nodular areas like medial malleoulus.
- chronic, itchy red and swollen can lead to lipodermatosclerosis which is hard to touch.
- TREAT CAUSE!
why does the calf muscle fail to pump and who is at risk from this?
- plantar flexion in ankle joint needs to be used for calf muscle to pump.
- deep vein incompetence causes retrograde flow and superficial incompetence causes calf muscle pump to overflow.
- risk : immobile, obese, injured.
- ligation and vein stripping helps treat.
what is the risk with the lower limp and thrombosis?
- arterial thrombosis : most common cause is atheroma, platelet rich accumulation of plaque.
- venous thrombosis : STASIS and trauma/ medication/ dehydration/ chemo/ inflammation in fibrin rich env.
what is DVT?
deep vein thrombosis.
- clotting of blood in deep vein (calf) impairing venous return and hyper-coagulability.
- due to inflammation response following thrombosis.
- well’s score : pre-test probability for suspected DVT.
*presents as calf tenderness, warmth, distended and visible superficial veins, oedema, unexplained pyrexia, asymmetry. (differential : soft tissue trauma, cellulitis, lymphatic obstruction).
how would you reduce risks of surgery and DVT?
- promote mobility after surgery.
- prophylaxis to reduce DVT associated with surgery like anticoagulants, physical activity, gradient stockings.
- risk of PE!
what is acute limb ischaemia?
- happens due to acute occlusion which doesnt allow for time for collaterla development.
- due to trauma or embolism : A-fib, popliteal artery aneurysm, rupture of plaque.
- presents as 6p’s : pain, pallor, perishing cold, pulselessness, paraestheia, paralysis.
*needs imaging at vascular surgery unit : angioplasty, thrombectomy, intra-arterial thrombolysis or amputation.
what is chronic peripheral arterial disease?
( similar to coronary artery disease intermittent claudication of lower limb )
- claudication : cramping pain in leg induced by exercise.
- caused atherosclerosis and is induced by exercise like stable angina, pain goes at rest.
*management : exercise, smoking cessation, anti-platelet drugs, angioplasty, bypass graft.
describe the pathology of claudication.
- most common presentation of atheroma = atherosclerosis of superficial femoral artery that present s with calf claudication.
- if untreated ISCHAEMIA.
*stenosis location dictated area of claudication and where pulses palpated (if any). easier above occlusion.
what can be used to assist diagnostics of peripheral artery disease?
- Ankle-brachial index.
- divide ankle systolic by branchial systolic and if ABI i less than 0.9 indicated peripheral artery disease.
