Vacular Examination Flashcards
Imaging: whats the main way blood vessels are looked at now
Magnetic resonance angiography
Blood vessels are normally imaged in which plane
Coronal
Which plane is good for looking at the aortic arch
Left anterior oblique
Which views do you do for looking at the calves
Rotational and timed
Describe the path of vessels
Aorta, common iliac artery, external iliac and internal, common femoral
What does the common femoral artery split into
Profunda femoris and superficial femroal
Where does the superficial artery become the popliteal artery
Region of adductor canal
What does teh below knee popliteal artery become
Anterior tibial artery and tibioperoneal trunk
What does the tibioperonal trunk become
Peroneal artery and posterior tibial artery
Where is the femoral pulse
Point of maximal pulsation over the femoral head
How do you palpate the popliteal artery
Gently lift the knee from couch, allow your fingers to feel the pulse, deep in the popliteal fossa. Relaxed leg.
Why is the popliteal artery hard to palpate when leg is extended
The deep fascia is taut
Where is the dorsalis pedis
Between extensor hallucis longus and extensor digitorum longus
How do you feel the dosalis pedis pulse
Ask patient to pull big toe towards them. Tendon stands out. Artery is lateral.
Where is the posterior tibial
Behind the medial malleolus
What does 0 mean for pulses
Absent
What does 1 mean for pulses
Diminished
What does 2 mean for pulses
Normal
What is the right ankle brachial pressure
Higher of the right ankle systolic pulses/ higher arm pressure (left or right)
How is an ABPI conducted
Using a doppler probe
What is 1-1.2 ABPI
Normal
What is 0.9-1 ABPI
Acceptable
0.8-0.9 ABPI
Mild arterial disease
0.5-0.8 ABPI
Moderate arterial disease
<0.5 ABPI
Severe arterial disease
Invasive vessel imaging
Catheter angiography
Non invasive imaging
Ultrasound, computed tomography, magnetic resonance imaging
How does digital subtraction angiography work
Catheter is inserted using the seldinger technique into the common femoral artery. Then contrast is injected.
Which catheter is used for angiograms
Pigtail
Who is at risk of bleeding at the puncture site
Abnormal clotting, warfarin, aspirin. Vessel damage.
Who is at risk of contrast agent reactions
Asthma, renal failure, metformin
What are the two main superficial veins of the lower limb
Great and small saphenous veins
Where is the small saphenous vein
Posterior (lateral to medial)
Where is teh great saphenous vein
Anteromedial
Which nerve is associated with the small saphenous vein
Sural nerve
Which nerve is associated with the great saphenous vein
Saphenous nerve
Whats the difference between CTA and Ultrasound
CTA has ionizing radiation, iodinated contrast
What contrast is used for MRI
Gadolinium. It is very safe.
Which imaging normally has issues with claustrophobia
MRI more than CTA
What are contraindications to MRI/A
Metal implants and pacemakers
What is balloon angioplasty
Balloon mounted on catheter, to treat stenotic disease of vessel
Why do you treat stenosis
Prevent haemodynamic consequences and embolic consequences
What is vessel remodelling
Neointimal hyperplasia and endothelialisation restores smooth luminal surface.
Early causes of PTA failure
Intimal dissection, elastic recoil, incomplete dilatation, rupture, distal embolisation
Late causes of PTA failure
Intimal hyperplasia
Progression of atherosclerosis
What is the most common causes of CT
Too claustrophobic for MRI
Why do stents fail
Disruption/ disintegration
Neointimal hyperplasia
When wouldnt you give gadolinium (MRI contrast)
Breastfeeding or pregnant
Why are you normally treating flow limiting stenosis
Haemodynamic consequences such as claudication
What is PTA
Percutaneous transluminal angioplasty
Why stent in vascular
Improve initial luminal patency and reduce embolisation. When angioplasty hasnt worked.
Where are stents commonly used
Carotid, mesenteric, renal , aorta, brachiocephalic and iliac.
Two types of stent
Self expanding and preluminated
Common cause of stent failure
Neointimal hyperplasia. And also disruption/disintegration
Which vessels are more affected by atherosclerosis
Medium and larger vessels
Other inflammatory Artery diseases
Takayasus disease, giant cell arteritis, mixed connective tissue disorders
Other haematological Artery disease
Antiphospholipid syndrome
Non modifiable atherosclerosis risk factors
Age, gender FHx
Modifiable atherosclerosis risk factors
Smoking, HTN, hyperlipidaemia, diabetes
What can atherosclerosis lead to
Embolism, stenosis, occlusion, aneurysm
What can critical leg ischaemia lead to
Rest pain, ulceration and gangrene
How is lower limb vascular disease assessed
History, examination and ABPI
When is chronic ischaemia worst
When in bed due to gravity
Tests for vascular disease
Bloods, duplex, CT/MRA, Angiography
Blood tests for vascular disease
FBC, U&Es, Blood glucose, troponin, lipids
Describe risk factor modification for vascular disease
Exercise and weight reduction. Control risks
Antiplatelet therapy
Smoking cessation
Antiplatelet for vascular disease
Clopidogrel
Intervention for long occlusions
Vein or prosthetic bypass
Intervention for short occlusion and stenoses
Endarterectomy or angioplasty/stenting
Intervention for irreversible ischaemia
Amputation or TLC
What is TLC
Reversacularisation
6Ps of acute ischaemia
Pain, paralysis, paraesthesia, perishingly cold, pulseless, pallor
Which Ps are late signs
Paraesthesia and paralysis
Most common place for aneurysm
Aorta
What are the two sets of veins in the leg
Superficial and deep
What the two connections between the deep and superficial
Great saphenous= groin
Small saphenous= behind knee
What are varicose veins
Dilated tautuoeus superficial vein
Risk factors for varicose veins
Age, sex, body shape
Pregnancy
Family history
standing, tight clothes
Which group has more varicose veins
Men
Two auxillary methods for venous return
Non return valves and calf muscle pumps
Which veins are affected by calf muscle pumping
Only deep veins. Therefore they carry most of the blood.
What are type 1 valves
Carry blood back to the heart
What are type 2 valves
Connect deep and superficial veins
Which valves are affected in varicose veins
Type 2
Why does varicose veins happen
Vein wall weakening.
When does the legs swell in varicose vein sufferers
End of the day
Symptoms of varicose veins
Cosmetic, worry about future, complications, minor symptoms
Varicose veins complications
Bleeding, thrombophlebitis, skin changes at ankle
Examination of varicose veins
Prove its a vein, distribution, tendelenburg, complications (skin changes at ankle), doppler(2 noises)
Treatment of varicose
Injection sclerotherapy, valvular, symptomatic (stockings+camouflage)
Signs of DVT
Acute swelling of one leg, tender warm calf, superficial veins, homans sign
What is homans sign
Tenderness when you flex the ankle
Treatment of DVT
Rest, elevation, anticoagulation, PE
How do thrombolytics work
increases plasminogen?
Define chronic venous insufficiency
Leg swelling and ankle/tibial skin changes (+- ankle/tibial ulceration)
What are ankle/tibial skin changes
Liposclerosis and pigmentation
Contributing factors for venous ulcer
Infection, dependency, immobility, neuropathy, arterial disease, oedema, poor hygeine
How do contributing factors cause venous ulcers
impair calf muscle pump or healing
Pathophysiology of venous uclers
Raised pressure from incompetent valves can cause skin damage with eczema, pigementation and scarring of the fat under the skin
Why does albumin move out of the veins
Increased venous pressure
What causes scarring of the fat under the skin
Collecting of plasma proteins and fibrin
Treatment for venous ulcers
Wound care, infection, arterial treatment, compression, venous correction
Wound care for venous ulcers
Clean, debribe, rest, hollistic factors
