Vascular Disease Flashcards
what is the key difference in arteriole structure, venule structure and capillaries
- arteriole have 3 tunica
- venules only feature a tunica intima
- capillaries consist of single epithelium
where does dorsalis pedis pass deep into the foot, and what does it join
between the first and second metatarsals, to join the lateral plantar artery (plantar arch)
what does dorsalis pedis branch into
- lateral tarsal arterty
- arcuate artery
- 1st dorsal metatarsal artery
where does the dorsal venous arch drain
the great saphenous vein (medially) and
the small saphenous vein (laterally)
what are typical venous pressures
- ankle, suppine 10-25 mmHg
- ankle, standing 90 mmHg
- ambulatory pressure - 250 mmHg
- sustained exercise - 25-39 mmHg
- 40 secs to return to normal after exercise
what diseases are included in periferal vascular disease
- periferal arterial disease
- atherosclerosis
- Buerger’s disease
- Raunaud’s disease
what is atherosclerosis
the build up of fatty plaques in vessels
what is Virchow’s triad
- stasis of blood flow
- endothelial injury
- hypercoagulability
what factors contribute to atherosclerosis
- smoking
- hypertension
- DM
- obesity
- sedentary lifestyle
- high cholesterol
- stress
where is the most common site for an annurism in the lower limb
popliteal area
key points of Buerger’s disease
- males 25-40
- commonly lower limb
- greater prevalence in HLA A9 and B5
- sometimes anti-collagen antibodies
- affects small - med arteries and veins
- strong association with heavy tobacco use
what causes varicose veins
- valve weakness
- pelvic tumours (pregnancy)
- obesity
- standing jobs
- trauma
what are the objective symptoms of varicose veins
- aching
- pain and oedema, alleviated by elevation
- apparent on standing
what are the subjective symptoms of varicose veins
- fatigue, leg heaviness
- nocturnal cramps
- claudication
- pain from stasis dermatitis
observations of varicose veins
- teliangectasia (spider veins)
- oedema
- family history
- leg ulcers
- history of PE
- pigmentation
key points of venous ulcers
- 85% of all leg ulcers
- more common in women
- gaiter area
- inverted champagne bottle
appearance of venous ulcers
- swollen, diffuse, shallow
- irregular border
- necrosis
- painful if infected
- indolent
- malignant changes
trendellenberg test
- soft rubber cuff applied below the knee when patient is supine
- when patient stands - immediate filling means perforators are incompetant
- filling from top down means superficial veins are incompetant
perthe’s test
- standing patient, cuff below knee
- plantarflex foot repeatedly
- periferal veins should be empty
- (if not, indicate incompetant perforators)
PHLEBOTHROMBOSIS
simple clotting in the blood vessel
problems with thrombosis
- PE
- common in lower limb
- circulatory stasis
- injury to vessel wall
- increased coaguability
DVT
- usually in soleal arcade
- may resolve
- can lead to obstruction
- can lead to phlebitic limb
clinical features of thrombsis
- painful, swelling
- may be silent in younger patients
- discomfort in calf on walking
clinical features of post phlevitic syndrome
- nocturnal leg cramps
- necrosis
- claudication
- swelling
- varicosities
- pigmentation
- chronic indurated cellulitis
- stasisdermatitis
- venous stasis ulceration
management of venous disorders
- support hoisery
- weight reduction
- emollients
- rest with feet up
- protect prominent veins
surgical interventions for venous disorders
- injection sclerotherapy
- ligation (tying) and stripping
management of patients with venous disorders
- analgesics
- antibiotics
- anti-inflammatory drugs
- anticoagulents
management of patients with DVT
- refer ASAP, 999, avoid walking
- hospitalisation, bed rest
- drug therapy
signs and symptom vascular
- temperature
- colour
- skin appendages
- skin texture
- visual angina etc
- claudication distance
- rest pain
vascular tests
- pulses
- reperfusion time
- doppler sounds
- ABPI
- pole test
- toe pressures
- plethsmography
- angiograms
vascular tests
- pulses
- reperfusion time
- doppler sounds
- ABPI
- pole test
- toe pressures
- plethsmography
- angiograms
what are the 6P’s of ischemia/PVD
- pallor
- pain
- parasthesia
- perishing cold
- pulselessness
- paralysis
what other signs of PVD
- arterial/ischemic ulcers - dry punched out
- swelling
- claudication of larger muscles
- night pain
- rest pain
- shiny skins
- lack of hair
- atrophic skin
- distance claudication
how to assess PVD
- visual assessment
- doppler
- capillary refil test
- ABPI (0.9-1.2)
- medical history
- lifestyle
- angiogram
- toe pressures
- poles test
- beurgers elevation test - 30°
how does venous disease present
- varicose veins - painful, heavy
- pitting oedema
- anhidrotic and puritis
- leg fatigue
- reduced mobility
- wet, moth-eaten ulcers
- venous eczema
- telangiectasia (spider veins)
- fibrosis of skin
- lipodermtosclerosis
- heamosiderosis
- indolent
- reduced skin integrity
venous assessment
- dopler venous flow
- venogram - imaging
- ultrasound
- pitting oedema
