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CVS > Session 11: Peripheral Arterial and Venous Disease > Flashcards

Session 11: Peripheral Arterial and Venous Disease Flashcards

1
Q

What is the lower limb venous system divided into?

A

Superficial and deep veins

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2
Q

Where are deep veins located?

A

Underneath deep fascia along with major arteries

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3
Q

Where are superficial veins located?

A

Located in subcutaneous tissue.

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4
Q

Are deep veins and superficial veins connected?

A

Yes

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5
Q

How are deep veins and superficial veins connected?

A

Via perforating veins

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6
Q

In which direction does the blood flow? Superficial -> Deep or Deep -> Superficial

A

Superficial -> deep.

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7
Q

Where does the long saphenous vein run?

A

Down the medial aspect of the leg and anterior to the medial malleolus to enter the dorsal aspect of the foot.

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8
Q

Which muscles generally contribute to the calf muscle pump?

A

Soleus and gastrocnemius

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9
Q

What is the calf muscle pump?

A

Contributes to push blood against gravity back into heart.

(Venous return)

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10
Q

Give examples of peripheral venous disease.

A

Varicose veins, venous hypertension, and DVT

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11
Q

What are varicose veins?

A

Tortuous and twisted veins that can be seen on the skin.

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12
Q

Common site of varicose veins. (Site and veins)

A

Lower limb in saphenous veins (superficial veins)

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13
Q

Cause of varicose veins

A

Ineffective valves and slow or reversed blood flow (stasis)

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14
Q

Symptomatic presentation of varicose veins.

A

Description of heaviness, aching, muscle cramp an throbbing thin and itchy skin along the affected vein/s.

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15
Q

Complications of varicose veins.

A

Venous hypertension, varicose eczema, skin pigmentation, lipodermatosclerosis, venous ulceration ad oedema.
Can also cause haemorrhage and thrombophlebitis

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16
Q

What is lipodermatosclerosis and why can it occur?

How does it present?

A

Inflammation of fat layer under the skin which can occur due to the superficial veins located in the subcutaneous layer.
Chronic, and painful. It is itchy and red + swollen.

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17
Q

Where does venous ulceration usually occur?

A

Hard nodular areas typically medial malleolus.

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18
Q

What is usually the cause of lipidermatosclerosis/venous eczema/ venous ulceration?

A

Varicose veins and venous hypertension.

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19
Q

What might cause hypertension of the veins?

A

Calf muscle pump failure

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20
Q

Why would the calf muscle pump fail?

A

When a person doesn’t use the calf muscles properly by not plantar flexing the ankle joint during walking.

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21
Q

Who is at risk of calf muscle pump failure?

A

Sedentary lifestyle

Injury so they can’t walk

Immobile people in general

Hip problem leading to insufficient plantarflexion

Obesity

22
Q

What happens to the flow of blood in calf muscle pump failure? (Also consider deep vs. Superficial veins)

A

Deep vein imcompetence leading to retrograde flow as it is overwhelmed. Superficial veins become incompetent so flow goes from being superficial to deep to being deep to superficial.

23
Q

Most common cause of arterial thrombosis

A

Atheroma leading to atherosclerosis.

24
Q

Difference between arterial thrombosis and venous thrombosis.

A

Arterial are platelet rich which are activated, aggregate and plug hole.

Venous thrombosis have a low flow and small platelet count and fibrin rich.

25
Q

Common cause of venous thrombosis. (+Risk factors)

A

Stasis and usually another factor like trauma, COCP, dehydration, chemotherapy, inflammatory conditions, pregnancy, surgery.

26
Q

3 components of Virchow’s triad.

A

Vessel wall damage

Stasis

Hypercoagulability

27
Q

Common causes of DVT

A

Calf impaired venous return and hypercoagulability.

Post-surgery + pre-surgery.

28
Q

Signs of DVT

A

Calf tenderness, warmth, distended and visible superficial veins, oedema, pyrexia (without other obvious causes) and asymmetry between the legs.

29
Q

Differential diagnoses of DVT signs.

(Calf tenderness, warmth, distended and visible superficial veins, oedema, pyrexia (without other obvious causes) and asymmetry between the legs.)

A

Soft tissue trauma, cellulitis, lymphatic obstruction.

30
Q

Why would post-surgery lead to DVT?

A

Prothrombotic state after surgery (surgery = traumatic state) + maybe immobility after surgery as well.

31
Q

Prophylaxis of DVT

A

Anticoagulant agents (usually during surgery) and antiplatelets.

32
Q

Consequence of DVT

A

Pulmonary embolism

33
Q

Leading cause of acute and chronic limb ischaemia. (General)

A

Peripheral arterial disease.

34
Q

Physiological response to limit acute ischaemia.

A

Collateral circulation.

Obstruction of a blood vessel can lead to new collateral circulations.

35
Q

When might you see collateral circulation form?

A

Partial stenosis of a vessel.

36
Q

Does formation of collateral circulation work in acute limb ischaemia?

A

No, collateral formation takes time (months to years)

37
Q

Most common causes of acute limb ischaemia

A

Trauma, embolism, atrial fibrillation or abdominal aortic aneurysm (AAA)

38
Q

Signs of leg ischaemia.

A

The 6 Ps:

Pain

Pallor

Perishing with cold

Pulseless

Paraesthesia

Paralysis or reduced power.

39
Q

Management of leg ischaemia

A

Manage according to severity.

Imaging first -> angioplasty/thromboectomy/intra-arterial thrombolysis

If too severe -> amputation.

40
Q

Common causes of chronic peripheral arterial disease.

A

Intermittent claudication of lower limb caused by atherosclerosis. (Obstruction/stenosis)

41
Q

Most common symptom of intermittent claudication.

A

Pain induced by exercise like stable angina. The pain then goes away upon rest.

42
Q

Most common symptom of critical ischaemia of lower limb. (To distinguish between intermittent claudication)

A

Pain at rest like unstable angina.

Patients usually hang out their foot out of the bed to relieve the pain when they have been lying in bed for a while.

43
Q

What dictates where you palpate pulse in a patient with claudication?

A

It depends on where the stenosis is. This will be the site of claudication and also which pulses that can be palpated.

44
Q

Where can you palpate the femoral pulse?

A

Felt at the mid inguinal point midway between anterior superior iliac spine and pubic symphysis.

45
Q

Where can you palpate the popliteal pulse?

A

Deep in popliteal fossa

46
Q

Where can you palpate the dorsals pedis pulse?

A

Lateral to extensor hallucis longus tendon.

47
Q

Where can you palpate the posterior tibial pulse?

A

Posterior to medial malleolus

48
Q

What would you use to measure the change in flow of stenosis/claudication?

A

Doppler ultrasonography.

49
Q

What is Doppler ultrasonography used for?

A

A sonogram using ultrasound and Doppler effect to measure real-time flow and velocity.

50
Q

Give examples of where Doppler ultrasonography is used.

A

Heart as part of echocardiogram in heart failure or valve disease.

In distal vessels diagnosing peripheral arterial disease like atheroma -> stenosis -> velocity changes.

51
Q

Explain how the Doppler effect is used in stenosis.

A

At the stenosis there is an increase in velocity and turbulence beyond the point of the stenosis.

Doppler effect will pick this up and show the area of high velocity and turbulence.

So the increase in velocity indicates stenosis just prior to that point.

52
Q

What does the size of the doppler signal depend on?

A

Blood velocity, ultrasound frequency.

CVS (18 decks)

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