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Vacular Examination Flashcards

1
Q

Imaging: whats the main way blood vessels are looked at now

A

Magnetic resonance angiography

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2
Q

Blood vessels are normally imaged in which plane

A

Coronal

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3
Q

Which plane is good for looking at the aortic arch

A

Left anterior oblique

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4
Q

Which views do you do for looking at the calves

A

Rotational and timed

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5
Q

Describe the path of vessels

A

Aorta, common iliac artery, external iliac and internal, common femoral

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6
Q

What does the common femoral artery split into

A

Profunda femoris and superficial femroal

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7
Q

Where does the superficial artery become the popliteal artery

A

Region of adductor canal

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8
Q

What does teh below knee popliteal artery become

A

Anterior tibial artery and tibioperoneal trunk

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9
Q

What does the tibioperonal trunk become

A

Peroneal artery and posterior tibial artery

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10
Q

Where is the femoral pulse

A

Point of maximal pulsation over the femoral head

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11
Q

How do you palpate the popliteal artery

A

Gently lift the knee from couch, allow your fingers to feel the pulse, deep in the popliteal fossa. Relaxed leg.

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12
Q

Why is the popliteal artery hard to palpate when leg is extended

A

The deep fascia is taut

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13
Q

Where is the dorsalis pedis

A

Between extensor hallucis longus and extensor digitorum longus

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14
Q

How do you feel the dosalis pedis pulse

A

Ask patient to pull big toe towards them. Tendon stands out. Artery is lateral.

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15
Q

Where is the posterior tibial

A

Behind the medial malleolus

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16
Q

What does 0 mean for pulses

A

Absent

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17
Q

What does 1 mean for pulses

A

Diminished

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18
Q

What does 2 mean for pulses

A

Normal

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19
Q

What is the right ankle brachial pressure

A

Higher of the right ankle systolic pulses/ higher arm pressure (left or right)

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20
Q

How is an ABPI conducted

A

Using a doppler probe

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21
Q

What is 1-1.2 ABPI

A

Normal

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22
Q

What is 0.9-1 ABPI

A

Acceptable

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23
Q

0.8-0.9 ABPI

A

Mild arterial disease

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24
Q

0.5-0.8 ABPI

A

Moderate arterial disease

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25
<0.5 ABPI
Severe arterial disease
26
Invasive vessel imaging
Catheter angiography
27
Non invasive imaging
Ultrasound, computed tomography, magnetic resonance imaging
28
How does digital subtraction angiography work
Catheter is inserted using the seldinger technique into the common femoral artery. Then contrast is injected.
29
Which catheter is used for angiograms
Pigtail
30
Who is at risk of bleeding at the puncture site
Abnormal clotting, warfarin, aspirin. Vessel damage.
31
Who is at risk of contrast agent reactions
Asthma, renal failure, metformin
32
What are the two main superficial veins of the lower limb
Great and small saphenous veins
33
Where is the small saphenous vein
Posterior (lateral to medial)
34
Where is teh great saphenous vein
Anteromedial
35
Which nerve is associated with the small saphenous vein
Sural nerve
36
Which nerve is associated with the great saphenous vein
Saphenous nerve
37
Whats the difference between CTA and Ultrasound
CTA has ionizing radiation, iodinated contrast
38
What contrast is used for MRI
Gadolinium. It is very safe.
39
Which imaging normally has issues with claustrophobia
MRI more than CTA
40
What are contraindications to MRI/A
Metal implants and pacemakers
41
What is balloon angioplasty
Balloon mounted on catheter, to treat stenotic disease of vessel
42
Why do you treat stenosis
Prevent haemodynamic consequences and embolic consequences
43
What is vessel remodelling
Neointimal hyperplasia and endothelialisation restores smooth luminal surface.
44
Early causes of PTA failure
Intimal dissection, elastic recoil, incomplete dilatation, rupture, distal embolisation
45
Late causes of PTA failure
Intimal hyperplasia | Progression of atherosclerosis
46
What is the most common causes of CT
Too claustrophobic for MRI
47
Why do stents fail
Disruption/ disintegration | Neointimal hyperplasia
48
When wouldnt you give gadolinium (MRI contrast)
Breastfeeding or pregnant
49
Why are you normally treating flow limiting stenosis
Haemodynamic consequences such as claudication
50
What is PTA
Percutaneous transluminal angioplasty
51
Why stent in vascular
Improve initial luminal patency and reduce embolisation. When angioplasty hasnt worked.
52
Where are stents commonly used
Carotid, mesenteric, renal , aorta, brachiocephalic and iliac.
53
Two types of stent
Self expanding and preluminated
54
Common cause of stent failure
Neointimal hyperplasia. And also disruption/disintegration
55
Which vessels are more affected by atherosclerosis
Medium and larger vessels
56
Other inflammatory Artery diseases
Takayasus disease, giant cell arteritis, mixed connective tissue disorders
57
Other haematological Artery disease
Antiphospholipid syndrome
58
Non modifiable atherosclerosis risk factors
Age, gender FHx
59
Modifiable atherosclerosis risk factors
Smoking, HTN, hyperlipidaemia, diabetes
60
What can atherosclerosis lead to
Embolism, stenosis, occlusion, aneurysm
61
What can critical leg ischaemia lead to
Rest pain, ulceration and gangrene
62
How is lower limb vascular disease assessed
History, examination and ABPI
63
When is chronic ischaemia worst
When in bed due to gravity
64
Tests for vascular disease
Bloods, duplex, CT/MRA, Angiography
65
Blood tests for vascular disease
FBC, U&Es, Blood glucose, troponin, lipids
66
Describe risk factor modification for vascular disease
Exercise and weight reduction. Control risks Antiplatelet therapy Smoking cessation
67
Antiplatelet for vascular disease
Clopidogrel
68
Intervention for long occlusions
Vein or prosthetic bypass
69
Intervention for short occlusion and stenoses
Endarterectomy or angioplasty/stenting
70
Intervention for irreversible ischaemia
Amputation or TLC
71
What is TLC
Reversacularisation
72
6Ps of acute ischaemia
Pain, paralysis, paraesthesia, perishingly cold, pulseless, pallor
73
Which Ps are late signs
Paraesthesia and paralysis
74
Most common place for aneurysm
Aorta
75
What are the two sets of veins in the leg
Superficial and deep
76
What the two connections between the deep and superficial
Great saphenous= groin | Small saphenous= behind knee
77
What are varicose veins
Dilated tautuoeus superficial vein
78
Risk factors for varicose veins
Age, sex, body shape Pregnancy Family history standing, tight clothes
79
Which group has more varicose veins
Men
80
Two auxillary methods for venous return
Non return valves and calf muscle pumps
81
Which veins are affected by calf muscle pumping
Only deep veins. Therefore they carry most of the blood.
82
What are type 1 valves
Carry blood back to the heart
83
What are type 2 valves
Connect deep and superficial veins
84
Which valves are affected in varicose veins
Type 2
85
Why does varicose veins happen
Vein wall weakening.
86
When does the legs swell in varicose vein sufferers
End of the day
87
Symptoms of varicose veins
Cosmetic, worry about future, complications, minor symptoms
88
Varicose veins complications
Bleeding, thrombophlebitis, skin changes at ankle
89
Examination of varicose veins
Prove its a vein, distribution, tendelenburg, complications (skin changes at ankle), doppler(2 noises)
90
Treatment of varicose
Injection sclerotherapy, valvular, symptomatic (stockings+camouflage)
91
Signs of DVT
Acute swelling of one leg, tender warm calf, superficial veins, homans sign
92
What is homans sign
Tenderness when you flex the ankle
93
Treatment of DVT
Rest, elevation, anticoagulation, PE
94
How do thrombolytics work
increases plasminogen?
95
Define chronic venous insufficiency
Leg swelling and ankle/tibial skin changes (+- ankle/tibial ulceration)
96
What are ankle/tibial skin changes
Liposclerosis and pigmentation
97
Contributing factors for venous ulcer
Infection, dependency, immobility, neuropathy, arterial disease, oedema, poor hygeine
98
How do contributing factors cause venous ulcers
impair calf muscle pump or healing
99
Pathophysiology of venous uclers
Raised pressure from incompetent valves can cause skin damage with eczema, pigementation and scarring of the fat under the skin
100
Why does albumin move out of the veins
Increased venous pressure
101
What causes scarring of the fat under the skin
Collecting of plasma proteins and fibrin
102
Treatment for venous ulcers
Wound care, infection, arterial treatment, compression, venous correction
103
Wound care for venous ulcers
Clean, debribe, rest, hollistic factors

2b (28 decks)

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