S8 Peripheral Arterial and Venous Disease Flashcards
What is the lower limb venous system divided into?
- superficial veins - in the subcutaneous fat
* deep veins - underneath the deep fascia, with major arteries
In which direction does blood move in respect to superficial and deep veins?
Moves superficial to deep
What are the superficial veins in the lower limbs?
- short saphenous vein
- long saphenous vein
- tributaries of the long saphenous vein)
What are the deep veins of the lower limbs?
- inferior vena cava
- common iliac
- external iliac
- common femoral
- deep femoral
- superficial femoral
- popliteal
- anterior tibial
- posterior tibial
- peroneal
What is the calf muscle pump?
The soleus and gastrocnemius contribute to pushing blood against gravity back towards the heart
So venous pressure in the foot is reduced during exercise
What are varicose veins? What is the most common site of this pathology?
When the valves are ineffective and blood movement is slow/reversed - veins are twisted. No problems but can be symptomatic .
Saphenous veins
How do varicose veins develop?
- Walls of the veins weaken
2. Leading to development of varicosities and the valve cusps separate - become incompetent
What symptoms does someone with varicose veins have?
- heaviness
- aching
- muscle cramps
- throbbing
- varicose eczema
- superficial vein thrombophlebitis
- painful erythema
What is someone with varicose veins at increased risk of developing?
DVT
What is chronic venous insufficiency?
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
What can chronic venous insufficiency lead to?
- haemosiderin staining
- lipodermatosclerosis
- venous ulceration
What is lipodermatosclerosis?
Inflammation and thickening of fat layer under skin
What can venous eczema lead to?
Lipodermatosclerosis - hard to the touch
What does venous eczema present as?
Chronic, itchy red, swollen and tight skin
What does venous ulceration present as? Where does it usually occur?
Chronic and painful
Usually occurs around hard modular areas like the medial malleolus
When does the calf muscle pump fail?
When not using the calf muscle properly - not doing plantarflexion of ankle joint during walking
Who’s at risk of calf muscle pump failure?
Those who are (more) immobile - injured, post/pre-op patients, elderly, obese
And people with Parkinson’s disease - no plantarflexion of ankle joint
How do you treat ulceration?
Ligation and vein stripping
What is the main cause of arterial thrombosis?
Atheroma as arteries are platelet rich
What is the main cause of venous thrombosis?
Stasis and another factor E.g. * dehydration * trauma * chemotherapy * inflammatory conditions * pregnancy
What is DVT? What response does it lead to?
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
When is stasis e.g. no calf pump muscle likely? What is it good to do in response?
- before surgery
- after surgery
- trauma
- malignancy
- pregnancy
Promote mobility soon after surgery
What is usual treatment/prophylaxis for DVT?
Anticoagulant agents
What is the fatal consequence of a DVT?
Pulmonary embolism
