Vascular disease 2

Question 1

What are the anatomical positions of DVTs?

Answer 1

Deep veins in leg, originating around the valves
Anterior tibial 
Posterior tibial 
Perineal 
Superficial femoral 
Popliteal

Question 2

What are DVT risk factors?

Answer 2

Stasis & coagulability = main risk factors
Age/immobility 
Pregnancy/oral contraceptive pill 
Malignancy 
Obesity 
Post-op (week 2) 
Previous DVT

Question 3

What is the presentation of a DVT?

Answer 3

Asymptomatic
Calf tenderness & firmness
Oedema
Erythema & calor (heat)
Superficial vein distension
Superficial thrombophlebitis: tender, erythematous, palpable superficial vein
Homan’s sign: pain on dorsiflexion of ankle (should not be tested for as may dislodge thrombus)

Atypical presentations…
Ilio-femoral thrombosis: severe pain, few physical signs
Complete occlusion of large vein: cyanotic discolouration

Question 4

What is the presentation of a pulmonary embolism?

Answer 4

More common with iliofemoral thrombosis
Sudden onset unexplained dyspnoea 
Pleuritic chest pain 
Haemoptysis 
Increased pulmonary artery pressure/right heart strain 
Ischaemia of the lung 
V/Q mismatch 
Raised JVP 
Cyanosis 
Evidence of a DVT

Question 5

What are the investigations for a DVT?

Answer 5

D-dimer: sensitive, non-specific for DVT (infection, pregnancy, malignancy, post-op)
Compression USS: Non-collapsing veins indicate presence of DVTs
Thrombophilia screen: Prior to commencing anticoagulant

Question 6

What are the types of PE?

Answer 6

Massive PE (5%): >60% pulmonary circulation is blocked, rapid CV collapse
Major PE (10%): middle-sized pulmonary arteries blocked, leading to breathlessness, pleuritic chest pain, haemoptysis 
Minor PE (85%): small peripheral vessels are blocked, may be asymptomatic, or present as major 
Massive PE may ensue following a minor PE = 'premonitory embolus'

Question 7

What are investigations for PE?

Answer 7

Bloods: FBC, U&E, clotting, d-dimer
ABG: type 1 respiratory failure
CXR: normal/dilated pulmonary artery, wedge shaped opacities
ECG: tachycardia, RBBB, RV strain, S1Q3T3
Echo: confirm right heart strain
CTPA: gold standard (V/Q if this is unavailable)

Question 8

What is the definition for lymphedema?

Answer 8

Swelling resulting from an increased quantity of fluid in the interstitial space of soft tissues, due to failure of lymphatic drainage
Chronic non-pitting oedema, commonly affecting the legs

Question 9

What is primary vs secondary lymphedema?

Answer 9

Primary: presents early in life, result of inherited deficiency of lymphatic vessels (e.g. Milroy’s)
Secondary: obstruction of lymphatic vessels: filaria infection, repeated cellulitis, malignancy, post-operative

Question 10

Which arteries relate to the locations of claudication of the leg?

Answer 10

Hips/bum- aorta/iliac
Thigh- common femoral
Upper 2/3 calf- superficial femoral 
Lower 1/3 calf- popliteal
Foot- tibial/peroneal