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Vascular > Quiz 4 (lower extremity) > Flashcards

Quiz 4 (lower extremity) Flashcards

1
Q

what are the 3 lower extremity peripheral artery trees?

A
  • aortoiliac
  • femoropopliteal
  • tibioperoneal
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2
Q

where does the abdominal aorta bifurcate into the right and left iliac?

A

level of the umbilicus

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3
Q

where does the internal iliac artery extend?

A

medially to supply pelvic organs

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4
Q

what branch is distal to the internal iliac arteries?

A

external iliac arteries

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5
Q

what do the branches below the external iliac arteries supply?

A

lower extremities

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6
Q

what is the artery called after passing the inguinal canal?

A

common femoral arteries

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7
Q

what does the common femoral artery bifurcate into?

A
  • femoral artery (superficial femoral artery)

- deep femoral artery (profundal artery)

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8
Q

what artery branches just proximal to the common femoral bifurcation?

A

lateral circumflex artery

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9
Q

what is the path of the deep femoral artery?

A

bifurcates laterally from the femoral artery and travels deeply supplying the thigh muscles with many branches

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10
Q

what does the deep femoral artery supply?

A

thigh muscles

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11
Q

what does the DFA connect?

A

branches connecting the EIA and popliteal artery

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12
Q

when does the femoral artery become the popliteal artery?

A

in the distal femur at hunters canal passing obliquely behind the knee in the popliteal fossa

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13
Q

where does the popliteal artery trifurcate?

A

below the popliteal fossa

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14
Q

what is the trifurcation below the popliteal called?

A

tibioperoneal trunk

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15
Q

what does the tibioperoneal trunk bifurcate into?

A
  • peroneal artery

- posterior tibial artery

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16
Q

what is the third branch that comes off the tibioperoneal trunk?

A

anterior tibial artery

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17
Q

what does the anterior tibial artery become at the ankle level?

A

dorsalis pedis artery which supplies the foot

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18
Q

what does the posterior tibial artery terminate into at the heel level?

A

becomes the plantar arteries in the foot

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19
Q

what does the peroneal artery supply?

A

lateral lower leg and heel

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20
Q

what types of veins are in the legs?

A
  • deep
  • superficial
  • perforating
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21
Q

what do the deep veins do?

A

accompany the arteries and share their names

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22
Q

where do veins originate?

A

distally in the foot

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23
Q

what do veins in the foot form?

A

form the plantar arches which give rise to calf veins

  • anterior tibials
  • posterior tibials
  • peroneal
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24
Q

what veins are paired?

A
  • anterior tibials
  • posterior tibials
  • peroneal
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25
Q

how many calf veins are there?

A

6

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26
Q

what do anterior tibial veins arise from and what do they accompany?

A

arise from the arch and accompany the anterior tibial artery

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27
Q

what is the course of the anterior tibial veins?

A

rise up the calf from anterior compartment and course between tibia and fibula

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28
Q

what do the anterior tibial veins unite to form?

A

singular anterior tibial trunk

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29
Q

what does the anterior tibial trunk unite to form what?

A

anterior tibial trunk unites with the posterior tibial-peroneal trunk to form the popliteal vein

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30
Q

what is the coarse of the posterior tibial veins?

A

arise from the arch and coarse posterior to the tibia, rise up the calf to form the common tibial trunk

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31
Q

where do the peroneal veins arise?

A

medial to the lateral malleolus of the ankle

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32
Q

what is the coarse of the peroneal veins?

A

follow medial surface of the fibula, then course medially to form the common peroneal trunk in the upper third of calf

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33
Q

what do the common tibial trunk and common peroneal trunk converge to form?

A

tibioperoneal trunk

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34
Q

what deep veins drain the soleus and gastrocnemius muscles?

A
  • soleal sinus

- gastrocnemius vein

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35
Q

are the gastrocnemius veins paired?

A

yes, join a common trunk before dumping into popliteal vein

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36
Q

which deep vein is not accompanied by an artery?

A

soleus sinus

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37
Q

where does the soleal sinus dump into?

A

drain into the posterior tibial and peroneal veins

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38
Q

what are an important part of the calf muscle pump?

A

venous sinus-act as a reservoir

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39
Q

what converges to form the popliteal vein?

A

common tibial-peroneal trunk

anterior tibial trunk

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40
Q

what are the valves of the calf veins?

A

6-12 bicuspid valves

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41
Q

what do the veins in the calf do?

A
  • promote unidirectional flow

- regulate venous pressure in distal lower extremity

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42
Q

what does the popliteal vein do in the popliteal fossa?

A

extends cephalad to the medial aspect of the femur

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43
Q

what does the popliteal pass through?

A

hunters canal (adductor hiatus) this is where is becomes the femoral vein

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44
Q

is the popliteal duplicated?

A

can be

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45
Q

how many valves does the popliteal have?

A

3-4

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46
Q

what superficial vein dumps into the popliteal vein at the level of the crease?

A

short saphenous-gastrocnemius is just inferior to this

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47
Q

what is the femoral vein a continuation of?

A

popliteal vein

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48
Q

where does the femoral vein coarse?

A

medial aspect of the thigh

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49
Q

how many valves does the femoral vein contain?

A

3-6 valves

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50
Q

where does the common femoral vein lie?

A

medial to the common femoral artery within Scarpa’s triangle

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51
Q

how many valves does the common femoral vein have?

A

3-5 valves

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52
Q

where does the superficial-great saphenous vein dump into the common femoral vein?

A

at the level of the groin crease-anteromedially

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53
Q

how many valves does the external iliac vein contain?

A

a single valve

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54
Q

what is the longest superficial vein?

A

great saphenous vein

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55
Q

where does the great saphenous vein coarse?

A

extends from the anterior aspect of the medial malleolus upwards to the groin

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56
Q

where does the great saphenous vein drain?

A

into the CFV anteromedially

57
Q

what does the great saphenous vein drain blood from?

A

drains blood from the superficial tissues (skin and fat) into the deep system

58
Q

what is the coarse of the small saphenous vein?

A

extends from the posterior aspect of the lateral malleolus and runs up the center of the calf and dumps into the popliteal vein at the popliteal fossa crease level

59
Q

occasionally where can the SSV dump into?

A

continue up the posterior part of the leg and dump into the GSV

60
Q

if the SSV does not dump into the popliteal vein at the fossa level, what is the vein called?

A

vein of giacomini

61
Q

what is upper thing extension of the SSV?

A

the SSV may continue up the thigh into the deep system at the femoral vein

62
Q

where is pressure greater in veins?

A

in the superficial system

63
Q

what is the direction of flow in veins?

A

superficial to deep

64
Q

what are perforators?

A

short vessels that connect the 2 systems and have valves conducting the flow-anastomosis between deep and superficial systems

65
Q

what is a large perforator?

A

hunterian perforator

66
Q

what can cause varicosities?

A

larger perforators (hunterian)

67
Q

what flow characteristics can sonography evaluate in venous flow?

A
  • spontaneity
  • phaticity
  • augmentation
  • competence of valves
  • absence of pulsatiity
  • compression images
68
Q

what are some sonographic features of normal veins?

A 
Thin (invisible) wall
Smooth wall
Anechoic lumen  
Compressible
Unidirectional flow toward the heart
Flow augmentation with distal compression
Spontaneous flow
Phasic flow
Flow ceases with valsalva maneuver
69
Q

where does spontaneous flow occur?

A

veins closest to heart
less in popliteal
not seen in calf veins

70
Q

where is pressure lowest in veins?

A

furthest from heart

71
Q

what will have an effect on spontaneous flow?

A
  • augmentation
  • Valsalva
  • respiration
  • pumping the calf muscle
72
Q

what veins are phasic with respiration?

A

lower extremities

73
Q

blood flow in lower extremities ______ with inspiration and __________ with expiration

A

ceases and augments

74
Q

what may pulsatiity of flow be caused by?

A

right sided heart failure or veins close to the heart

75
Q

what happens to lower extremities with inspiration?

A

stopped

76
Q

what is the most important feature to rule out DVT?

A

compressibilty

77
Q

what happens to flow with augmentation?

A

flow is increased when manually compressed with hand

78
Q

what does augmentation confirm?

A

patency of veins between the level where compression occurs and the level where the probe is situated

79
Q

if reversal of flow does not occur during Valsalva, what does this mean?

A

there are competent valves

80
Q

what rouleaux?

A

slower, sluggish flow (does not mean disease)

81
Q

what affects venous flow?

A 
Respiratory variations
Cardiac function
Calf muscle pump
Competent venous valves
Venous pressure
Exercise
82
Q

is DVT’s higher in men or women?

A

women

83
Q

DVT’s is highest in which nations?

A

African americans

84
Q

DVTs are lowest in which nations?

A

Asian and native americans

85
Q

what is ultrasound the gold standard in?

A

evaluating the lower extremity venous system

86
Q

what are the hereditary risk factors for DVT’s?

A
  • blood disorders
  • antithrombin deficiencies
  • elevated clotting factors
  • plasminogen deficiency
  • prothrombotic disease
87
Q

what are the acquired risk factors for DVT’s?

A
  • age, obesity
  • advanced malignancy
  • recent surgery
  • trauma
  • immobilization
  • pregnancy
  • OC use
88
Q

where does DVT’s most commonly originate?

A

in calf at valve leaflets and may extend proximally into the calf and thigh

89
Q

what are signs and symptoms of DVT’s?

A
  • lower extremity swelling
  • pain
  • positive homan’s sign (pain on forced dorsiflexion of foot)
90
Q

what is Virchow’s Triad?

A
  • endothelial damage
  • venous stasis
  • hypercoagulable state
91
Q

D-Dimer assay

A

measures fibrin degeneration products that accumulate in the blood when thrombus forms

92
Q

What does D-Dimer assay have to be if DVT is unlikely?

A

negative

93
Q

what are some causes of false positives for D-Dimer assay?

A

not helpful in patients over 80, hospitalized, pregnant, cancer, its usually elevated in this group

94
Q

what is PT-prothrombin time?

A

time it takes plasma to clot

95
Q

want is PT affected by?

A

DIC-disseminated intravascular coagulation

96
Q

what is PTT-partial thromboplastin time?

A

unexplained bleeding or clotting

97
Q

what does acute thrombus look like?

A

faintly echogenic, almost invisible

98
Q

how are acute thrombus detected?

A

by limited compression and faint visible edge of clot

my have a long snakelike clot swaying back and forth in lumen

99
Q

what clot is at most risk for emboli?

A

acute thrombus

100
Q

what is chronic thrombus?

A

complete dissolution of clot over time may occur naturally. May age and become more solid

101
Q

what does a chronic thrombus look like?

A

older clot is firmer and more echogenic

102
Q

what may develop with chronic thrombus?

A

large collaterals will develop

103
Q

in chronic DVT the clot may shrink, what does it look like then?

A

bright echogenic scar along wall or within lumen. May appear as a string or cord within the lumen

104
Q

what is bilateral lower extremity swelling most likely?

A

cardiovascular in origin-secondary to right heat failure

105
Q

is homans sign a reliable diagnostic criterion?

A

no

106
Q

are patients with DVT symptomatic?

A

not usually

107
Q

what are non specific symtoms of DVT?

A

pain and swelling

108
Q

what are some complications of DVT?

A 
Pulmonary embolism
Incompetent valves 
Post thrombotic syndrome
Recurrent DVT
Varicose veins
Chronic venous insufficiency
Ulcers
109
Q

what percent of untreated pulmonary embolism will sustain a a non-fatal PE?

A

25%

110
Q

what does pulmonary embolism result in?

A

emboli breaks off and goes to the lungs and results in pressure on the right ventricle

111
Q

what are symptoms of PE?

A
  • difficulty breathing
  • chest pain on inspiration
  • palpitations
112
Q

what are the clinical symptoms of PE?

A
  • low blood oxygen saturation and cyanosis
  • rapid breathing
  • rapid heart rate
113
Q

what are symptoms of PE in severe cases?

A
  • collapse
  • abnormally low blood pressure
  • sudden dealth
114
Q

how do you diagnose PE?

A

D-Dimer
CT
pulmonary angiography

115
Q

what is the treatment of PE?

A

anticoagulant-heparin and warfin

116
Q

what is the surgical intervention of PE?

A

pulmonary thrombectomy

117
Q

when may DVT reoccur?

A

damage to walls and valves

118
Q

what does chronic venous obstruction and reflux manifests as?

A
  • chronic leg swelling
  • ankle pigmentation
  • ultimately ulcers form
119
Q

what is responsible for brown skin pigmentation?

A

metabolic breakdown of hemoglobin

120
Q

Increased hydrostatic pressure in deep venous system does ______

A

not help

121
Q

how can ulcerations develop?

A

spontaneously or as a result of trauma-inflammatory reaction in the tissue

122
Q

what does non phasic flow indicate?

A

obstruction of flow above this level

-indicates DVT

123
Q

how do varicose veins develop?

A

extra pressure in veins largely due to absent or incompetent valves

124
Q

what happens to flow with onset of Valsalva?

A

flow reverses

125
Q

what does Valsalva flow reversal indicate?

A

severe incompetence of venous valves

126
Q

what should happen to flow with Valsalva?

A

flow should cease

127
Q

what may chronic venous insufficiency be a result of?

A

recanalized vein post DVT

128
Q

________of competent valves or be avalvular

A

congenital absence

129
Q

where does valvular incompetence occur?

A

superficial, deep, and perforator veins

130
Q

what does chronic venous insuffiency result in?

A

increased venous hydrostatic pressure
varicosed veins
edema
skin changes

131
Q

what are some ways to check for reflux?

A
  • spectral doppler
  • colour flow doppler
  • gray scale
132
Q

what may be used as a graft in the event of arterial disease instead of man made variety?

A

great saphenous vein

133
Q

what other veins are used for man made variety?

A
  • great saphenous (legs)
  • small saphenous (legs)
  • cephalic vein (arm)
  • basilic veins (arm)
134
Q

when is SVT examined?

A

when signs of thrombosis are apparent

135
Q

what are symptoms of SVT?

A
  • tenderness and pain
  • warm skin
  • redness or inflammation of the skin
  • palpable cord may be apparent in subcutaneous tissues, hardening of the vein
136
Q

when is there only a risk of PE in SVT’s?

A

when thrombus is near the attachment to the deep system or extending into it

137
Q

primary varicose veins

A

abnormally dilated and tortuous superficial veins in the absence of deep venous disease

138
Q

what is primary varicose veins a result of?

A

valvular incompetence of SFJ

139
Q

secondary varicose veins

A

associated with obstruction (DVT) or incompetence of the deep venous system valves

Vascular (10 decks)

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