Session 11-Peripheral Arterial And Venous Disease Flashcards
Which deep veins in the lower limb do we need to know?
External iliac vein
Femoral vein
Popliteal vein
Which superficial veins in the lower limb do we need to know?
Short saphenous vein
Long saphenous vein
Where is the long saphenous vein located in relation to the medial malleolus?
Anterior
True or false: blood always flows from deep to superficial veins
FALSE - superficial to deep
What are varicose veins?
Tortuous, twisted or lengthened veins
Describe the pathophysiology of varicose veins
Vein wall is weak, leading to dilatation and separation of valve cusps so they become incompetent
What are the symptoms of varicose veins and where do these occur?
Heaviness
Tension
Aching
Itching
All occur along the vein itself
Which complications of varicose veins result from the vein itself?
- Haemorrhage
- Thrombophlebitis (inflammation of wall of vein with thrombosis=painful!)
Which complications of varicose veins result from venous hypertension?
- oedema
- skin pigmentation
- varicose eczema
- lipodermatosclerosis
- venous ulceration
Why does haemosiderin staining occur along varicose veins?
Venous hypertension and increased capillary permeability
What is lipodermatosclerosis?
Fat becomes thick and hard around vein
What is the result of calf muscle pump failure?
Venous hypertension
What are the causes of calf muscle pump failure?
- failure of calf muscle contraction - immobility, obesity, reduced hip, knee and/or ankle movement
- deep vein incompetence
- volume overload - superficial vein incompetence
How does venous ulceration occur?
Calf muscle pump dilates because some blood re-enters calf muscle system -> venous hypertension -> venous ulceration
What is the pathophysiology of thrombosis (Virchow’s triad)?
- changes in lining of vessel wall
- changes in blood flow
- changes in constituents of blood
What is the pathophysiology of arterial thrombosis?
Changes in lining of vessel wall (atheroma)
What is the pathophysiology of venous thrombosis?
Changes in blood flow (stasis)
Stasis plus which other factors can lead to venous thrombosis?
Surgery (trauma)
Oral contraceptive pill
Dehydration
Cancer
True or false: arterial thrombi are platelet rich
TRUE
What are venous thrombi rich in?
Fibrin
Which pathway is majorly involved in venous bleeding?
Intrinsic
True or false: arterial bleeding needs platelets and both intrinsic and extrinsic pathways
TRUE
What are the symptoms of deep vein thrombosis?
- pain, cannot walk
- swelling
- blue-red skin discolouration
What are the signs of deep vein thrombosis?
- calf tenderness
- muscle induration
- skin warmth
- skin discolouration
- distended, warm superficial veins
- oedema
- pyrexia
What is the association between surgery and DVT?
- immobility prior to surgery
- no calf muscle pump during surgery
- immobility after surgery
What is often the fatal consequence of DVT?
Pulmonary embolism
Where is natural collateral circulation common?
Across joints such as elbow and knee
What does collateral circulation develop in response to?
Stenosis
What is acute limb ischaemia?
Limb goes from normal blood supply to greatly impaired blood supply over period of minutes, no chance for collateral vessel development
What are the commonest causes of acute limb ischaemia?
Embolism
Trauma
What can happen if acute limb ischaemia is not reversed within 6 hours?
Limb cannot be recovered and if not amputated, patient will die (hyperkalaemia due to dead tissue releasing intracellular potassium)
What are the symptoms/signs of acute ischaemia (6 Ps)?
Pain Paralysis Paraesthesia Pallor Perishing cold Pulseless
In chronic peripheral arterial disease, what is the equivalent to:
1) stable angina
2) unstable angina
3) MI
1) intermittent claudication
2) rest pain
3) ulceration/gangrene
What is claudication?
Pain in muscles of lower limb elicited by walking/exercise
Which muscles are most frequently affected in claudication?
Calf muscles
How is pain relieved in claudication?
Stopping exercise for a few minutes, even whilst standing up
Where is the femoral pulse felt?
Mid-inguinal point
Where is the popliteal pulse felt?
Deep in popliteal fossa and difficult to feel
Where is the dorsalis pedis pulse felt?
Lateral to extensor hallucis longus tendon
Where is the posterior tibial pulse felt?
Behind medial malleolus
What is the commonest finding in patients with claudication?
Superficial femoral artery occlusion:
-femoral pulse present, absent popliteal and pedal pulses
What is rest pain?
Pain in foot that comes on when patient goes to bed and is relieved by hanging foot out of bed - ischaemia so severe that foot skin, muscles and bones are ischaemic at rest = not enough O2 to provide for cells basic metabolic requirements
If left untreated, what can rest pain progress to?
Gangrene and/or ulceration
