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CVS * > S8 Peripheral Arterial and Venous Disease > Flashcards

S8 Peripheral Arterial and Venous Disease Flashcards

1
Q

What is the lower limb venous system divided into?

A
  • superficial veins - in the subcutaneous fat

* deep veins - underneath the deep fascia, with major arteries

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2
Q

In which direction does blood move in respect to superficial and deep veins?

A

Moves superficial to deep

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3
Q

What are the superficial veins in the lower limbs?

A
  • short saphenous vein
  • long saphenous vein
  • tributaries of the long saphenous vein)
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4
Q

What are the deep veins of the lower limbs?

A
  • inferior vena cava
  • common iliac
  • external iliac
  • common femoral
  • deep femoral
  • superficial femoral
  • popliteal
  • anterior tibial
  • posterior tibial
  • peroneal
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5
Q

What is the calf muscle pump?

A

The soleus and gastrocnemius contribute to pushing blood against gravity back towards the heart

So venous pressure in the foot is reduced during exercise

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6
Q

What are varicose veins? What is the most common site of this pathology?

A

When the valves are ineffective and blood movement is slow/reversed - veins are twisted. No problems but can be symptomatic .

Saphenous veins

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7
Q

How do varicose veins develop?

A
  1. Walls of the veins weaken

2. Leading to development of varicosities and the valve cusps separate - become incompetent

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8
Q

What symptoms does someone with varicose veins have?

A
  • heaviness
  • aching
  • muscle cramps
  • throbbing
  • varicose eczema
  • superficial vein thrombophlebitis
  • painful erythema
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9
Q

What is someone with varicose veins at increased risk of developing?

A

DVT

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10
Q

What is chronic venous insufficiency?

A

When the venous wall and valves in leg aren’t working effectively - so difficult to return blood back to heart - causes pooling of blood (stasis) which leads to venous hypertension oedema

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11
Q

What can chronic venous insufficiency lead to?

A
  • haemosiderin staining
  • lipodermatosclerosis
  • venous ulceration
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12
Q

What is lipodermatosclerosis?

A

Inflammation and thickening of fat layer under skin

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13
Q

What can venous eczema lead to?

A

Lipodermatosclerosis - hard to the touch

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14
Q

What does venous eczema present as?

A

Chronic, itchy red, swollen and tight skin

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15
Q

What does venous ulceration present as? Where does it usually occur?

A

Chronic and painful

Usually occurs around hard modular areas like the medial malleolus

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16
Q

When does the calf muscle pump fail?

A

When not using the calf muscle properly - not doing plantarflexion of ankle joint during walking

17
Q

Who’s at risk of calf muscle pump failure?

A

Those who are (more) immobile - injured, post/pre-op patients, elderly, obese

And people with Parkinson’s disease - no plantarflexion of ankle joint

18
Q

How do you treat ulceration?

A

Ligation and vein stripping

19
Q

What is the main cause of arterial thrombosis?

A

Atheroma as arteries are platelet rich

20
Q

What is the main cause of venous thrombosis?

A 
Stasis and another factor 
E.g.
* dehydration
* trauma 
* chemotherapy 
* inflammatory conditions 
* pregnancy
21
Q

What is DVT? What response does it lead to?

A

Clotting of blood in a deep vein (usually the calf) due to impaired venous return and hypercoagulability

Leads to an inflammatory response - pain, swelling, redness

22
Q

When is stasis e.g. no calf pump muscle likely? What is it good to do in response?

A
  • before surgery
  • after surgery
  • trauma
  • malignancy
  • pregnancy

Promote mobility soon after surgery

23
Q

What is usual treatment/prophylaxis for DVT?

A

Anticoagulant agents

24
Q

What is the fatal consequence of a DVT?

A

Pulmonary embolism

25
Q

What prevents acute ischaemia when we flex/bend a joint?

A

Collateral circulation

26
Q

What is our adaptive response to stenosis of a major vessel over a long period?

A

Collateral circulation

27
Q

When doesn’t collateral circulation develop in ischaemia? What are some examples of this?

A

When the occlusion is acute - happens in minutes-days

Trauma and embolism e.g. atrial fibrillation, popliteal artery aneurysm, sudden rupture of atherosclerotic plaque

28
Q

What are the 6 Ps of leg ischaemia?

A
  • pain
  • pallor
  • perishing with cold
  • pulseless
  • paraesthesia
  • paralysis or reduce power

Pallor, paraesthesia and paralysis could be subtle

29
Q

How does chronic peripheral arterial disease present?

A
  • intermittent claudication - exercise induced

* pain goes away upon rest

30
Q

How do you manage chronic peripheral arterial disease?

A

Exercise, smoking cessation, antiplatelet drugs, angioplasty, bypass graft

31
Q

What is critical ischaemia? What occurs if left untreated?

A

Pain at rest (due to v poor blood supply)

Ulceration and gangrene

32
Q

What is the most common presentation of claudication? What occurs if left untreated?

A

Atheroma (atherosclerosis of superficial femoral artery - present with calf claudication)

Leads to critical ischaemia

33
Q

What lower limb pulses can be palpated?

A
  • femoral pulse (mid-inguinal point)
  • dorsal is pedis pulse (lateral to extensor hallucis longus tendon)
  • popliteal pulse (deep in popliteal fossa)
  • posterior tibial pulse (behind the medial malleolus)
34
Q

What can you use to measure realtime flow and velocity of blood?

A

Ultrasound and the Doppler effect

35
Q

What is the ankle-brachial pressure index (ABPI)?

A

Divide the ankle systolic pressure by the brachial systolic pressure

An ABPI of less than 0.9 indicates peripheral artery disease

36
Q

How is Doppler ultrasonography used in distal blood vessels?

A

Used in legs when diagnosing peripheral arterial disease e.g.

Atheroma, stenosis, means flow and velocity changes

CVS * (17 decks)

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